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Kol- Pharm 323 Spring > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Heart failure leads to inadequate ____ _____ AND/OR ____ ______

A

Inadequate tissue perfusion AND/OR volume overload

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2
Q

inability of the heart to adequately pump all the blood it has received. The lack of cardiac output thus fails to meet the metabolic needs of the body

A

Heart Failure

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3
Q

Is there a cure for heart failure?

A

Nope

Goal = prevent, treat, and remove UNDERLYING CAUSE

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4
Q

How does chronic hypertension lead to HF?

A

Too much afterload for too long.

Too much pressure for the L ventricle to pump against

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5
Q

What is cardiac remodeling?

A

reduced cardiac output&raquo_space;> compensatory responses&raquo_space;»

^increase HR
^venous/arterial pressure

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6
Q

What are the compensatory responses as a result of reduced cardiac output?

A
  1. Cardiac Dilation
  2. Activation of SNS
  3. Activation of RAAS
  4. Retention of water/increased bld volume
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7
Q

What does left sided HF result in?

A

pulmonary HTN

Pulmonary Edema –> wet lungs

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8
Q

What does right sided HF result in?

A

Veins distended
Edema in Legs
Ascites in belly

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9
Q

what are the 2 goals of drugs to treat HF?

A
  1. increase force of contraction (positive ionotropic effect)
  2. decrease HR to reduce O2 consumption
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10
Q

List the main classes of drugs to treat HF (7) (6 if you lump one in with another)

A

1.Diuretics
Thiazide Diuretics: Hydrocholorthiazide
Loop Diuretics: furosemide
K Sparing Diuretics: spironolactone
2.Drugs that Inhibit RAAS
ACE: lisinopril (Zestril)
ARB: valsartan
ARNI: sacubitril/valsartan (Ernesto)
Aldosterone receptor blocker: spironolactone
3.Beta Blockers: carvedilol (Coreg), metoprolol XL (Toprol-XL), bisoprolol (Zebeta)
4.HCN Channel Blocker :ivabradine (Crolanor
5.Cardiac Glycosides: digoxin
6.Vasodilators: isosorbide dinitrate with hydralazine
7.Acute HF drugs: IV infusions

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11
Q

3 diuretics to treat HF

A

Thiazide Diuretics: Hydrocholorthiazide
Loop Diuretics: furosemide
K Sparing Diuretics: spironolactone

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12
Q

Drugs that inhibit RAAS to TREAT HF

A

ACE: lisinopril (Zestril)
ARB: valsartan
ARNI: sacubitril/valsartan (Ernesto)
Aldosterone receptor blocker: spironolactone

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13
Q

1st line therapy drug class for HF? why?

A

diuretics!

Reduce the blood volume (preload) –> decreases workload on heart

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14
Q

Are diuretics a cure for HF?

A

reduces symptoms, does not prolong survival

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15
Q

3 ways diuretics treat HF

A
  1. treat pulmonary/peripheral edema
  2. decrease preload/afterload
  3. causes cardiac dilation
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16
Q

prototype for Loop Diruetics?

A

furosemide (Lasix)

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17
Q

how does furosemide (Lasix) fxn?

A

-Loop Diuretic

Inhibits reabsorption of Na & Cl at loop of Henle –> resulting in decrease BLOOD VOLUME

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18
Q

onset/duration for PO furosemide (Lasix)

A

onset 1hour - duration for 8 hours

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19
Q

onset/duration for IV furosemide (Lasix)

A

onset 5 min - duration 2-3 hours

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20
Q

Most efficacious diuretic for HF?

A

furosemide (Lasix)

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21
Q

which diuretics have risk of HYPOkalemia?

A

Thiazide Diuretics: Hydrocholorthiazide

Loop Diuretics: furosemide

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22
Q

What other electrolytes get messed up with Thiazide Diuretics: Hydrocholorthiazide and Loop Diuretics: furosemide

A

Na and Cl

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23
Q

Loop and Thiazide diuretics have risk of ____ and _____ toxicity

A

digoxin and lithium

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24
Q

Which HF drug has risk of transient ototoxicity? why?

