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Pharm 2 Exam SHEA > Heart Failure 1 > Flashcards

Heart Failure 1 Flashcards

1
Q

Results from the inability of the heart to pump sufficient blood to meet metabolic needs of the body

A

Heart failure

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2
Q

Reduced mechanical pumping action (contractility) and reduced EF

A

Systolic dysfunction

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3
Q
  • Stiffening and loss of adequate relaxation playing a major role in reducing filling and cardiac output
  • EF may be normal
A

Disastolic dysfunction

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4
Q

Which 6 drugs tx HF?

A
  • Diuretics
  • Beta Blockers
  • ACE I
  • ARBs
  • Hydralazine + nitrate
  • Aldosterone antagonists
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5
Q

Which 5 drugs prolong survival?

A
  • BB
  • ACE
  • ARNI (angiotensin receptor-neprilysin inhibitor)
  • Hydralazine + nitrate
  • Aldosterone antagonists
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6
Q

GDMT

  • What meds for Stage A HF?
A
  • ACE I or ARB or BB
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7
Q

GDMT
What meds for Stage B?

A
  • ACE or ARB
  • BB
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8
Q

GDMT

What meds for Stage C?

A

HFrEF

  • Diuretics
  • ACE or ARB
  • BB
  • Aldosterone antagonists
  • Ivabradine
  • Sacubitiril / valsartan

In select pts:

  • Hydralazine
  • Digitalis
  • CRT
  • ICD
  • Revascularization
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9
Q

Which stage?

  • Pt at risk, but w/o structural cardiac abnormalities or sxs of HF
A

A

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10
Q

Which stage?

  • Pt w/ structural cardiac abnormalities, but w/o sxs of HF
A

B

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11
Q

Which stage?

Pts w/ sxs of HF

A

C

(most patients)

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12
Q

Which stage?

  • Pts w/ advanced or refractory HF sxs
A

D

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13
Q

What is the main goal of drug therapy w/ HF patients?

A

Prevent cardiac remodeling

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14
Q
  • Which 2 drugs?
  • Which drug class?

(increases Ca, increase contractility)

(used in acute HF)

A
  • Dobutamine
  • Dopamine
  • Class: Beta adrenoreceptor agonists
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15
Q

Which drug?

  • Na/K ATPase inhibitors
  • Increase Ca, increase cardiac contractility
  • For chronic HF
A

Digoxin

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16
Q

Which drug?

  • Renal sodium transporter inhibitors
  • Reduce preload/afterload
  • Used in Acute and Chronic HF
A
  • Furosemide
  • Spirinolactone

(Other diuretics)

17
Q

Which drug?

  • ACE inhibitors
  • Reduce preload/afterload
  • Reduce remodeling
  • Used in chronic HF
A
  • Lisinopril

(others)

18
Q

Which drug?

  • Beta adrenoceptor antagonists
  • Reduce afterload
  • Reduce remodeling
  • Used in chronic stable HF
A
  • Carvedilol
  • Labetalol
  • Metroprolol
19
Q

Which drug?

  • Vasodilators
  • Reduce preload/afterload
  • Used in acute HF
A
  • Nitroprusside
  • Nitroglycerine
  • Hydralazine
  • Isosorbide
20
Q

Which drug?

  • Phosphodiesterase inhibitors
  • Vasodilation
  • Increase contractility
  • Used in acute HF
A

Milrinone

21
Q

Which drug?

  • Natriuretic peptide
  • Vasodilation reduces preload/afterload
  • Has some diuretic effect
  • Used in acute HF
A

Nesiritide

22
Q

Which drug?

  • HCN / f current
  • Slows HR
  • Used in chronic stable worsening HF
A

Ivabradine

23
Q

Which drug?

  • Decreases NaCL, KCl, Ca, Mg, reabsorption in thick ascending limb of loop of henle in nephron
  • Increased excretion of salt and water
  • Reduces preload/afterload
  • Reduces pulm and periph edema
  • Used in acute/chronic HF
  • Toxicity: Hypovolemia, hypo: K, Ca, Mg
  • Orthostatic hypotension, ototoxicity
  • ***Sulfonamide allergy***
A

Furosemide (loop diuretic)

24
Q

Name the 3 loop diuretics for HF

A
  • Furosemide
  • Bumetanide
  • Torsemide
25
Q

Which drug?

  • Decreases NaCl reabsorption in the distal convoluted tubule
  • Same as Furosemide, but less efficacious
  • Mild chronic failure, has NOT been shown to reduce mortality
  • Toxicity: hyponatremia, hypokalemia, hyperglycemia, hyperuricemia, HLD
  • Sulfonamide allergy
A

Hydrochlorothiazide

26
Q

Which drug?

  • Blocks cyoplasmic aldosterone receptors in collecting tubules of nephron
  • Increased salt/water excretion
  • Reduces remodeling/mortality
  • Used in chronic HF, aldosteronism
  • Toxicity: hyperkalemia, antiandrogen actions
A

Spirinolactone

(Eplerenone is a similar drug which also has been shown to reduce mortality)

27
Q

What is a recommended strategy for reducing the risk of Hyperkalemia w/ Aldosterone Antagonists?

A

Avoid starting AA in patients w/ serum potassium concentration >5.0 mEq/L

(**K-Cl is a NaCl substitute**)

28
Q

Which drug?

  • Inhibits ACE
  • Arteriolar and venous dilation: reduces aldosterone secretion
  • Used in chronic HF
  • Has been shown to reduce mortality***
  • Toxicity: cough, hyperkalemia
A

Lisinopril

29
Q

Which drug?

  • Antagonize all effects of AT1 receptors
  • Effects are “like ACE-I”
  • Has been shown to reduce mortality
  • Toxicity: hyperkalemia, angioneurotic edema
A

Losartan

30
Q

Which drug?

  • ANRi
  • For patients taking a low dose of ACE/ARB or not taking these
  • Entresto
  • Discontinue ACE at least 36 hrs before initiating this drug
A

Sacubitril / Valsartan

Pharm 2 Exam SHEA (15 decks)

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