Chronic Heart Failure

Question 1

Heart Failure:

Answer 1

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

Question 2

Risk factors for chronic heart failure

Answer 2

HTN
Male
Valve disorder
Pregnancy
smoking
Rx Drugs
Alcohol/drugs
pericarditis
hyperthyroidism
DM
obesity

Question 3

Presentation of chronic heart failure

Answer 3

SOB
Edema-peripheral/pulm
DOE
Orthopenia
Ascites
Hepatomegaly
heart murmurs

Question 4

Describe systolic heart failure

Answer 4

• problem with ejection of blood to the lungs or systemic circulation
• result of hypertrophy and dilation of ventricle
• EF less than 40

Question 5

Describe diastolic heart failure

Answer 5

• inability of the heart to fill appropriately
• results from stiffness of the myocardium
• more difficult to treat
• EF >55%

Question 6

What is MC systolic or diastolic heart failure?

Answer 6

Systolic

Question 7

What class is more effective in HF?

Answer 7

Loop Diuretics

Question 8

Beta blockers to treat heart failure?

Answer 8

Metoprolol succinate
bisprolol
carvedilol

Question 9

MOA BB?

Answer 9

blockage of beta receptors lead to decrease heart rate, decrease BP, increase coronary artery blood flow

Question 10

BB indications (stages)

Answer 10

Can be used in stages A and B

Should be used in stage C

Question 11

ADE BB

Answer 11

bradicardia
worse HF if dose is too high
respiratory issues

Question 12

ACE I/ARB names

Answer 12

lisinopril

• prils
• sartans

Question 13

ACE I/ARBS MOA

Answer 13

interference with RAAS ending with disrupting angiostensin II, produce decrease BP, Sodium/H2O retention, after load reducer

Question 14

ACE I/ARBS indications

Answer 14

all stages of HF

goal dose is needed to max mortality/morbidity benefit

Question 15

What meds are used in ALL stages of heart failure?

Answer 15

ACE I/ARBs

Question 16

ADE ACE I/ARBs

CI

Answer 16

ADE: hyperkalemia, cough, hypotension
CI: prego 
hyperkalemia-K greater than 5.0
bilateral renal artery stenosis
angioedema

Question 17

ACE I/ARBs excreted in the:

Answer 17

Kidneys

Question 18

Spironolactone

Eplirione

Answer 18

Aldosterone blockers

Question 19

MOA spironlactone/eplirione?

Answer 19

compete w/aldosterone for intracellular mineralcortocoid receptor causing Na/H2O to excrete which decreases preload

Question 20

Aldosterone blockers in indicated for which stages of HF?

Answer 20

C and D HF

Question 21

ADE aldosterone blockers

Answer 21

hyperkalemia
gynecomastia
CI: hyperkalemia

Question 22

Are aldosterone blockers protein bound?

Where are they excreted?

Answer 22

Yes, Highly

Kidneys

Question 23

Vasodilator drugs

Answer 23

hydralzaine

isosorbide dinitrate

Question 24

hydralazine MOA

Answer 24

direct arterial vasodilator- coronary, cerebral and renal arteries
HA (hydralzaine arterial)

Question 25

Isosorbide dinitrate MOA

Answer 25

direct venodilator- convert into NO for vasodilation

Question 26

Vasodilators are indicated for what patients?

Answer 26

African American pts with stage C HF (along w/ ACE, BB etc) used in B/C/D HF Not CI to ACE I Any race!

Question 27

ADE of vasodilators

Answer 27

Tolerance to nitrates hypotension CI: not really excreted

Question 28

Are vasodilators dosed multiple times a day?

Answer 28

Yes so they have bad compliance

Question 29

What are the Loop Diuretics?

Answer 29

Furosemide butmetanide torsemide

Question 30

Whats the MOA of Loops?

Answer 30

Exert action at loop of henle increases Na + H2O excreted reduces preload and edema

Question 31

What is the indication of Loops?

Answer 31

Initial: Sx HF (C or D) goal: after diuresis + fluid reduction, get pt to lowest dose possible or consider d/c

Question 32

ADE Loops

Answer 32

electrolytes- hypokalemia, hypomagnesemia hyperglycemia hyperuricemia

Question 33

Do pts with renal failure need higher or lower doses of Loops?

Answer 33

Higher

Question 34

MOA Digoxin

Answer 34

increase inotropic activity and decrease chronotropic activity increase intracellular Na + Ca which increases force of contraction

Question 35

Indication Digoxin

Answer 35

low does for normal renal fxn only in Sx HF stage C/D elderly/renal insufficient- dose every other day!

Question 36

ADE digoxin

Answer 36

Toxicity- monitor it! electrolytes- hypokalemia, hypomagnesemia bradycardia GI disturbance

Question 37

Why do the elderly/renal insufficient have a lower dose of digoxin?

Answer 37

a large VD large in obese/small in elderly and primarily renally excreted

Question 38

Drugs to use for Morbidity?

Answer 38

morbiDDDD | digoxin and diuretics

Question 39

How does potassium effect digoxin?

Answer 39

hypoK increases effects | hyperK decreases effects

Question 40

What are the 4 compensatory mechanism of HF

Answer 40

RAAS SNS Ventricular Hypertrohy Frank Starlings Law of the heart

Question 41

What blocks the RAAS

Answer 41

ACE-I ARBs Aldosterone blockers

Question 42

What blocks the SNS

Answer 42

BB

Question 43

What blocks ventricle hypertrophy

Answer 43

BB ACE-I ARBs Aldosterones

Question 44

What Blocks the Frank Starling Law

Answer 44

Hx of HF because there is a natural temporary fixing of first event HF (NO hx MI)

Question 45

What drugs are used to prevent mortality?

Answer 45

ACE I/ARBS BBs Aldosterone blockers Vasodilators (in AAs)