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FPC2 Exam 8 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What are the 4 functional classifications of HF

A

I: asymptomatic
II: symptomatic with moderate exertion
III: symptom with minimal exertion
IV symptomatic at reset despite therapy

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2
Q

What are the ejection fraction levels

A

reduced: <40%
mildly reduced 41-49%
preserved >50
improved: previous <40 now >40

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3
Q

What are the best treatment options for HFrEF

A

ARNIs, ACEIs, ARBs (only select one), β blockers, SGLT2Is, mineralocorticoid receptor antagonists (MRA)

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4
Q

What are the sodium-glucose cotransporter 2 inhibitors

A

“liflozin”

dapaglifozin, empaglifozin

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5
Q

What are the 4 pillars of survival for HFrEF therapies? This reduced all cause mortality by up to 72%

A

ARNI, βb, MRA, SGLT2i

arni is preferred over ACEIs and ARBs

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6
Q

ARNI MOA?

A

Sacubitril breaks down ANP and BNP-> decrease vasodilation

Valsartan hits Angiotensin1 receptor-> vasoconstriction

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7
Q

When are ANP and BNP released

A

in response to stretch and volume overload

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8
Q

Cough is an adverse effect of ____

A

ACE inhibitors. This is due to bradykinin blockage.

give ARBs instead.

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9
Q

Should you switch a patient who is stable on an ACEI or ARB to and ARNI?

A

you can, as long as no history of angioedema.

CV mortality affected

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10
Q

When are ARBs preferred over ACEIs and ARNIs in HFpEF

A

intolerant to the cough or angio edema

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11
Q

When are ACEIs ok over ARBs

A

alterations in renal function or serum potassium. they all have these adverse effects

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12
Q

ARNI can be started after __ hours after last dose of ACE inhibitor

A

36 hours

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13
Q

AEs of RAAS drugs

A

hypotension, worsening renal fxn, hyper K+, cough, angioedema

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14
Q

What are contraindications of RAAS drugs

A

pregnancy, hypotension, AKI, renal artery stenosis, hyper K+

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15
Q

Β blockers hit (sympathetic system)
β1-> ?
α1 peripheral-> ?

A

β1: decrease tachycardia, raise CO

α1: decrease BP, raise CO

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16
Q

Potential adverse effects of β blockers

A

metabolic alterations (glucose intolerance, masked hypoglycemia, lipid change TG up, HDL down), bronchospasm, bradycardia, exercise intolerance

17
Q

Caution using β blocker when

A

there is preexisting lung dx. start when patients are stable and euvolemic

18
Q

What are contraindication for β blockers

A

cariogenic shock, decompensated HF

bradycardia>1st degree AV block without pacemaker

19
Q

MRAs block what pathway

A

Angiotensin II to aldosterone

20
Q

You can give MRA for HFrEF if

A

eGFR>30mL/min/1.53m2 and serum K is <5.0mEq/L

21
Q

Potential adverse effects for MRAs

A

steroid effects of gynecomastia, menstrual irregularities (spirono only)
hyper K, hypotension

22
Q

Contraindications of MRAs

A

Hyperkalemia (if not <5.5mEq/L, discontinue), renal failure, anuria, adrenal insufficient, routine with ACE and ARB-> risk of hyper K

23
Q

What happens if serum potassium is >5.5?

A

risk of arrythmias

24
Q

What is MOA of SGLT2i

A

reduce glucose reabsorption at kidney and release glucose in urine

25
Q

What are the SGLT2i cardioprotective effects?

A

decrease cardiac remodeling, inflammation, sympathetic NS, BP
Cause diuresis, natriuresis, erthyropoiesis, improved cardiac energy metabolism

26
Q

SGLT2i’s are indicated for HFrEF stage _?

A

C
EF<40%, use with other GDMT
give regardless of diabetes

27
Q

What must the eGFR be for the two SGLT2i’s (dapaliflozin and empagliflozin)

A

> 30 for dapa

>20 for empa

28
Q

What population is hydralazine/isosorbide dinitrate used in?

A

African Americans and individuals who cannot tolerate RAAS drugs from hyperK+

29
Q

hydralazine/isosorbide dinitrate MOA

A

hemodynamic effects. nitrates are vasodilators-> reduce venous return-> reduce preload
hydralazine is an arteriole dilator, reduce afterload

30
Q

When would diuretics be used in HFrEF patients

A

stage C-D with fluid retention. treat congestive symptoms (JVP, pulmonary congestion, peripheral edema). want to minimize electrolyte abormalities.

31
Q

Loop diuretics MOA

A

Inhibit Na+ reabsorption in the ascending loop of henle

32
Q

Thiazide and thiazide-like MOA

A

inhibit Na+ reabsorption in the DCT (resistance on high dose loop diuretics)

33
Q

Diuretic monitoring

A

urine output, daily weights, symptoms of congestsion

34
Q

What to watch for when taking an diuretic

A

electrolyte wasting, serum creatinine, BUN, ototoxicity, myalgia, BP, heart rate

35
Q

what could be used for treatment in HFmrEF

A

a ok: diuretics
less great: SGLT2i’s
meh: RAAS, MRA, β blockers

36
Q

what could be used for treatment in HFpEF

A

a ok: diuretics
less great: SGLT2i’s
meh: ARB, MRA, β blockers

37
Q

What drugs are we avoiding, especially in HFrEF

A

NSAIDs, class 1 and 3 antiarrhytmics (flecainide and propafenone and class III dronedarone)
Non-DHP CCB
Thiazolidinediones

FPC2 Exam 8 (5 decks)

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