A

Loop Diuretics: furosemide (Lasix)

-if give IV too fast

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25
Q

If diuretics are decreasing blood volume things are we watching for in patient

A

hypotension, dehydration, postural hypotension, hypovolemia

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26
Q

Which HF drug will increase uric acid/ gout flare up?

A

Thiazide Diuretics: Hydrocholorthiazide

Loop Diuretics: furosemide

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27
Q

Prototype for thiazide diuretics?

A

hydrochlorothiazide (HCTZ)

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28
Q

how does hydrochlorothiazide (HCTZ) fxn?

A

1) reduces BLOOD VOLUME
- works on the distal tubule
- Results in excretion of H20, Na, K+
2) Reduces arterial resistance (over time)

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29
Q

Onset/ duration/ peak for hydrochlorothiazide (HCTZ)

A

2 hrs., peak 4-6, lasts 12 hours

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30
Q

what is our most WIDELY USED diruetic?

A

hydrochlorothiazide (HCTZ)

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31
Q

Which HF drug has risk of hyperglycemia in DM patients?

A

hydrochlorothiazide (HCTZ)

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32
Q

hydrochlorothiazide (HCTZ) is contraindicated with which other allergy

A

sulfa

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33
Q

prototype for Potassium Sparing Diuretics

A

spironolactone (Aldactone)

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34
Q

how does spironolactone (Aldactone) fxn?

A

Competes with aldosterone at receptors in the distal tubule blocking aldosterone
–> fluid lost, K remains
= potassium sparing!

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35
Q

Onset for spironolactone (Aldactone)

A

Potassium Sparing Diuretic
Aldosterone Receptor Blockers

Takes up to 48 hours to work

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36
Q

Side effects for spironolactone (Aldactone)?

A

Potassium Sparing Diuretics
Aldosterone Receptor Blockers

  • hyperkalemia (high K+)
  • Endocrine effects: gynecomastia
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37
Q

Nursing consideration for HYPOkalemia associated with diuretics?

A 
Hypokalemia (Thiazide/Loop)
✔ K levels before admin. 
Teach high K+ foods 
Risk for dysrhythmias
Risk for digoxin & lithium toxicity
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38
Q

Nursing consideration for HYPERkalemia associated with diuretics? (think about other drugs you would or would not give this with)

A

✔ K levels before admin.

Typically, don’t admin. with RAAS drugs, K supplements

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39
Q

Why do we check daily wait for HF patient on diuretics

A

*Patients may be given a ‘sliding scale’ based on daily wt.

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40
Q

Which diuretic are we definitely not giving to someone pregnant?

A

Loop Diuretics: furosemide (Lasix)

41
Q

What happens when you block angiotensin (in relation to HF)?

A

vasodilation, dec. Na and water retention and prevent cardiac remodeling

42
Q

What happens when you block aldosterone (in relation to HF)?

A

prevent Na and water retention and prevent cardiac remodeling

43
Q

Do we give RAAS drugs in pregnancy?

A

NOPE

44
Q

All RAAS drugs have a risk for….

A

HYPERkalemia!

45
Q

What is the one RAAS drug we are NOT using in HF treatment?

A

direct renin inhibitor

46
Q

How are angiotensin and aldosterone the same and how are they different in treating HF

A

BOTH:

  • decrease Na/H20 retention
  • prevent cardiac remodeling

ANGIOTENSIN:
causes vasodilation

47
Q

What is prototype for ACE Inhibitors?

A

lisinopril (Zestril)

48
Q

How does Lisinopril treat HF?

A

Ace inhibitor

  • arteriolar dilation: reduces afterload, increase renal blood flow
  • Venous dilation = reduces preload
  • Suppresses Aldostone
  • prevents cardiac remodeling

STOP ANGIE

  1. Blocks the conversion of angie 1 to angie 2-> vasodilation and decreased fluid volume
  2. Block aldosterone
  3. Increase bradykinin
49
Q

3 things that happen when you stop Angiotensin?

A
  1. Blocks the conversion of angie 1 to angie 2-> vasodilation and decreased fluid volume
  2. Block aldosterone
  3. Increase bradykinin
50
Q

side effects of lisinopril (4)

A

ACE Inhibitor

Dry cough, angioedema, 1st dose hypotension, Increased K+

51
Q

prototype for Angiotensin II Receptor Blockers

A

valsartan (Diovan)

52
Q

How does valsartan (Diovan) fxn in HF?

