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Cardio Final > Congestive heart Failure -kumar > Flashcards

Congestive heart Failure -kumar Flashcards

1
Q

What occurs when cardiac output is inadequate to provide the oxygen needed by the body?

A

Heart failure

Heart failure can lead to various symptoms and complications due to insufficient blood flow and oxygen delivery.

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2
Q

What are the two major types of heart failure?

A
  • Systolic failure (HFrEF)
  • Diastolic failure (HFpEF)

Systolic failure is characterized by reduced contractility and ejection fraction, while diastolic failure involves stiffening and inadequate relaxation.

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3
Q

What is a common symptom of heart failure?

A
  • Tachycardia
  • Shortness of breath
  • Cardiomegaly
  • Decreased exercise tolerance

These symptoms reflect the body’s compensatory mechanisms and the heart’s inability to meet its demands.

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4
Q

What is the mechanism of action of loop diuretics?

A

Inhibit Na+-K+-2Cl- symporter in the ascending loop of Henle

This action increases Na+ and water delivery to the distal tubule, leading to diuresis.

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5
Q

Name three examples of loop diuretics.

A
  • Furosemide
  • Bumetanide
  • Torsemide

These medications are commonly used to manage fluid overload in heart failure.

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6
Q

What is diuretic resistance?

A

A compensatory increase in renal tubular reabsorption of Na+

This can occur when patients become less responsive to diuretics over time.

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7
Q

Fill in the blank: Loop diuretics do not improve the _______ rate in patients.

A

mortality

While effective for symptom management, loop diuretics have not been shown to reduce mortality in heart failure.

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8
Q

What are the common adverse drug reactions (ADRs) associated with furosemide?

A
  • Nausea
  • Vomiting
  • Dizziness
  • Hypokalemia
  • Ototoxicity

These ADRs can lead to significant complications, especially in elderly patients.

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9
Q

What is the primary use of aldosterone antagonists?

A

Treatment of hypertension and congestive heart failure

Aldosterone antagonists help manage fluid retention and blood pressure.

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10
Q

What is the mechanism of action of eplerenone?

A

Blocks the binding of aldosterone to mineralocorticoid receptors

This action inhibits one arm of the Renin-Angiotensin-Aldosterone System (RAAS).

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11
Q

What are the contraindications for eplerenone?

A
  • Hyperkalemia
  • Creatinine clearance < 50 mL/min
  • Serum creatinine > 1.8 M, 2.0 F

These contraindications help prevent dangerous levels of potassium in the blood.

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12
Q

Fill in the blank: Sodium Nitroprusside acts as a _______ by relaxing both resistance and capacitance vessels.

A

vasodilator

It is used in acute situations to rapidly reduce preload and improve cardiac function.

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13
Q

What is a major risk associated with prolonged administration of sodium nitroprusside?

A

Cyanide toxicity

This occurs due to the release of cyanide during the biotransformation of nitroprusside.

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14
Q

How does hydralazine function as a treatment for heart failure?

A

Directly acts as a vasodilator to decrease systemic vascular resistance

This allows the heart to pump more efficiently, improving symptoms of heart failure.

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15
Q

True or False: ACE inhibitors are superior to hydralazine in reducing mortality in CHF.

A

True

ACE inhibitors have been shown to provide better outcomes in terms of survival for CHF patients.

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16
Q

What are the advantages of inhibitors over hydralazine in CHF?

A

Inhibitors are superior in reducing mortality in CHF

ADRs of inhibitors include withdrawal effect and lupus-like syndrome.

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17
Q

What is the mechanism of action (MOA) of hydralazine?

A

Hydralazine binds with endothelium receptors in the arterioles, causing NO release and relaxation of vascular smooth muscle.

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18
Q

In what combinations is hydralazine often used?

A

Hydralazine is more often used in combination with isosorbide dinitrate.

19
Q

List the major uses of Minoxidil.

A
  • Antihypertensive
  • Alopecia treatment to promote hair growth
20
Q

What is the MOA of Minoxidil for hair growth?

A

Enhanced microcirculation around hair follicles and direct stimulation of follicles.

21
Q

What are the effects of beta-blockers in CHF?

A
  • Reduces sympathetic tachycardic reflex
  • Improves left ventricular morphology
  • Decreases cardiomyocyte apoptosis
22
Q

What is the initial effect of beta-blockers on systolic function in CHF?

