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Pharm II MHM - Exam 3 > 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

Risk factors for chronic heart failure

A 
HTN
Male
Valve disorder
Pregnancy
smoking
Rx Drugs
Alcohol/drugs
pericarditis
hyperthyroidism
DM
obesity
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3
Q

Presentation of chronic heart failure

A 
SOB
Edema-peripheral/pulm
DOE
Orthopenia
Ascites
Hepatomegaly
heart murmurs
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4
Q

Describe systolic heart failure

A
  • problem with ejection of blood to the lungs or systemic circulation
  • result of hypertrophy and dilation of ventricle
  • EF less than 40
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5
Q

Describe diastolic heart failure

A
  • inability of the heart to fill appropriately
  • results from stiffness of the myocardium
  • more difficult to treat
  • EF >55%
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6
Q

What is MC systolic or diastolic heart failure?

A

Systolic

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7
Q

What class is more effective in HF?

A

Loop Diuretics

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8
Q

Beta blockers to treat heart failure?

A

Metoprolol succinate
bisprolol
carvedilol

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9
Q

MOA BB?

A

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

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10
Q

BB indications (stages)

A

Can be used in stages A and B

Should be used in stage C

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11
Q

ADE BB

A

bradicardia
worse HF if dose is too high
respiratory issues

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12
Q

ACE I/ARB names

A

lisinopril

  • prils
  • sartans
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13
Q

ACE I/ARBS MOA

A

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

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14
Q

ACE I/ARBS indications

A

all stages of HF

goal dose is needed to max mortality/morbidity benefit

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15
Q

What meds are used in ALL stages of heart failure?

A

ACE I/ARBs

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16
Q

ADE ACE I/ARBs

CI

A 
ADE: hyperkalemia, cough, hypotension
CI: prego 
hyperkalemia-K greater than 5.0
bilateral renal artery stenosis
angioedema
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17
Q

ACE I/ARBs excreted in the:

A

Kidneys

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18
Q

Spironolactone

Eplirione

A

Aldosterone blockers

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19
Q

MOA spironlactone/eplirione?

A

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

20
Q

Aldosterone blockers in indicated for which stages of HF?

A

C and D HF

21
Q

ADE aldosterone blockers

A

hyperkalemia
gynecomastia
CI: hyperkalemia

22
Q

Are aldosterone blockers protein bound?

Where are they excreted?

A

Yes, Highly

Kidneys

23
Q

Vasodilator drugs

A

hydralzaine

isosorbide dinitrate

24
Q

hydralazine MOA

A

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

25
Q

Isosorbide dinitrate MOA

A

direct venodilator- convert into NO for vasodilation

26
Q

Vasodilators are indicated for what patients?

A

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!

27
Q

ADE of vasodilators

A

Tolerance to nitrates
hypotension
CI: not really excreted

28
Q

Are vasodilators dosed multiple times a day?

A

Yes so they have bad compliance

29
Q

What are the Loop Diuretics?

A

Furosemide
butmetanide
torsemide

30
Q

Whats the MOA of Loops?

A

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

31
Q

What is the indication of Loops?

A

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

32
Q

ADE Loops

A

electrolytes- hypokalemia, hypomagnesemia
hyperglycemia
hyperuricemia

33
Q

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

A

Higher

34
Q

MOA Digoxin

A

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

35
Q

Indication Digoxin

A

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

36
Q

ADE digoxin

A

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

37
Q

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

A

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

38
Q

Drugs to use for Morbidity?

A

morbiDDDD

digoxin and diuretics

39
Q

How does potassium effect digoxin?

A

hypoK increases effects

hyperK decreases effects

40
Q

What are the 4 compensatory mechanism of HF

A

RAAS
SNS
Ventricular Hypertrohy
Frank Starlings Law of the heart

41
Q

What blocks the RAAS

A

ACE-I ARBs Aldosterone blockers

42
Q

What blocks the SNS

A

BB

43
Q

What blocks ventricle hypertrophy

A

BB ACE-I ARBs Aldosterones

44
Q

What Blocks the Frank Starling Law

A

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

45
Q

What drugs are used to prevent mortality?

A

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

Pharm II MHM - Exam 3 (5 decks)

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