Exam 2 - Treatment for HF and CHD (lecture) Flashcards
Which HF drug improves contractility?
digoxin
Would you give digoxin for systolic or diastolic heart failure?
systolic
which HF drugs slow deterioration and prevent remodeling?
ACE-I
BB
spironolactone
Which HF drugs improve diastolic function?
antihypertensives
(to decrease LVH)
Which HF drug do you give to blacks to prevent remodeling?
Hydralazine
What are some non-pharm tx for HF?
remove precipitating factors
bed rest (+ anticoags)
elastic stockings
low salt diet
Which HF drugs relieve symptoms and reduce preload?
loop diuretics
Which HF drugs are not loop diuretics, but have a diuretic effect?
ACE-I, ARBs
Which drugs decrease mortality in HF?
ACE-I
BBs
Hydralazine
vasodilators
Do ACE-Is reduce afterload, preload, or both?
both
Do ACE-Is dilate veins or arteries?
both :)
Can you give beta blockers in a HF patient who is unstable?
no!
What HF drugs decrease SVR, increase CO, and relieve symptoms?
vasodilators
How do you treat acute angina?
NTG sublingual
Does NTG vasodilate or venodilate?
venodilates
Does NTG decrease preload or afterload?
preload
How often can you repeat a dose of NTG?
every 3-5 minutes if symptoms haven’t left
What is prophylaxis for acute angina?
NTG sub-lingual
5 min before activity
What drugs prevent acute angina (5)?
BBs
Long acting nitrates (isoborbide)
CCBs
Ranolazine
Anti-platelets
Which 2 beta blockers are best to give for acute angina prevention?
metoprolol
atenolol
what do BBs do to the heart?
dec HR, contractility, BP
improves exercise tolerance
With what dz should you avoid BBs?
lung disease
do CCBs dilate arteries or veins?
arteries (peripheral)
do CCBs decrease preload or afterload?
afterload
Do CCBs decrease mortality after an MI?
NO
Which CCB type goes well in adjunct with BBs?
dihydropuridines
Which CCB type goes well in adjunct with nitrates?
nondihydropyridines
Which type of CCB should you avoid in HF?
nondihydropyridines
Which nondihydropyridine CCB should you especially avoid with a beta blocker?
What can happen?
veramapil
heart block
When would you give ranolazine in acute angina?
When a pt is nonresponsive to other treatment
What is the MOA of ranolazine?
decrease sodium –> decreases Ca –> decreases contraction and O2 need
What will ranolazine cause to happen on EKG, which is totally fine?
Prolonged QT interval
What agent is used in ALL patients with CHD?
ASA
What can you give as an ASA alternative?
Clopidogrel
Which angina patients are candidates for surgery (4)?
they have symptoms despite treatment
they have 3 vessel CAD
they have disease in L main artery
they have ischemia/acute MI
Which type of revascularization surgery is indicated for 1-2 vessel disease and involves placing a stent?
Percutaneous Coronary Intervention
(a type of angioplasty)
which type of revascularization surgery involves replacing the diseased vessel(s) with part of the saphenous vein or internal mammary artery?
coronary artery bypass grafting (CABG)
How do you treat Prinzmetal’s angina?
nitrates
CCBs
How do you treat unstable angina (non-STEMI)?
Hospitalize, bed rest, O2
fully anticoag and antiplatelet
(LMWH + ASA)
nitrates, BB, CCB all used to decrease 02 need
What should you give to your STEMI patients within 1-3 hours of symptom onset (if they qualify)?
thrombolytics (tPA)
How do you manage an acute STEMI?
Hospitalize + ASA
morphine IV
nitro IV
What management will you send your STEMI patient home with?
LMWH + ASA
BB
If an elderly person has a STEMI, what treatment is preferred?
surgery
(percutaneous transluminal coronary angioplasty)
What drugs might you also rx with large infarcts?
ACE-I and ARBs
What drug should you NOT give with infarction?
nsaids!
