Heart Failure Flashcards
Problem with filling of the left ventricle
relaxation = diastole
Problem with ejection of the blood from the left ventricle
contraction = systole
What is an ultrasound of the heart called and what does it provide an estimate of
ECHO, tells you the amount of left ventricular ejection fraction (EVEF) aka systolic dysfunction
ACC/AHA Staging system
A) At high risk but without HF (HTN, CAD, DM, obesity, eg)
B) Structural heart disease (i.e. low EF) but without signs or symptoms
C) Structural heart disease with symptoms
D) Advanced with symptoms despite maximized tx
NYHA functional class
1) no limitations of physical activity
2) Slight limitation of physical activity - comfortable at rest but minimal exertion
3) marked limitation of physical activity
4) Symptoms present even at rest (D)
CO equation
HR x SV
Key drugs that can worsen HF
Drug Information NATION
Dipeptidyl peptidase 4 inhibitors
Immunosuppressants
Non DHP CCB (Diltiazem and Verapamil)
Antiarrhythmics (Class 1)
Thiazolidines (increase risk of Edema)
Oncology Drugs
NSAIDS
Problem in HF
Low CO
How heart compensates for low CO
activates neurohormonal pathways ti increase blood volume or force speed of contractions, mainly through RAAS, SNS, and vasopressin (naturitic peptides become insufficient)
Long term effects of compensating for low CO
cardiac remodeling
What does Angiotensin 2 cause
Vasoconstriction (think ace
What does aldosterone cause
sodium and water retention
What does vasopressin cause
vasoconstriction and water retention
What does NE cause
an increase in HR, contractility (posiive ionotropy) and vasoconstriction
What do ace/ARBS and ARAS act on?
Stop RAAS and have mortality benefit
What do beta blockers act on
Sympathetic nervous system activation by blocking EPI and NE
Where do arnis act (sacubatril)
increases naturitic peptides
sulfa allergy is a concern in which drug class
diuretics
different between loop diuretics and thiazides in terms of calcium
thiazides increase calcium whereas loops decrease everything
Lasix
Furosemide
Bumez
Bumetanide
Vasotec
Enalipril
Enalapril vs Enalaprat
Enaliprat is for hypertension
Prinivil
Lisinopril (1/2)
Zestril
Lisinopril (2/2)
Accupril
Quinapril
Altace
Ramipril
Cozaar
Losartan
Diovan
Valsartan
Entresto
Sacubitril/Valsartan
Toprol XL
Metoprolol Succinate
Which are the only three beta blockers recommended in heart failure
Bisoprolol, Metoprolol succinate (B1 selective), Carvedilol (nonselective beta blocker and alpha blocker)
B1 selective blocker pneumonic
AMEBBA
Atenolol, Metoprolol, Esmolol, Bisoprolol, Betaxolol, Acebutolol
Oral equivilent dosing for duretics
ethacrynic acid 50 = furosemide 40 = torosemide 20 = bumetanide 1
furosimide PO is 2x IV
What is a concern for rapid iv administration of a diuretic
ototoxicity
Oral equivalent for statins
Pharmacists - Pitavastatin 2 Rock - Rosuvastatin 5 At - Atorvastatin 10 Saving - Simvastatin 20 Lives - Lovastatin 40 Preventing - Pravastatin 40 Fat - Fluvastatin 80
Do not refrigerate pneumonic
Dear - Dex edetomine (precedex)
Sweet - Sulfamethoxazole-TMP/Bactrim
Pharmacist - Phenytoin/Dilantin (crystalizes)
Freezing - Furosemide/Lasix (crystalizes)
Makes - Moxifloxacin (Avelox)
Me -Metronidazole/Flagyl
Edgy - Enoxaparin/Lovenox
What drug to avoid in heart failure?
NSAIDS
ace inhibitor vs arb inhibitor moa
ACE: block conversion angiotensin 1 to angiotensin 2
arbs: block angiotensin 2 from binding
ace/arb major contraindication
angioedema
target dose for vasotec
enalapril
10-20mg po BID
target dose for prinivil, zestril
lisinopril
20-40mg daily
target dose for accupril
quinapril
20 mg bid
target dose for altace
ramipril
10mg daily
target dose cozaar
losartan
50-150mg daily
target dose diovan
valsartan
160mg bid
metoprolol target dose
200 mg daily
carvedilol target dose
if greater than 85kg 50 mg bid
if less than that half that dose
which beta blocker needs to be taken with food?
carvedilol
Spironolactone target dose
25 mg daily or bid
Digoxin target dose and dosing
0.125 - 0.25 mg
Theraputic range is 0.5 - 0.9 in HF (in afib its 0.8-2)
decrease dose frequency when CrCl <50
Decrease dose by 20ish percent when switching from PO to IV
digoxin antidote
digifab
10% klor kon is what in meq.ml
20meq/15ml
Boxed warning Ace/Arb
Pregnancy
Nephrilysin moa
The sacubitril component is responsible for the degradation of vasodilatory peptides
Difference between spironolactone and eplerenone
Spironolactone is non selective therefore has androgen side effects
contraindications for aldosterone
hyperkalemia, Addison’s disease, crcl less than 30 (can cause hyperkalemia)
Who is bidil indicated for
black patients who are still symptomatic despite optimal treatment
DILE causing drug
anything with hydralizine (BIDIL)
Digoxin MOA
inhibits NA-K-ATPase pump
Digoxin Effect
positive ionotropic (CO), negative Chronotropic (HR)
Signs of digoxin toxicity
yellow green halos, blurred vision, n/v/loss of apetite, bradycardia
purpose of ivabradine
reduces the risk of hospitalizations but not mortality
major s/e of ivabradine
bradycardia (QT prolonging), hypertension, afib
HR needed to start Ivarbradine
> 70 BPM because can cause bradycardia
Micro K administration
can open and sprinkle on food
Klor-Con M
Can cut in half or dissolve in water
Klorcon, K-tab
must swallow whole
What can aggravate hypokalemia
drugs and magnesium
Drugs that have mortality benefit
ace/arbs, BB, ARA, ARNI, entresto in AA patients
Drugs that have no mortality benefit
loop, digoxin, ivabradine
