CHF Flashcards
CHF is insufficient ____ _____ associated with increased blood volume and edema
cardiac output
This class reduces congestive symptoms
diuretics
This class reduces preload and ventricular wall stress (benefit) but can increase RAAS activation
diuretics
_____ therapy should be accompanied by dietary salt restriction and lowest dose needed
diuretic
This class shows no reduction in mortality except aldosterone antagonists
diuretics
____ diuretics work when GFR is low
loop
_____ diuretics are ineffective when GFR is low
thiazides
Major problem with loop diuretics is _____ depletion
K
Diuretic resistance is often seen as CHF progresses due to issues of compliance, _____ in Na+ reabsorption, and decreased _____ perfusion
compensation
renal
______ diuretics are used primarily to potentiate the action of loops
thiazide
can produce even greater K+ depletion
thiazide
Aldosterone antagonists (K+ sparing) inhibit ______ and thus reduce _____
remodeling
mortality
aldosterone antagonists can cause ______ (‘lyte abnormality)
hyperkalemia
_____ inhibitors decrease production of Ang2, aldosterone and SNS activity
ACE
Ang2 levels move toward _____ with sustained use of _____
baseline
ACEI’s
clinical efficacy is maintained after prolonged use of ACEIs probably due to _____ related effects
bradykinin
High doses of _____ reduce mortality
ACEIs
_____ block AT1 but not AT2 receptors
ARBs
Maintain beneficial Ang2 effects and avoids Ang2 escape seen with ACEIs
ARBs
Alternative for patients intolerant of ACEIs (cough)
ARBs
T or F: ARBs reduce mortality
true
_____ mainly reduce preload and tolerance is an issue when used alone
nitrates
____ reduces pulmonary and systemic vascular resistance (afterload)
hydralazine
____ has a moderate direct positive inotropic effect
hydralazine
Fixed-dose combo of ______ and _______ reduces mortality especially in African-Americans
isosorbide
hydralazine
These drugs counterintuitively decrease mortality because they reduce contractile force
beta blockers
_____ _____ prevent cardiac ischemia and consequently unstable tachyarrhythmias
beta blockers
these drugs inhibit cardiac remodeling and reduce renin secretion
beta blockers
these reduce cardiac remodeling
ACEIs
ARBS
beta blockers
ACEI result in elevated bradykinins which can be good and bad - good things include _____ and decreased _____ while bad thing(s) are _____
vasodilation
remodeling
cough
Cardioselective beta blockers
metoprolol
bisoprolol
carvedilol
the primary pharmacological effect of ____ is to have a (+) inotropic effect
digoxin
Use of ____ in CHF therapy is controversial due to toxicity, does not reduce mortality and may decrease survival in women
digoxin
decreases hospitalization in advanced CHF
digoxin
Inhibits Na/K-ATPase in myocyte membranes
digoxin
Hyperkalemia will ____ the inotropic effect of digoxin
reduce
Hypokalemia will ____ the inotropic effect of digoxin
increase
_____ will result in an increased digoxin binding and thus increased inhibition of ATPase
hypokalemia
____ will result in a decreased digoxin binding to the ATPase
hyperkalemia
hypokalemia promotes ____ overload
calcium
can produce sinus bradycardia at low therapeutic doses
digoxin
decreases conduction velocity and prolongs effective refractory period
digoxin
causes calcium overload at toxic levels
digoxin
excreted unchanged by the kidney
digoxin
does not reduce mortality and may actually increase in females
digoxin
Digoxin _____ ____ is used after an overdose and is an immune complex that sequesters digoxin
immune FAB
Fatigue and yellow/green halos around objects typically indicate toxicity before cardiac signs appear when using ____
digoxin
____ and ____ increase potassium and decrease digoxin efficacy
ACEIs
ARBs
Drugs that reduce mortality in CHF (4)
isosorbide-hydralazine
ACEIs/ARBs
Aldosterone antagonists
beta blockers
drugs that only relieve symptoms
diuretics (loop/thiazide)
digoxin
which 2 antiarrhythmics can increase plasma digoxin levels
quinidine
verapamil
most common warning sign preceding digoxin toxicity
nausea/vomiting
anorexia
