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Pharmacology II > Exam 1 - HF > Flashcards

Exam 1 - HF Flashcards

1
Q

Structural or functional cardiac disorder that impairs the ability of ventricle to fill with or eject blood (disorder of impaired CO)

A

HF

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2
Q

2 symptoms of HF:

A

Dyspnea

Fatigue

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3
Q

2 signs of HF:

A

Edema

Rales

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4
Q

Is there a diagnostic test for HF?

A

No

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5
Q

Systolic dysfunction ventricular emptying; increased or decreased?

A

Decreased

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6
Q

What does diastolic dysfunction heart look like?

A

Increased heart wall

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7
Q

What 3 things occur with chronic use of Frank-Starling?

A

Sodium retention
Water retention
Venoconstriction

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8
Q

When is sympathetic nervous system triggered?

A

Decrease in CO

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9
Q

What does sympathetic nervous system activate?

A

RAAS

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10
Q

What 3 things occur with activation of RAAS?

A
  1. Water retention
  2. Increased contractility
  3. Vasoconstriction
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11
Q

What does RAAS trigger?

A

Aldosterone

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12
Q

Diagnosis of HR requires the simultaneous presence of what?

A

2 major criteria

1 major criterion with 2 minor criteria

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13
Q

BNP >500 pg/ml

NT-proBNP >1800 pg/ml

A

Likely HF

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14
Q

What 3 things do you have to rule out with somewhat elevated BNP?

A
  1. Pulmonary embolism
  2. Renal failure
  3. Pulmonary HTN
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15
Q

What stage: Patients at high risk for developing HF?

A

Stage A

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16
Q

What stage: pts with structural heart disease but no HF s/s?

A

Stage B

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17
Q

What stage: pts with structural heart disease and current or previous symptoms?

A

Stage C

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18
Q

What stage: refractory HF requiring specialized interventions?

A

Stage D

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19
Q

What stage examples: HTN, CAD, atherosclerosis, DM, obesity, metabolic syndrome

A

Stage A

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20
Q

What stage examples: previous MI, LV hypertrophy, LV systolic dysfunction

A

Stage B

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21
Q

What stage examples: LV systolic dysfunction and symptoms (dyspnea, fatigue, and reduced exercise tolerance)

A

Stage C

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22
Q

What stage examples: pts with treatment refractory symptoms at rest despite max medical therapy

A

Stage D

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23
Q

What class: no symptoms

A

Class 1

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24
Q

What class: symptoms with moderate exertion

A

Class 2

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25
Q

What class: symptoms with minimal exertion

A

Class 3

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26
Q

What class: symptoms at rest

A

Class 4

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27
Q

5 steps of treatment:

A
  1. Establish Dx of HFrEF; assess volume, initiate GDMT
  2. Consider scenario
  3. Implement indicated GDMT
  4. Reassess symptoms
  5. Consider additional therapy
28
Q

Is metoprolol tartrate or carvedilol better for chronic HF?

A

Carvedilol

29
Q

What period with effects from BB:

  • negative inotropy
  • reduced HR
  • improved myocardial substrate utilization
  • some with increased signs of reduced CO
  • some with symptomatic relief
A

Days to weeks

30
Q

What period with effects from BB:

  • improvement in invasive and non invasive measurements of cardiac function
  • stabilization of clinical symptoms
A

Weeks to months

31
Q

What period with effects from BB:

  • improvement in clinical symptoms and possibly physical capacity
  • reduced risk of hospitalization and death
A

Months to 1yr

32
Q

How much do you increase BB dose?

A

50-100% every 2-4wks

33
Q

Decreases spontaneous pacemaker activity of SA node:

A

Ivabradine

34
Q

What does ivabradine do overall?

A

Slow HR

35
Q

What treatment to use with symptomatic HFrEF if HR >70 while on max BB?

A

Ivabradine

36
Q

3 adverse effects of ivabradine:

A
  1. Bradycardia
  2. Atrial fibrillation
  3. Luminous phenomena
37
Q

What is recommended in pts with symptomatic HF and EF <40%?

A

ACE inhibitors

38
Q

Do you continue ACE inhibitors perioperatively in HF pts?

A

YES

39
Q

What is recommended in pts with HF and EF <40% that are intolerant to ACE inhibitors because of cough or angioedema?

A

ARB

40
Q

Do you continue ARBs perioperatively in HF pts?

A

YES

41
Q

What do you add to pts with background ACE-I and BB therapy in pts with symptomatic HF and EF <40%?

A

Aldosterone antagonist

42
Q

What are the 2 aldosterone antagonists?

A

Spironolactone

Eplerenone

43
Q

What 2 contraindications are for aldosterone antagonists?

A
  1. Potassium >5

2. CrCl <30

44
Q

What drug: Venodilation and reductions in preload; increase in NO

A

Isosorbide dinitrate

45
Q

What drug: artieral dilation to reduce afterload and increase SV and CO; increase in NO

A

Hydralazine

46
Q

What attenuates myocardial remodeling and may play a protective role in HF?

A

NO

47
Q

What is recommended to be added on for black HF pts who remain symptomatic despite optimal medical therapy?

A

Hydralazine/isosorbide dinitrate

48
Q

First line therapy in all HF pts unable to tolerate either ACE-I or ARBs because of renal insufficiency, hyperkalemia, or hypotension?

A

Hydralazine/isosorbide dinitrate

49
Q

What drug for HF pts who have evidence of fluid retention?

A

Diuretics

50
Q

Which diuretic is better: loop or thiazide?

A

LOOP

51
Q

What type of diuresis:

  • dyspnea on exertion
  • increased lower extremity and abdominal swelling
  • increased wt
A

Under

52
Q

What type of diuresis:

  • blood urea nitrogen increased to 61
  • serum creatinine increased to 2.5
  • orthostatic BP changes with standing
A

Over

53
Q

What drug increases parasympathetic activity?

A

Digoxin

54
Q

What drug

  • increases CI
  • decreases preload with little effect on BP
A

Digoxin

55
Q

Does digoxin have a narrow therapeutic range

Women, older pts, pts with impaired renal function

A

YES

56
Q

What is indicated in pts who have symptomatic HF, LVEF <35%, and widened QRS complex?

A

Cardiac resychronization therapy (CRT)

57
Q

Is there any evidence-based treatment for HFpEF?

A

NO

58
Q

Rapid onset or change in s/s of HF, resulting in need of urgent therapy

A

Acute HF

59
Q

What does acute HF look like on graph?

A

Upward slopes gradually going down

60
Q

Main medical management for AHFS?

A

Based on precipitating factors and clinical presentation

61
Q

What should be started with warm and wet AHFS?

A

Loop diuretics

62
Q

Warm and wet AHFS in pts with fluid overload in a sense of systemic hypotension, what should be used?

A

Nitroglycerin

Nitroprusside

63
Q

Effect of HF treatment should be monitored with measurement of what 4 things?

A
  1. Fluid intake and output
  2. Vital signs
  3. Body wt
  4. Perfusion and congestion
64
Q

Cold and wet AHFS in pts, what drugs should be used? (4)

A
  1. Dopamine
  2. Dobutamine
  3. Milrinone
  4. NorE
65
Q

What 4 things do you monitor intraoperative?

A
  1. Intraarterial P
  2. Pulmonary artery catheter
  3. TEE
  4. Esophageal Doppler monitor

Pharmacology II (8 decks)

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