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Therapeutics > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What the main problem in Heart Failure?

A

decreased cardiac output due to changes in heart leading to a hypoperfused state

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2
Q

what is the CO equation?

A

CO=HR x SV

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3
Q

What is the BP equation?

A

BP= CO x SVR

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4
Q

What does stroke volume depend on?

A

preload contractility afterload

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5
Q

define preload

A

fliling of the ventricle after diastole and before systole

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6
Q

what condition is increased preolad associated with?

A

pulmonary congestion peripheral edema jugular venous pressure increase edema

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7
Q

what is afterload?

A

resistance to ejection

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8
Q

what symptoms are associated with increaseed afterload

A

cold/cool extremities

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9
Q

what lab values can measure contractility?

A

LVEF decreased urine output presence of S3

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10
Q

What are S1, S2, S3, S4 sounds correspond to?

A

S1 closing of the mitral/triscupid valves S2 closing of the aortic and pulmonic valves S3 turbulence with ventricle in early filling S4 sudden contraction of atria in response to ventricular hypertrophy

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11
Q

Signs and symptoms of CHF

A

peripheral edema SOB fatigue Rales and Rhonchi abnormal chest xray (Pulmonary congestion) may have abnormal INR or increased AST ALT may have increased SCr due to dec blood flow to kidney hyperurecemia anemia

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12
Q

what is the MAP equation?

A

DBP + 1/3 PP PP= SBP-DBP

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13
Q

what is the ejection fraction equation?

A

SV/ EDV stroke volume over end diastolic volume

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14
Q

which medications can worsen/precipitate heart failure?

A

NSAIDs- Na/H20 retention, renal failure TZDs: peripheral edema CCB; edema metformin EtOH anthracyclines (“rubicins”) Triptans` Class I, IV and some III antiarrhythmics

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15
Q

what is decompensated heart failure?

A

when the mechanisms to compensate for reducesd CO fail leading to impaired heart function.

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16
Q

In heart failure, what mechanisms occur in compensation?

A

increased size of ventricles to hold more volume increasing mass of ventricles increased sympathetic flow

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17
Q

what can cause decompensated heart failure?

A

Myocardial infarction arrhythmias uncontrolled hypertension excessive fluid and salt intake use of medications that can exacerbate CHF

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18
Q

what five agents are used in Acute decompensated heart failure?

A

IV furosemide milrenone dobutamine nesiritide nitroglycerine

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19
Q

what class of agents can be used in chronic CHF?

A

ACEi/Arbs beta blockers diuretics digoxin vasodilators

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20
Q

what are the advantages of using diuretics in CHF patients?

A

improve symptoms of fluid overload

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21
Q

what are the disadvantages of using diuretics in CHF patients?

A

hypotension hypokalemia hyperglycemia possible metabolic alkalosis (increased H+ excretion) no mortality benefit

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22
Q

what are the advantages of using digoxin in CHF

A

improves symptoms only

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23
Q

what are the disadvantages of using digoxin in CHF

A

no mortality benefit prolongs QT

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24
Q

what are the advantages of using ACE/ARBS in HF

A

decrease mortality prevent progression of HF (dec remodeling) cause vasodilation (dec afterload) decrease aldosterone production (dec na/h2o retention and preload) decrease sympathetic outflow

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25
Q

what are the disadvantages of ACE/ARbs in HF

A

caution in SCR > 3.0, K>5 hyperkalemia risk of angioedema cough with ACEis

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26
Q

when should you monitor blood chemistry after changing dose of ACE

A

1-2 weeks after dose change

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27
Q

what are the advantages of using BB in HF?

A

increase beta receptor density inhibit cardiotoxic effects of catecholamines decreased HR anti ischemia (helps with angina)

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28
Q

what should you monitor with pts on BBs?

A

HR BP weight 1-2 weeks after out patient use

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29
Q

what are disavantages of BBs

A

can cause heart block with other agents should avoid in asthmatic pateitns should not stop abruptly takes 3-6months for sx improvements

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30
Q

how do you dose BBs in HF?

