Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

Heart Failure vs.

Acute Decompensated Heart Failure

A

Heart failure is an ongoing situation where the heart cannot fill and empty effectively.

Acute Decompensated HF is NEW or WORSENING signs & symptoms requiring ED visit
Examples:
Exacerbation of HF
Cardiogenic Shock
ADHF + hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HF can be classified according to sys of dia: systolic HF

A

Heart failure with 40% or lower ejection fraction (HFrEF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HF can be classified according to sys of dia: Diastolic

A

Heart failure with 50% or more preserved ejection fraction (HFpEF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Beta blockers can cause HF if the person also has

A

fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

NSAIDs and COX-2 inhibitors can cause HF by

A

causing fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anti-diabetic meds can cause HF by

A

causing fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Summarize how diuretics help with HF

A

Provides relief of acute symptoms of congestion and maintenance of euvolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a good combination for treating HF

A

Loops + ACEI, BB and sodium restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Maintenance dose of diuretics is

A

that which maintains dyspnea-free status (stable dry weight)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diuretics do not help improve

A

mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ACE Inhibitors

A

Slows progression of disease process
Decreases mortality
Decreases risk of developing new onset HF in pts with CV risk factors
Recommended for all patients with left ventricular dysfunction (unless other CI)
Reduce symptoms -> reduces hospitalizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ACE Inhibitors: Slows

A

progression of disease process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ACE Inhibitors: Decreases 2 things

A

mortality and risk of developing new onset HF in people at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ACE Inhibitors: Recommended for all patients with

A

left ventricular dysfunction (unless other CI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ACE Inhibitors: what do you check before titrating the dose

A

Is the SBP more than 80

Is the K level less than 5.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ACE Inhibitors: Contraindications

A

Pregnant
Severe hepatic instability
Renal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Metolazone (diuretic): 4 things

A

Synergistic when given with a loop diuretic
Given 30-60 minutes before loop
Monitor electrolytes
Used to avoid high doses of loops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ARBs: 3 things to know

A

Alternative for people who can’t use ACEi

ACEI intolerance may not be due to: hypotension, hyperkalemia, or renal insufficiency

Thiazides may be added if diuretic resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ARBs: Alternative

A

for people who can’t use ACEi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ARBs: ACEI intolerance may not be due to

A

hypotension, hyperkalemia, or renal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ARBs: if diuretic resistant,

A

Thiazides may be added

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Entresto

A

Brand name of a combination medication. It’s a combination of Sacubitril and Valsartan, which is an ARNI and and ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Entresto (Sacubitril/ Valsartan) implications: Can be used as ___ or ___ therapy

A

Initial or replacement therapy,

Can be used as initial therapy instead of ACEI/ARB in conjunction with BB and aldosterone antagonists

Can also be used as replacement of an ACEI or ARB in individuals with chronic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Entresto (Sacubitril/ Valsartan) implications: Adjust if there is

A

hepatic or renal problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Entresto (Sacubitril/ Valsartan) implications: ARNI should NOT be combined with

A

ACEI or within 36 hours of switching from or to an ACEI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Entresto (Sacubitril/ Valsartan) implications: results

A

Less mortality and less hospitalization

27
Q

Entresto (Sacubitril/ Valsartan) ADRs:

A

hypotension, hyperkalemia, renal insufficiency, angioedema, increased BNP, and cough

28
Q

Entresto (Sacubitril/ Valsartan) implications: Contraindications

A

Previous angioedema with ACEI or ARB

Pregnancy

29
Q

Beta blockers help with HF by

A

Inhibit the adverse effects of the sympathetic nervous system activation

30
Q

Benefits of Beta Blockers

A 
decrease mortality and slow disease progression-> decrease hospitalizations
Improvement in functional class (What does "functional class mean"?)
31
Q

What is the downside of using Beta Blockers

A

May lead to symptomatic worsening or decompensation

32
Q

To whom would you recommend a beta blocker

A

Recommended for all STABLE individuals with 0-minimal fluid overload and reduced LVEF

