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Pharm-HTN/CHF > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

Heart failure

A

inability to provide enough oxygenated blood to the rest of the body

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2
Q

Preload

A

Amount of blood at end of diastole (end diastolic volume)

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3
Q

Afterload

A

Amount of pressure the heart has to pump up against for systole

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4
Q

Ejection fraction (%)

A

Amount of blood pumped / end diastolic volume

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5
Q

what other etiologies cause or increase the risk of developing HF?

A 
HTN
Male
Valve disorders
Pregnancy
Smoking
 Rx Drug induced
Alcohol/Illicit drug use
Pericarditis
Hyperthyroidism
Diabetes
Obesity
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6
Q

HF Presentation

A 
SOB
Dyspnea on exertion
Edema- peripheral and/or pulmonary
Need for multiple pillows at night to sleep
Easily fatigued
Ascites
Hepatomegaly
Heart mumurs
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7
Q 
ACC/AHA Stages of HF
class A
A 
At high risk for HF but without structural heart disease or symptoms of HF 
Hypertension
CAD
Diabetes mellitus (DM)
Obesity
Metabolic syndrome
OR
Using cardiotoxins
Family Hx of cardiomyopathy
TX: ACE or ARB
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8
Q 
ACC/AHA Stages of HF
class B
A 
Structural heart disease but without signs or symptoms of HF
Previous MI
LV remodeling including LVH and EF
Asymptomatic valvular disease
 Tx: ACE or ARB, BB
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9
Q 
ACC/AHA Stages of HF
class C
A

Structural heart disease with prior or current symptoms of HF
Known structural heart disease
AND
Shortness of breath, fatigue, reduced exercise tolerance

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10
Q 
ACC/AHA Stages of HF
class D
A

Refractory HF requiring specialized interventions
Marked symptoms at rest despite maximal medical therapy

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11
Q

NYHA functional classification

A

Ordinary activity does not cause symptoms

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12
Q

NYHA functional classification

Class II

A

Ordinary activity causes symptoms

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13
Q

NYHA functional classification

Class III

A

Less than ordinary activity causes symptoms

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14
Q

NYHA functional classification

Class IV

A

Symptoms are present at rest

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15
Q

Systolic HF

A

Most common
Problem with ejection of blood to the lungs or systemic circulation
Result of hypertrophy and dilation of ventricle

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16
Q

Diastolic HF

A

Inability of the heart to fill appropriately
Usually results from stiffness of myocardium
More difficult to treat
Treatment not well defined

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17
Q

Mortality reducing agents used in HF

A

ACE/ARBs
BB
Aldosterone blocking agents
Vasodilators (hydralazine/nitrates) in african americans

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18
Q

Which BB can be used for HF

A

Metoprolol succinate (toporol)
Bisoprolol
Carvedilol

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19
Q

BB MOA

A

blockage of beta receptors leading to decreased heart rate, decreased blood pressure, increased coronary artery blood flow

20
Q

Metoprolol succinate dosing& goal

A

6.25-12.5 mg/day; goal 200 mg/day

21
Q

Bisoprolol dosing & goal

A

1.25 mg/day; goal 10 mg/day

22
Q

Carvedilol dosing and goal

A

3.125 mg twice daily; goal 25 mg twice daily

23
Q

beta blocker ADR

A

Bradycardia
Worsening of HF if dose is started too high or up titrated too quickly
Respiratory issues

24
Q

ACEi/ARBs MOA

A

Interference with RAAS ending with disrupting angiotensin II
Produces decreases BP, Na/H2O retention
Afterload reducer

25
Q

Lisinopril staring dose and goal?

A

start at 5 mg daily, goal dose of 20-40 mg daily

26
Q

ACE/ARB ADR?

A

Hyperkalemia
Cough (ACEi)
Hypotension

27
Q

ACE/ARC CI?

A

Pregnancy
Hyperkalemia (K>5.0 meq/L)
Bilateral renal artery stenosis
Angioedema

28
Q

Aldosterone Blockers MOA

A

Competes with aldosterone for intracellular mineralcorticoid receptors → Na and H2O excreation (this also increases K in the blood)
Decreases preload

29
Q

what drugs belong to the aldosterone blocker class

A

spironolactone, eplirinone

30
Q

When should you use spironolactone

A

when you are at goal and still symptomatic

31
Q

Aldosterone Blockers ADR

A

Hyperkalemia

Gynecomestia

32
Q

what 2 drugs are vasodilatiors

A

Hydralazine

Isosorbide dinitrate

33
Q

Hydralazine MOA

A

Predominately vasodilates in coronary, cerebral, and renal arteries

34
Q

Isosorbide dinitrate MOA

A

Converts into nitric oxide which produces vasodilation

35
Q

When are vasodilators used

A

in patients who can not tolerate ACE/ARB and also used in African american patients
used in stage C in African Americans and in B/C/D if a contraindication to ACEi exists, race does not matter

36
Q

Which drug class is most effective in HF?

A

loop diuretics

37
Q

Loop Diuretics MOA

A

exerts their action at the loop of Henle. Increase Na and H2O excretion. Since all diuretics reduce pre-load and edema why are loop diuretics preferred over other agents (such as thiazide diuretics)

38
Q

what are the driving factors in loop diuretic dosing

A

age and weight

39
Q

When should loop diuretics be used

A

Initial dosing: Should only be used for symptomatic HF (C or D)

40
Q

what drugs are part of the loop diuretic class

A

Furosemide
Bumetanide
Torsemide

41
Q

what is the goal after using loop diuretics

A

after initial diuresis and reduction of fluid, try to get to the lowest dose possible or even consider discontinuing

42
Q

Loop diuretics ADR

A 
Electrolyte imbalances (most common)
Hyperglycemia
Hyperuricemia
Hypokalemia
hypomagnesemia
43
Q

Digoxin MOA

A

positive inotropic activity and negative chronotropic activity
Increase in intracellular Na and Ca→ increase in force of contraction
What is the driving force behind digoxin producing negative chronotropic activity?
Reduced intracellular K and increased intracellular Ca

44
Q

what are some key Pharmocokinetics of digoxin

A

Large VD, larger in obese/smaller in elderly
VERY NARROW Therapeutic index!!!!!
Which is more likely to have unintended toxicity?
Elderly-smaller VD leads to increase concentration in the blood
Primarily renally excreted

45
Q

digoxin dosing regiment

A

recommend low dose for normal renal function→ 0.125 mg/day (should only be used in symptomatic HF- stage C/D)
Elderly or renal insuficiency → 0.125 mg every other day
Monitor digoxin levels only for toxicity (>2 ng/dl), not efficacy

46
Q

digoxin ADR

A 
High potential for digoxin toxicity
Electrolyte disturbances
Hypomagnesemia
Hypokalemia
Bradycardia
GI disturbances

Pharm-HTN/CHF (4 decks)

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