A

start low dose then double q 2 weeks until you reach target

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31
Q

what are the symptoms of hypo perfusion

A

decreased mentation decreased urine output hepatic congestions systemic hypotension

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32
Q

what are non pharmacological treatments for CHF (SELF)

A

avoid excess salt daily weight monitoring ( if > 2kg inc in 3 days contact provider) no smoking or drinking alcohol 20min x 3 day/week flu shot and pneumococcal vaccine

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33
Q

Non pharm tx for CHF ( clinician)

A

dialysis and ultrafiltration pacemakers, implantable defibrillator (ICD) ventricular arrhythmias cardiac transplant

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34
Q

what is the target level to achieve for digoxin tx in CHF?

A

0.6-0.8ng/ml

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35
Q

when should you avoid aldosterone antagonists? what should you monitor?

A

scr >2.5 or K > 5.0 monitor electrolytes every 4 weeks

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36
Q

which vessels do nitrates target?

A

veins

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37
Q

which vessels does hydralazine target?

A

arteries

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38
Q

which agents have mixed dilation of veins and arteries

A

ACE/ARB nitroprusside potassium channel activators

39
Q

milrenone dosing for ADHF

A

0.375 micrograms/kg/min infusion adjust dose renally

40
Q

dobutamine dosing for ADHF

A

2.5 micrograms/in infusion

41
Q

nesiritide dosing for ADHF and brand

A

2 mcg/kg iv push, then 0.01 mcg/kg/min infusion Natrecor

42
Q

nitroglycerin dosing for ADHF

A

5-10mcg/min infusion

43
Q

dosing for CHF po bumetanide and brand

A

0.5 to 1.0 mg po qd or bid (oral) 1mg IV load then 0.5-2mg infusion max 10mg/day bumex

44
Q

dosing for CHF po furosemide and brand

A

20-40mg po qd or bid (oral) 40mg IV load then 10-40mg/hour infusion max 200mg/day Lasix

45
Q

dosing for CHF po Torsemide and brand

A

5-20mg qd max 200mg/day (oral) 20mg IV load then 5-20mg/hour infusion demadex

46
Q

dosing for CHF po chlorthalidone

A

12.5-25mg qd , max 100/day

47
Q

dosing for CHF po HCTZ

A

25mg po qd or bid, max 200/day

48
Q

dosing for CHF po indapamide

A

2.5mg qd max 5mg qd

49
Q

dosing for CHF po metolazone

A

2.5mg po qd max 20/day

50
Q

dosing for CHF po spironolactone and brand

A

25-50 mg po qd , max 50mg/day aldactone

51
Q

dosing for CHF po triamterene

A

50-75mg bid, max 200mg/day

52
Q

what are the three dosings for sequention nephron blockade

A

metolazone 2.5-10mg qd +loop HCTZ 25-100mg qd or bid + loop Chlorothiazide IV 500-1000mg qd +loop

53
Q

dosing for CHF po captopril and brand

A

6.25mg tid capoten

54
Q

dosing for CHF po enalapril

A

2.5mg bid, max 20 bid

55
Q

dosing for CHF po lisinopril

A

2.5-5mg qd, max 40 qd prinvil, eztril

56
Q

dosing for CHF po ramipril

A

1.25-2.5 qd , max 10 qd altace

57
Q

dosing for CHF po candesartan

A

4-7mg once, max 32 qd atacand

58
Q

dosing for CHF po losartan

A

25-50mg qd, max 100 qd cozaar

59
Q

dosing for CHF po valsartan

A

20-40mg bid, max 160mg bid diovan

60
Q

dosing for CHF po eplerenone

A

25mg qd, max 50mg qd

61
Q

dosing for CHF po carvedilol

A

3.125 mg bid, max 25bid unless > 85kg it is 50 bid, with food

62
Q

dosing for CHF po metoprolol succinate

A

12.5-25mg po qd max 200mg qd toprolol xl and lopressor xl

63
Q

dosing for CHF po bisoprolol

A

1.25mg qd , max 10mg qd

64
Q

what can cause heart failure?