33
Q

What meds would you prescribe with a beta blockers

A

diuretics and ACEI

34
Q

How do you start out taking Beta Blockers

A

Initiate low, double dose every 2 weeks, as tolerated

Patient should be clinically stable and euvolemic at time of initiation

35
Q

How long does it take for Beta Blockers to be effective

A

2-3 months

36
Q

Aldosterone Antagonists or Mineralocorticoid Receptor Antagonists (MRAs): If they have HFrEF (HF with reduced ejection fraction), use these meds for

A

symptomatic HF or standard therapy

Left ventricular dysfunction early after MI

37
Q

Aldosterone Antagonists or Mineralocorticoid Receptor Antagonists (MRAs): If the have HFpEF (HF with preserved ejection fraction), use these meds for

A

elevated BNP or HF admission within 1 year to decrease hospitalizations

38
Q

Aldosterone Antagonists example

A

Spironolactone

39
Q

Spironolactone drug class

A

Aldosterone Antagonist

40
Q

Eplerenone drug class

A

Mineralocorticoid Receptor Antagonists

41
Q

Mineralocorticoid Receptor Antagonist example

A

Eplerenone drug class

42
Q

If you combine Eplerenone (a Mineralocorticoid Receptor Antagonist) with a CYP3A4 inhibitor (ketoconazole, itraconazole, nefazodone, ritonavir, nelfinavir, clarithromycin) you can have

A

hyperkalemia

43
Q

For Eplerenone (a Mineralocorticoid Receptor Antagonist), watch out for N___, C____, A____ or A____, P____, F____

A

NSAIDs, COX-2 inhibitors, high doses of ACEI or ARBs, potassium supplements, foods with high potassium (bananas, avocado, raisins, oranges, tomato)

44
Q

Isosorbide dinitrate/ Hydralazine: outcomes include

A

Better QOL and decreased EF

45
Q

Isosorbide dinitrate/ Hydralazine: Two special times you might use these meds

A

As an alternative to ACEI (when intolerant)

In addition to standard therapy in African Americans with symptomatic HF

46
Q

Isosorbide dinitrate/ Hydralazine: do not use with

A

sildenafil, tadalafil

47
Q

Digoxin works by

A

inhibits Na/K ATPase

Neurohormonal modulating effect

48
Q

What is not a benefit of digoxin

A

doesn’t slow the disease progression or decrease mortality

49
Q

When might you use digoxin

A

Stage C or D + reduced EF + persistent HF symptoms despite ACEI, BB, and diuretic

Chronic A. fib

50
Q

Digoxin is not recommended for

A

Management of acute HF exacerbation

Individuals with preserved EF

51
Q

Digoxin exclusion criteria

A

electrolyte imbalance like hypokalemia

52
Q

Digoxin: monitor for

A

toxicity in presence of nausea/vomiting; potassium, magnesium and calcium

53
Q

Digoxin: for the elderly and renal patients

A

do not give digoxin 0.25mg; doses must be lower

54
Q

Drugs that increase Digoxin levels

A

Clarithromycin/ erythromycin
amiodarone/verapamil
posaconazole/voriconazole/itraconazole

55
Q

Digoxin has an interaction with amiodarone/verapamil. What’s the implication of this?

A

You can still give dig with these meds, but you need to reduce the dose to only a half

56
Q

Drugs that decrease Digoxin levels

A

Cholestyramine

Antacids -> separate dose by 2-4 hours

57
Q

Since antacids decrease dig levels,

A

Don’t give them together, wait 2-4 hours

58
Q

Calcium Channel Blockers: Diltiazem and Verapamil: Avoid with

A

a patient with decreased LVEF

59
Q

Calcium Channel Blockers: Diltiazem and Verapamil: These meds are good for

A

HF with preserved EF

60
Q

Calcium Channel Blockers: Amlodipine and felodipine: They do not help with

A

mortality

61
Q

Calcium Channel Blockers: Amlodipine maybe will improve

A

symptoms

62
Q

Ivabradine contraindications

A

anything other than normal sinus rhythm
low BP/low heart rate
CYP3A4 inhibitors

63
Q

Ivabradine is recommended for

A

Symptomatic, stable, chronic HFrEF on standard therapy including a BB and HR at least 70bpm at rest

64
Q

Ivabradine ADR

A

Bradycardia, hypertensiton, A fib

Pharm (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions