CHF Flashcards by O lawformonde

Aldosterone ags

spironolactone ALDACTONE

* eplerenone INSPRA

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ACEI

catopril

* enelapril

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ARBs

Candesartan

* Valsartan

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BBlocker

Carvedilol

Metoprolol

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Funny channel blocker

Ivabradine CORLANOR

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Combined vasodilators

*isosorbide dinitrate/ hydralazine BIDIL

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Phosphodiesterase Inhibitor

Milrinone PRIMACOR

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RAAS axis

ALDOSTERONE ANTAG
*spironolactone, eplerenone

ACEI
*Captopril, enalapril

ARB
*candesartan, valsartan

ARNI
*sacubitril/valsartan ENTRESTO

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DOWN adverse remodeling

BBLOCKER

*carvedilol, metoprolol

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DOWN HR

FUNNY CHANNEL BLOCKER

*ivabradine CORLANOR

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UP CONTRACTILITY

PHOSPHODIESTERASE INHIBITORS
*milrinone PRIMACOR

CARDIAC GLYCOSIDE
Digoxin

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Angiotensin receptor - neprolysin inhibitor (ARNI)

Sacubitril/valsartan ENTRESTO

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Cardiac glycoside

digoxin

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Heart failure with REDUCED EJ

systolic dysfunction

* Down systolic, up Diastolic

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Heart failure with PRESERVED ejection fraction

Diastolic dysfunction

* Down systolic, Down diastolic

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What compensation causes remodeling?

Chronic B1 receptor + Ang II receptor

Goals

Decrease preload, decrease afterload, increase contractility

Most common HF

Systolic = caused by HTN (volume overload)

Diuretics

Mech

thiazide
loop

K depleting
*REDUCE PRELOAD = relieve pulmonary congestion

RAAS system

Effect

UP Blood volume (Preload)
UP BP (Afterload)
Fibrosis (aldosterone)

DOWN RAAS]

SYMPA = Bblocker
ACE = ACEI
ANG II = ARB (vasodilation)
DOWN FIBROSIS = Spironolactone (+pee Na, keep K)

Spironolactone

ALDACTONE

DOWN morbidity+mortality
Aldosterone antag = UP Na excretion
Protect from fibrosi
high dose= diuretic
UP K (monitor)
W/ Digoxin = AV block
block progesterone/androgen receptors = gynecomastia

Eplerenone

INSPRA

like spironolactone

* More selective for aldosterone receptor = less gynecomastia

RAAS system Rx

Effects

ACEI, ARB, ARNI
*DOWN afterload
*DOWN preload
*Protect against adverse remodeling
*K+ retention (monitor electrolytes)
*DOWN GFR (ang ii efferent arteriole) = mild/moderate renal failure good (ACEI)
*monitor: K, kidney function (Cr/BUN)
WARNING: DEAD BABY

ARNI effects

*Same as angiotensin II *Inhibition of both pathways (up neprylisin, up angiotensin II) has greatest effects *ANRI = GREATER morbidity/mortality reduction than ACEI *STOP degredation of ANP/BNP by neprilysin = DOWN renin secretion, UP Na excretion, UP vasodilation

ACEI mech

Block Ang 1 to Ang 2

Neprolysin Rx + dose

Sacubitril (LBQ657) = ANP/BNP + Valsartan = takes care of ang 2 ENTRESTO

ARNI vs ACEI ``` S.E. WHICH MORE? *Hypotension *Mild angioedema *Renal Impairment *Hyperkalemia *Cough ```

*Hypotension = ARNI *Mild angioedema = ARNI *Renal Impairment = ACEI (ARNI will constrict afferent/dilate efferent, ACEI will dilate efferent)*CHECK THIS *Hyperkalemia = ACEI *Cough = ACEI

BBlocker Why give?

* inhibit RAAS * INHIBIT REMODELING Carvedilol/metoprolol (ONLY THESE) = DOWN morbidity/mortality w/ ACEI + diuretic +/- digoxin

Ivabradine CORLANOR

* blocks funny current (SA) * reduce HR * NO EFFECT ON CONTRACTILITY OR CONDUCTION * symptomatic CHF, LVEF <35%, HR >70 * REDUCE TACH * Reduce s/s, NO MORTALITY REDUCTION

Vasodilators Preload vs afterload?

*Preload = Isosorbide dinitrate NO => dephos Myosin light chain *Afterload = Hydralazine BIDIL

Isosorbide dinitrate

*holiday = must have 8 hours free of patch in day, pill needs 14 hours free *NO w/ PDE5 inhibitor (viagra) HAWAIIAN SYNDROME

Hydralazine

* have version w/ isosorbide (BiDil) = refractory to ACEI/ARB (blacks) * arterial dilation * CAREFUL CAD = drop BP

Diastolic Dysfunction Tx

* ARNI = might be able to help * BBlocker ==Rate control = carvedilol/metoprolol (improve diastolic filling) * CCA can (not in systolic!)

Contraindicated in Systolic failure

CCB!! | Block contractility

Milrinone | PRIMACOR

``` MYOCARDIUM = UP contractility PDE inhibitor (more cAMP, Up Ca2+) ``` ARTERIOLES = DOWN afterload Up cAMP = MLCK phosphorylated =>Relaxation *Acute Decompensated HF (less than2 days use)

Digoxin

``` AFib RATE CONTROL LESS S/S, SAME MORALITY *UP Ca2+ in (stop NaKATPase) *HyperK serum *UP CONTRACTILITY/CO (inital effect) *DOWN RAAS w/ UP CO (delayed effect) *DOWN HR (up vagal, down SA/AV node) *Toxicity = other drugs (antibio, diuretics (K) ) MONITOR TI, K, HR ```