A

Angiotensin II Receptor Blockers

block receptors for AT2 (angiotensin II) after it is formed

**Many of the same protective qualities of ACE inhibitors but —doesn’t decrease cardiac remodeling—

53
Q

Who is going to take valsartan (Diovan)?

A

a non pregnant person who ca’t tolerate an ACE inhibitor

54
Q

side effects of valsartan (Diovan)

A

cough , angioedema and hyperkalemia, hypotension

much less of a problem then ACE

55
Q

what is prototype for Angiotensin Receptor Neprilysin Inhibitor (ARNI)

A

sacubitril/valsartan (Entresto)

56
Q

how does sacubitril/valsartan (Entresto) fxn?

A

Angiotensin Receptor Neprilysin Inhibitor (ARNI)

-Increases natriuretic peptides by inhibiting neprilysin
neprlysin = normally breaks down natriuretic peptide
natriuretic peptide = signals body to get rid of fluid
–>(so blocking neprlysin = more natriuretic peptide = less fluid)
-Suppresses the negative effects of RAAS
-Valsartan part = blocks Angie II once formed
-Sacubitril = inhibits neprilysin

57
Q

what do neprlysin and natriuretic peptide do normally?

A

neprlysin = normally breaks down natriuretic peptide

natriuretic peptide = signals body to get rid of fluid

58
Q

who is taking sacubitril/valsartan (Entresto) and how are they taking it?

A

a non pregnant person who ca’t tolerate an ACE inhibitor

*off ACE for 36 hours before starting sacubitril/valsartan (Entresto)

59
Q

side effects of sacubitril/valsartan (Entresto)?

A

same as ARBs as it contains a ”sartan”

cough , angioedema and hyperkalemia. hypotension

60
Q

prototype for aldosterone receptor blockers?

A

spironolactone (Aldactone)

61
Q

spironolactone (Aldactone) falls into what 2 class of drugs?

A

Aldosterone Receptor Blockers (RAAS)

Potassium Sparing Diuretic (Diuretic)

62
Q

Do. we combine (ARBs) Angiotensin II Receptor Blockers, ACE, and spironalactone

A

typically not b/c of risk of hyperkalemia

63
Q

How do beta blockers work to treat HF?

A
  • Decreases HR (NEGATIVE CHRONOTROPE)
  • Slows conduction through myocardium (NEGATIVE DROMOTROPE)
  • Decreases force of contraction (NEGATIVE IONOTROPE)
  • Other actions: decreases peripheral vascular resistance over time and block beta1 on juxtaglomerular cells that release renin
64
Q

what is our prototype for beta blockers for HF?

A

-Metoprolol XL (Lopressor, Topol XL)

65
Q

What is unique about beta blockers for HF?

A

can worsen HF so only use 3 that are approved for HF
carvedilol (Coreg)
metoprolol XL (=succinate = long acting) (Toprol-XL)
bisoprolol (Zebeta)

66
Q

is Metoprolol XL (Lopressor, Topol XL) used as monotherapy to treat HF?

A

nope

-Usually used in combination with ACE + diuretics

67
Q

dosage for Metoprolol XL (Lopressor, Topol XL)

A
  • Start with small doses 1/10 or 1/20 and doubled every 2 weeks
    • –>full benefits not until 3 months out
    • ->decreasing sympathetic load on heart
68
Q

Side effects of Metoprolol XL (Lopressor, Topol XL)

A
  • Bradycardia
  • Decreased cardiac output
  • Watch for S/S of heart failure
  • AV heart block
    • slowing connection from SA-AV node through atrium, can have prolongation of PR interval
  • Rebound cardiac excitation if stop suddenly
  • May mask SNS s/s of hypoglycemia in diabetics
69
Q

Which HF drug can mask SNS s/s of hypoglycemia in diabetics?

A

Metoprolol XL (Lopressor, Topol XL)

70
Q

Which HF drug may cause Rebound cardiac excitation if stop suddenly?

A

Metoprolol XL (Lopressor, Topol XL)

71
Q

Common side effects of Metoprolol XL (Lopressor, Topol XL)?