A

Hypertension: pumping against high blood pressure hypothyoridism and diabetes: inc workload of heart CAD: reducede blood flow to heart muscle MI: section of heart damaged due to lack of O2

65
Q

why is metoprolol XL used in HF?

A

because it is beta 1 selective

66
Q

why is carvedilol used in HF

A

alpha and B1/B2 activity

67
Q

when are spironolactone and eplerenone indicated for HF?

A

in class III or class IV patients with sxs

68
Q

What is the MOA of digoxin in HF?

A

increases contractility but decreases heart rate

69
Q

define the NYHA class for HF

A

Class I asymptomatic and no limits with physical activity, but sx wit strenuous exercise class II Sx of HF with normal activity or moderate exercise Class III sx with minimal exertion & marked limitations with daily activities (bathing dressing) Class IV sx at rest, hospitalized or IV inotropic support

70
Q

what are the dose equivalencies between furosemide, bumetanide, torsemide

A

Furosemide 40 bumetanide 1 torsemide 20

71
Q

dose of ethacrynic acid in HF and brand

A

25,50 tabs, 50mg injection edecrin

72
Q

Loop diuretics side effects

A

hypokalemia orthostatic hypotension hyperuricemia hyperglycemia elevated lipids photosensitivity and rash dec NA, Mg, Cl, Ca ototoxicity especially with ethacrynic acid

73
Q

why are spironolactone and eplernone used in CHF?

A

not to deplete volume improve sx, increase survival

74
Q

eplerenone dose in CHF and brand

A

chf post MI 25-50mg/day Inspra

75
Q

what should u monitor for spioronolactone and eplerenone

A

potassium and crcl (due to inc risk of hyperkalemia donstarte if k > 5

76
Q

which ACE’s or ARBs have higher risk of angioedema?

A

ACEs> ARbs. IF ever present, both classes contraindicated

77
Q

what are the sx of angioedema

A

swelling of lips, mouth, tongue, face or neck can be quickly fatal

78
Q

ACE/ARB counseling points

A

report any facial swelling D/c if planning to get pregnant potassium level should be checked ace can cause cough, report

79
Q

irbesartan

A

avapro 150-300mg/day

80
Q

olmesartan

A

benicar 20-40 once daily

81
Q

telmisartan

A

micardis 40-80mg/day

82
Q

Benazepril

A

lotensin 10-40mg/day

83
Q

enalalprilat

A

vasotec 5-40mg/day

84
Q

fosinopril

A

monopril 20-80mg/day

85
Q

lisinopril

A

prinvil, zestril 10-40mg/day

86
Q

quinapril

A

accupril 40-80mg/day

87
Q

beta blocker side effects

A

dizziness, decrease HR, fatigue caution with diabetics: covers sx of hypoglycemia

88
Q

toxicity of digoxin

A

Early : vomiting, loss of appetite, dec HR Severe: visual disturbances,

89
Q

General patient education for patient with CHF

A

monitor weight daily in the morning before eating, document Restrict sodium in diet avoid smoking , alcohol, illicit drugs do not use NSAIDS or Cox inhibitors

90
Q

Coreg education

A

-take coreg with food -swallow Coreg CR whole, not to chew or crushed. Can put beads in cold applesauce and eat right away -can make you feel dizzy and tired -can cover hypoglycemic events

91
Q

counseling for digoxin

A

-makes your heart beat stronger and have a more regular rhythm -keep hydrated -many medications can interact, make sure your doctor knows which medications you are taking

92
Q

what are the side effects of nesiritide?

A

hypotension, increased scr HA, abdominal pain, insomnia do not use if SBP < 90

93
Q

what is the MOA of nesiritide

A

relaxes smooth muscle leading to deccreased systemic arterial pressure, increased diuresis, inc CO

Therapeutics (23 decks)

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