CV-CHF Flashcards
HTN L/2 LVH L/2 DEC CO L/2 DEC renal perfusion=?
DEC GFR. Which turns on RAAS, thus INC fluid retentin and periphearl constriction
RAAS system affectHF by?
INC AFTERLOAD due to agiotension vasoconstrction and INC PRELOAD d/t Aldosterone
SNS system affects HF by?
INC HR, INC contractility, INC vascular tone. Barorecepter desensitisd, don’t respond
IF SNS is activated then…
INC AFTERLOAD L/2 DEC ejection fraction and DEC CO
Is ther meds for angiotension affect on cardiac heart remodeling?
NO. But can test BNP. Remodeling occurs d/2 INC HTN , INC Workload-muscle rebuilds to main SV again afterload affect of HTN
If there is INC NE due to DEC tissue perfusion, what happens with receptors?
B1 Downregulate. Baroreceptors dec overtime
How do Beta blockers work?
They block NE release, thus DEC HR. BUT receptors upregulate b/c body thinks not enough receptors to bind NE, so symptoms worse in the begingin, but body gets used to it. REASON IMPORTANT to low dose all BB for HF. REG BB dose will worse HF.
ACE blocks which receptor?
AT1. AT1 promotes vasoconstrict, NE release, LV remodeling, Aldo an ADH release
What are released from the atria and is the body’s natural diuretic?
ANP and BNP hormones. Triggered when detects INC volume from RAAS effects of fluid retention
What is difference btwn HIGH output failure vs LOW output failure?
HIGH is healthy heart, but failure from other conditions causing heart to work harder. Anemia. LOW- weak heart leads to diminshed volume
If Pt has inc in weight, edema, JVD…what RX is ideal?
ACE first line. LOW dose BB later
Which RX treat systolic and diastolic dysfunction?
LOOPS
Which RX to treat systolic dysfunction?
ACE first line.- DEC afterload and preload. Improves mortality. DEC volume d/2 pump defect, weak dilated enlarged heart, DEC EF. GOAL dec volume. aDD BB-LOW DOSE
Which RX to treat diastolic dysfunction?
ACE filling issue from +/- stiff LVH ventricle, pulmonary congestion bc doesn’t expand, normal EF. GOAL- no true goal, DEC HTN- to dec LVH/futher remodeling, HR.
What is indicated for HFpEF?
CCB- to slow heart and enhacne filling. RARE
For symptoms of AA in Class 3-4 HF, what is given?
Hydral-Nitrates- vasodialtors, reduce preload and afterload
Why are loops must used for CHF?
They don’t reduce mortality, but sued for moderate - severe volume overload. ClCR<30-50
What should be monitored with loops?
Potassium, Creatine, BUN, Mg weigth loss 1-2/daily initally only
What ACE prodrug have active metablite ending in -prat?
Ramipril, Enlaopril, Fosinpril
What ACe had the shortes 1/2 good fro DM and AKI?
Captopril ,2hr. Too much vasodiation could reverse in glomerulus. Garden hose
What agent may be used if pt has heridatery angioedema w/ HF?
Icatibant- selevtive competive antagonist of bradykinin. ADR-LFTS. 2. Ecallantide INJ- All AVOID PREG
What condtion should ACE be avoid bc and make Renal artery stenosis worse?
ACE- long term vasodialtion not great for CKI. RAS people rely on that restriction
What should be monitored within 1-2 wk of using ACE?
BP-d/t hypotension, Renal fx, Electroylye-K**
Which drugs should be avoided with ACE?
Aliskiren- double RAAS shut down, Lithium, NSAIDs
What drugs are similar to ACE but used if people have cough w/ it?
L. VIC. Cande, Irbe, Lo,Val, -sartan
Which drugs should be avoided with ARBs?
Cimetidine, Fluconazole, phonbartial. Digoxin, Aliskren
what new drug is contraindicated with ACE and inibits blocking of peptides and bradykinin?
ARNI- requires 36 hr washout
What and why should added to ACE for HF?
BB synergesitic effect.
What is particular about diffeinateding BB?
Labetatol and Cavediol- NON SELECTIVE alpha and beta. 2. Bisoprolol, Metoprolol- selective. Heart Beta only.
What is MOST important with BB and ACE?
START LOW and DOSE SLOW. BB- 12.5-25mg. Never discontinue abruplty
What rate control agent affect SA NODE and approved for HF?
Ivabradine- dec. HR, INC. filling time. ADR- Hypertenis, bradycardia, A-fib
What reduces mortality in AA with Heart Failure?
hydralazine and isosorbide dinitrate-BiDil
What agent comes from purple foxglove?
Digoxin
The MOA of Digoxin inibits Na/k AtPase pump, which leads to INC intracelluar Na, this affect the heart how?
INC Ca bc INC Na DEC Na and Ca exchanger. INC CA inc actin myosin activity- INC contractiliy
Digitalis reduces HF symptoms, but no reduction of mortality by improving what?
Systolic HF
Since ditalis dec condutio velociyt and prolongs refractory period at AV node, then what are the risk?
A. Fib. HIGH. AV blocks, PVC, tachycardia
What electrolyts should be monitored with Digoxin?
Postassium. Can be low or HIGH-with inc dose.
What psychic somatic ADR are assoc with Digoxin?
Nightmares. OTHER- GI, Hazy halo vision
What DI with Digoxin makes potassium worse?
Loops make people hypokalemi, could get worse
Why is important to monitor Digoxin IV?
Delayed distrubtion dt/ long half life. Obtain level at 4hr after IV, 6-8hr after PO. DIG Level 2-6 Danger.
What is ideal Dig level?
0.5-0.9ng.ml
Why is erythromycian and tetracyclines DI with Digoxin?
Bacteria metabolized Digoxin, thus if bacterica gone, Digoxin levels HIGH
What Cardiac meds make Dig level HIGH d/t dec. clearance of Digoxin?
Amiodarone, Verapamil, Dilitazem
Due to narrow therupeutic window for Dig..What is reversal
Digibind, Digoxin -Fab antibody (sheep) complex- 30-4hr reversal
What are agents for Acute Decompensated HF?
Diurectics, Nitroprusside, Nitrates, Nesitride, Inotropes
Which decomp HF control BP rapidly, but has cyanide as ADR?
Nitroprusside- Work veins and arterials Dialtes
Which Drug induce HF?
NSAIDs, Gluccosteroids, Licorice, Cocaine, Chemtox, BB
