Heart Failure 1 Flashcards
Results from the inability of the heart to pump sufficient blood to meet metabolic needs of the body
Heart failure
Reduced mechanical pumping action (contractility) and reduced EF
Systolic dysfunction
- Stiffening and loss of adequate relaxation playing a major role in reducing filling and cardiac output
- EF may be normal
Disastolic dysfunction
Which 6 drugs tx HF?
- Diuretics
- Beta Blockers
- ACE I
- ARBs
- Hydralazine + nitrate
- Aldosterone antagonists
Which 5 drugs prolong survival?
- BB
- ACE
- ARNI (angiotensin receptor-neprilysin inhibitor)
- Hydralazine + nitrate
- Aldosterone antagonists
GDMT
- What meds for Stage A HF?
- ACE I or ARB or BB
GDMT
What meds for Stage B?
- ACE or ARB
- BB
GDMT
What meds for Stage C?
HFrEF
- Diuretics
- ACE or ARB
- BB
- Aldosterone antagonists
- Ivabradine
- Sacubitiril / valsartan
In select pts:
- Hydralazine
- Digitalis
- CRT
- ICD
- Revascularization
Which stage?
- Pt at risk, but w/o structural cardiac abnormalities or sxs of HF
A
Which stage?
- Pt w/ structural cardiac abnormalities, but w/o sxs of HF
B
Which stage?
Pts w/ sxs of HF
C
(most patients)
Which stage?
- Pts w/ advanced or refractory HF sxs
D
What is the main goal of drug therapy w/ HF patients?
Prevent cardiac remodeling
- Which 2 drugs?
- Which drug class?
(increases Ca, increase contractility)
(used in acute HF)
- Dobutamine
- Dopamine
- Class: Beta adrenoreceptor agonists
Which drug?
- Na/K ATPase inhibitors
- Increase Ca, increase cardiac contractility
- For chronic HF
Digoxin
Which drug?
- Renal sodium transporter inhibitors
- Reduce preload/afterload
- Used in Acute and Chronic HF
- Furosemide
- Spirinolactone
(Other diuretics)
Which drug?
- ACE inhibitors
- Reduce preload/afterload
- Reduce remodeling
- Used in chronic HF
- Lisinopril
(others)
Which drug?
- Beta adrenoceptor antagonists
- Reduce afterload
- Reduce remodeling
- Used in chronic stable HF
- Carvedilol
- Labetalol
- Metroprolol
Which drug?
- Vasodilators
- Reduce preload/afterload
- Used in acute HF
- Nitroprusside
- Nitroglycerine
- Hydralazine
- Isosorbide
Which drug?
- Phosphodiesterase inhibitors
- Vasodilation
- Increase contractility
- Used in acute HF
Milrinone
Which drug?
- Natriuretic peptide
- Vasodilation reduces preload/afterload
- Has some diuretic effect
- Used in acute HF
Nesiritide
Which drug?
- HCN / f current
- Slows HR
- Used in chronic stable worsening HF
Ivabradine
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***
Furosemide (loop diuretic)
Name the 3 loop diuretics for HF
- Furosemide
- Bumetanide
- Torsemide
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
Hydrochlorothiazide
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
Spirinolactone
(Eplerenone is a similar drug which also has been shown to reduce mortality)
What is a recommended strategy for reducing the risk of Hyperkalemia w/ Aldosterone Antagonists?
Avoid starting AA in patients w/ serum potassium concentration >5.0 mEq/L
(**K-Cl is a NaCl substitute**)
Which drug?
- Inhibits ACE
- Arteriolar and venous dilation: reduces aldosterone secretion
- Used in chronic HF
- Has been shown to reduce mortality***
- Toxicity: cough, hyperkalemia
Lisinopril
Which drug?
- Antagonize all effects of AT1 receptors
- Effects are “like ACE-I”
- Has been shown to reduce mortality
- Toxicity: hyperkalemia, angioneurotic edema
Losartan
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
Sacubitril / Valsartan