A

Initially decreases, but recovers over 2-4 months.

23
Q

Which drugs are classified as beta-blockers for CHF?

A
  • Atenolol
  • Metoprolol
  • Carvedilol
  • Bisoprolol
24
Q

What is recommended for patients with CHF and an ejection fraction < 35%?

A

Beta-blockers are recommended to counteract circulating catecholamines.

25
Q

What are the side effects of Carvedilol?

A
  • CNS: malaise, dizziness, fatigue
  • CV: A-V block, bradycardia
  • GI: nausea, vomiting, diarrhea
26
Q

What are the drug interactions associated with Carvedilol?

A
  • Increased levels with calcium channel blockers
  • Enhanced hypoglycemia with insulin
  • 70% reduction in levels with Rifampin
27
Q

What are the goals of inotropic therapy in CHF?

A
  • Normalize cardiac output
  • Relieve pulmonary congestion
  • Reduce ventricular dimension
  • Optimize blood pressure
  • Improve exercise tolerance
28
Q

What are the mechanisms of action for Digoxin?

A

Inhibits Na+/K+-ATPase, increases intracellular sodium, leading to increased intracellular calcium.

29
Q

What are the administration forms of Digoxin?

A
  • Tablets: 0.125, 0.25, 0.5 mg
  • Elixir: 0.05, 0.1, 0.2 mg
  • IV injection: 0.05, 0.1, 0.25 mg
30
Q

What are the signs of digitalis toxicity?

A
  • CNS: fatigue, confusion, psychosis
  • Cardiac: severe arrhythmias
  • Visual: yellow-green halos
31
Q

True or False: Digoxin has a narrow therapeutic index.

A

True

32
Q

What should be monitored to assess Digoxin toxicity?

A

G.I effects (diarrhea) and electrolyte levels.

33
Q

What is the MOA of Milrinone?

A

Inhibits phosphodiesterase III, increasing cAMP and calcium availability.

34
Q

What is the indication for Sacubitril/Valsartan (Entresto)?

A

Indicated to reduce the risk of cardiovascular death and hospitalization in chronic heart failure with reduced ejection fraction.

35
Q

What type of medication is Ivabradine?

A

A heart rate-lowering medicine.

36
Q

What is the mechanism of action of Ivabradine?

A

Selectively inhibits the ‘funny’ channel pacemaker current (If).

37
Q

What drug was approved by the FDA in April 2015 for the treatment of chronic heart failure?

A

Ivabradine

Ivabradine is indicated for patients with an ejection fraction of ≤35% in sinus rhythm.

38
Q

What are the criteria for patients to receive Ivabradine?

A

Patients must have:
* Ejection fraction of ≤35%
* Sinus rhythm
* Resting heart rate ≥70 beats per minute
* Not on beta-blockers due to contraindications or already receiving maximum beta-blocker dose

These criteria ensure the proper use of Ivabradine in heart failure management.

39
Q

What mechanism does Ivabradine use to lower heart rate?

A

It selectively inhibits the ‘funny’ channel pacemaker current (If) in the sinoatrial node

This action results in a dose-dependent reduction in heart rate.

40
Q

What is the role of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in the action of Ivabradine?

A

Ivabradine acts on HCN channels to inhibit the pacemaker current (If)

This inhibition leads to a lower heart rate and improved blood flow to the myocardium.

41
Q

How does Ivabradine compare to non-dihydropyridine calcium channel blockers and beta blockers?

A

Ivabradine is a ‘pure’ heart rate-lowering drug with a more favorable side effect profile

Non-dihydropyridine calcium channel blockers and beta blockers may cause adverse events due to negative ionotropic effects.

42
Q

What is the effect of Ivabradine on myocardial oxygen demand?

A

Ivabradine lowers the pacemaker firing rate, consequently lowering heart rate and myocardial oxygen demand

This mechanism helps improve oxygen supply and mitigate ischemia.

43
Q

What benefits does Ivabradine provide to patients with chronic heart failure?

A

It allows for:
* Improved oxygen supply
* Mitigation of ischemia
* Higher exercise capacity
* Reduction in angina episodes

These benefits enhance the quality of life for patients with chronic heart failure.

Cardio Final (2 decks)

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