Brainscape's Knowledge GenomeTM

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


See full index

CVS > CVS Pharmacology 3: Heart Failure. > Flashcards

CVS Pharmacology 3: Heart Failure. Flashcards

1
Q

Definition: a state which the heart is unable to pump blood at a rate sufficient to meet the body’s requirement or can do so only at elevated filling pressure?

A

Heart failure.

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

List 4 causes of HF?

A

1- MI.
2- cardiomyopathies.
3- viral infections.
4- excessive alcohol.

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

List the symptoms of left-sided heart failure?

A

1- low cardiac output.
2- elevated pulmonary venous pressure.
3- dyspnea.

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

List the symptoms of right-sided heart failure?

A

Symptoms of fluid retention; usually RV failure is secondary to LV failure.

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

List the 4 symptoms of low output (forward failure)?

A

1- fatigue.
2- dizziness.
3- SOB.
4- aggravated by physical exercise.

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

Increased filling pressure leads to what?

A

Congestions of the organs upstream of the heart (backward failure).

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

Backward failure leads to what?

A

Edema, maldigestion, and ascites.

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

Definition: an emergency condition in which the patient was asymptomatic before the onset of heart failure?

A

Acute HF.

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

Acute HF is seen in which conditions?

A

Acute injury such as MI.

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

Definition: long term syndrome in which the patient exhibits symptoms over a long period of time?

A

Chronic HF.

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

Chronic Hf is usually as a result of what?

A

A result of pre-existing cardiac condition.

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

List the 9 factors precipitating HF?

A

1- myocardial ischemia or infract.
2- dietary sodium excess.
3- excess fluid intake.
4- medication noncompliance.
5- arrhythmias.
6- intercurrent illness (e.g. infection).
7- conditions associated with increased metabolic demand (e.g. pregnancy, thyrotoxicosis).
8- administration of drug with negative inotropic property of fluid retaining properties (e.g. NSAIDs, corticosteroids).
9- alcohol.

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

Patients with HF are often categorized by the ____ classification.

A

NYHA.

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

List the 4 HF classes of NYHA? And what do they mean?

A

1- class I: asymptomatic.
2- class II: symptomatic with moderate activity.
3- class III: symptomatic with mild activity.
4- class IV: symptomatic at rest.

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

HF is often preventable by what?

A

By early detection of patients at risk and by early intervention.

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

List the 3 stages of HF?

A

1- stage A.
2- stage B.
3- stage C&D.

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

What is stage A HF?

A

Risk of developing HF (eg. HTN) aggressive t/t of HTN, modification of coronary risk factors, reduction of alcohol intake.

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

What is stage B HF?

A

Structural heart disease but no symptoms of HF (eg. Previous MI, LVH, valvular ds), ACE-I and BB, more aggressive t/t of HTN, surgical intervention.

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

What is stage C&D HF?

A
  • Clinical HF.
  • Patients refractory to therapy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which NYHA class is stage C HF?

A

NYHA II/III.

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

Stage D HF may need which type of management?

A

May need heart transplantation.

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

List the 4 compensatory physiological responses in HF?

A

1- increased sympathetic activity.
2- activation of the RAAS.
3- activation of natriuretic peptides.
4- myocardial dysfunction.

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

The pathophysiology of HF is complex and involves which four major interrelated systems?

A

1- the heart itself.
2- the vasculature.
3- the kidney.
4- neurohumoral regulatory circuits.

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

List the 7 drugs used in HF?

A

1- ACE-I.
2- ARBs.
3- aldosterone antagonist.
4- diuretics.
5- beta blockers.
6- direct vaso- and venodilators.
7- inotropic agents.

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

List the 3 new drugs used in HF?

A

1- HCN channel blocker.
2- B-type natriuretic peptide.
3- ARNI.

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

Give an example of HCN channel blocker?

A

Ivabradine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Give an example of B-type natriuretic peptide?

A

Nesirtide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List the 5 treatment principles of HF?

A

1- neurohumoral modulation.
2- preload reduction.
3- afterload reduction.
4- increased cardiac contractility.
5- heart rate reduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

List the 3 goals of HF treatment?

A

1- decrease symptoms.
2- slow disease progression.
3- improve survival.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which drugs improve mortality, morbidity, exercise tolerance, and left ventricular ejaction fraction?

A

ACE-I.

31
Q

List 4 examples of ACE-I?

A

1- capropril.
2- lisinopril.
3- enalapril.
4- ramipril.

32
Q

List 3 examples of ARBs?

A

1- losartan.
2- valsartan.
3- candesartan.

33
Q

Beta blockers protect the heart from which adverse long-term consequences of sympathetic overstimulation?

A

1- increased energy consumption.
2- arrhythmias.
3- cell death.
4- improve perfusion of the myocardium by prolonging diastole.

34
Q

List 4 BBs in HF?

A

1- bisoprolol.
2- carvedilol.
3- metoprolol.
4- nebivolol.

35
Q

Which patients should be treated with a beta blocker?

A

All patients with symptomatic HF (stage C, NYHA II-IV) and all patients with left ventricular dysfunction (stage B, NYHA I) after MI.

36
Q

Beta blockers should be initiated only in which patients and at what doses?

A

Only in clinically stable patients at very low doses.

37
Q

Beta blockers should not be used in which type of HF?

A

New-onset or acutely decompensated heart failure.

38
Q

Diuretics are useful in reducing the symptoms of volume overload by what?

A

1- decreasing the extracellular volume.
2- decreasing the venous return.

39
Q

Which type of diuretics are the most effective in severe HF?

A

Loop diuretics like furosemide and bumetanide.