A

fatigue, drowsy, dizzy, HA, sexual dysfunction, depression

72
Q

Prototype for HCN Channel Blockers

A

ivabradine

73
Q

how does ivabradine fxn?

A

HCN Channel Blockers

slows HR by inhibiting channels in the SA Node (decrease conduction)

*works similarly to beta blocker

74
Q

who is taking ivabradine?

A

Used if can’t tolerate Beta Blocker!

HF +High resting HR (>70)+ Low ejection fraction (<35%)

75
Q

What are HR goals for patient on ivabradine?

A

-HR Goal is 50-60 w/ this drug

76
Q

side effects of ivabradine

A

HCN Channel Blockers

Bradycardia, HTN w/ renal dysfunction, afib, luminous phenomena (transient enhanced brightness/halos)

77
Q

patient teachings for ivabradine

A

HCN Channel Blocker

  • Check radial pulse. Report brady or irregular
  • Teach about visual changes—transient and will disappear
78
Q

when do we hold Metoprolol XL (Lopressor, Topol XL)

A

apical pulse <60 bpm

79
Q

patient teaching for Metoprolol XL (Lopressor, Topol XL)

A
  • Check BP and Pulse before admin.
  • ->Hold if apical pulse <60 bpm
  • Teach pt not to stop suddenly > wean off medication
  • Teach diabetics to monitor bld. Sugar more closely and look for other signs of hypoglycemia.
  • Watch for s/s of heart failure (edema, wt gain, SOB)
80
Q

s/s of heart failure to educate patients about

A

edema, wt gain, SOB

81
Q

prototype for Cardiac Glycosides

A

digoxin (Lanoxin)

82
Q

How does digoxin (Lanoxin) fxn?

A
  • slow the heart (neg chronotropic)
  • ***increase force of contraction (pos. inotropic effect)
  • Increases CO
  • Improves Efficiency
83
Q

Which HF drug has narrow therapeutic range?

A

digoxin (Lanoxin)

Cardiac Glycosides

84
Q

what is therapeutic range for digoxin (Lanoxin)

A

(0.5-0.8ng/ml)

85
Q

what is half life digoxin (Lanoxin)

A

1/5 days

86
Q

How do we give digoxin (Lanoxin)?

A

–>Digitalization= gives loading doses of IV digoxin to get to dose faster, then switch to routine dose
Routine Dose: 0.125-0.25mg daily

87
Q

What is routine dose for digoxin (Lanoxin)

A

0.125-0.25mg daily

88
Q

Whats up with K and Digoxin

A

Hypokalemia increases risk of digoxin toxicity

89
Q

side effects of digoxin?

A
  • Fatigue, drowsiness, dizziness

- cardiac dysrhythmias (AV block, bradycardia)

90
Q

signs of digoxin toxicity?

A
  • Nausea, vomiting - will lose more potassium and get more dig toxic!, anorexia, fatigue
  • Visual disturbances (yellow/green halos, blurring)
91
Q

digoxin antidote?

A

digoxin immune Fab (Digibind)

92
Q

patient teaching for digoxin

A
  • Check apical pulse. Hold if <60
  • Teach patients to check pulse daily
  • Teach patients of drug-drug, drug-food interactions p. 540- LONG list
    • high fiber/bran
    • antacids
93
Q

2 HF drugs to hold if apical pulse is <60

A

Digoxin , Metoprolol XL

94
Q

Prototype for direct vasodilators

A

isosorbide dinitrate (Isordil) and hydralazine

95
Q

if isosorbide dinitrate (Isordil) and hydralazine come in same pill =

what is unique about this pill

A

BiDil

clinical trials only for African Americans

96
Q

how do isosorbide dinitrate (Isordil) and hydralazine fxn?

A

Isosorbide: Causes direct relaxation of venous smooth muscle
Hydralazine: causes dilation of arterioles

97
Q

Who takes isosorbide dinitrate (Isordil) and hydralazine

A

someon who cant take an ACE or an ARB

98
Q

side effects of isosorbide dinitrate (Isordil) and hydralazine

A
  • orthostatic hypotension
  • Reflex tachycardia
  • SLE syndrome (hydralazine)

Kol- Pharm 323 Spring (41 decks)

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