40
Q

List the 2 AE of diuretics?

A

1- loop diuretics and thiazides cause hypokalemia.
2- potassium sparing diuretics help in reducing the hypokalemia due to these diuretics.

41
Q

List 2 examples of potassium sparing diuretics?

A

Spironolactone or eplerenone.

42
Q

Which effects does aldosterone inhibition has?

A

Minimize potassium loss, prevent sodium and water retention, endothelial dysfunction and myocardial fibrosis.

43
Q

What is the AE of spironolactone?

A

Gynecomastia.

44
Q

Combination of potassium supplements of ACE-I can increase the risk of what?

A

Hyperkalemia.

45
Q

Which drugs can be used specially in patients who cannot tolerate ACE-I?

A

Isosorbide dinitrate and hydralazine.

46
Q

Nitrates and hydralazine improve outcomes in which race of patients?

A

African-Americans.

47
Q

List the MOA of digoxin?

A

1- inhibition of Na/K ATPase pump increase intracellular sodium concentration - eventually increase cytosolic calcium.
2- increases force of cardiac contraction.
3- restores the vagal tone (HR and oxygen demand decreases).
4- abolishes the sympathetic over activity.

48
Q

Digoxin comes from which plant?

A

Obtained from digitalis plant (foxglove).

49
Q

Which AE does digoxin has?

A

1- initial indicators of toxicity: anorexia, nausea, vomiting.
2- blurred vision, yellowish vision (xanthopsia).
3- cardiac arrhythmias: almost every type of arrhythmia can be produced.

50
Q

What is the treatment of digoxin toxicity?

A

1- stop digoxin.
2- digoxin antibody (digibind).

51
Q

What is the treatment for digoxin induced tachyarrhythmias?

A

When caused by chronic use of digitalis and diuretics - infuse KCI.

52
Q

What is the treatment for digoxin induced ventricular arrhythmias?

A

Lidocaine i.v.

53
Q

What is the treatment for digoxin induced supraventricular arrhythmias?

A

Propranolol.

54
Q

What is the treatment for digoxin induced AV block and bradycardia?

A

Atropine.

55
Q

What is the treatment of dyspnoea and other symptoms in refractory CHF?

A

Nesiritide.

56
Q

Which actions does nesiritide has?

A

1- enhances salt and water retention.
2- potent vasodilator.
3– reduces ventricular filling pressure.

57
Q

The latest addition to standard combination therapy of HF is what?

A

Angiotensin receptor-neprilysin inhibitor (ARNI).
Sacubitril and valsartan.

58
Q

Sacubitril has which type of effect?

A

Inhibits neprilysin.

59
Q

Valsartan has which type of effect?

A

ARB.

60
Q

ARNI combines which effects?

A

Inhibition of the RAAS with activation of a beneficial axis of neurohumoral activation, the natriuretic peptides.

61
Q

What is the ACC/AHA recommends for HF patients who remain symptomatic on an ACE-I, BB, aldosterone inhibitor?

A

Use of sacubitril/valsartan as a replacement for ACE-I.

62
Q

HCN channel blocker: ivabradine has which action?

A

Hyperpolarization-activated cyclic nucleotide-gated channel blocker.

63
Q

HCN channel blocker: ivabradine is responsible for which current?

A

I(f) current

64
Q

Inhibition of the HCN channel with ivabradine use results with which action on HR?

A

Results in a lower heart rate.

65
Q

List a use of HCN channel blocker: ivabradine?

A

Used in HFrEF to improve in patients with sinus rhythm above 70 bpm.

66
Q

Treatment of HF with reduced LVEF is aimed at what?

A

Relieving symptoms, improving functional status and preventing death and hospitalizations.

67
Q

Management of heart failure with reduced LVEF is based on correcting what?

A

Correction of reversible causes (eg. Valvular lesions, uncontrolled HTN, drugs with negative inotropy such as CCBs).

68
Q

What is the pharmacological treatment of HF with reduced LVEF?

A

A combination of a diuretic and an ACE-I should be the initial treatment in most symptomatic patients with early addition of BB.

69
Q

List the non-pharmacological management of HF with reduced LVEF?

A

Implantable cardioefibillators, diet and exercise training, coronary revascularaization, cardiac transplantation.

70
Q

Half of the patients with HF have which type of LVEF?

A

Normal LVEF, often with diastolic dysfunction.

71
Q

Which therapy has been shown to improve HF with normal LVEF?

A

No therapies have been shown to improve survival in this population.

72
Q

What is the management of acute HF and pulmonary edema?

A

1- oxygen (to maintain arterial PO2 greater than 60 mmHg).
2- morphine (increases vascular capacitance, lowering LA pressure, relieves anxiety).
3- iv diuretic therapy (furosemide is indicated even if the patient has not exhibited fluid retention).
4- nitrate therapy (reduces BP and LV filling pressure).
5- iv nesiritide (a recombinant form of human BNP, is a potent vasodilator that reduces ventricular filling pressures and improves cardiac output).

73
Q

List the 6 symptoms of acute HF and pulmonary edema?

A

1- acute onset or worsening of dyspnea at rest.
2- tachycardia, diaphoresis, cyanosis.
3- pulmonary rales, rhonchi; expiratory wheezing.
4- radiograph shows interstitial and alveolar oedema with or without cardiomegaly.
5- arterial hypoxemia.

74
Q

List the 6 causes of acute HF and pulmonary edema?

A

1- acute MI.
2- exacerbation of chronic HF.
3- acute severe HTN.
4- AKI.
5- acute volume overload.
6- high altitude.

CVS (11 decks)

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