Heart failure Flashcards
How is diastolic HF treated?
diuretics, vasodilators, inotropic drugs, BB, hydralazine/nitrates
What care the common signs of HF?
systolic: cough, diastolic: jugular distention
Which stages of HF are at risk for HF?
A and B
Which stages of HF are in HF?
C and D
If in systolic HF, what is the first choice of drug therapy?
diuretic + ACEi, add BB if needed
If in systolic HF and ACEi + diuretic + BB isnt working, what should you add?
aldosterone antagonist or switch to ARB
If in systolic HF and diuretic + ACEi + BB + aldosterone antagonist arent working how should you treat?
digoxin, LVAD, transplant
define stage A HF
at risk for developing HF without structural heart disease or sxs
What are pts like with stage A HF?
HTN, atherosclerosis, diabetes, obesity, metabolic syndrome OR using cardiotoxins, FH
Define stage B HF
structural heart disease without sxs of heart failure
What are pts like with stage B HF?
previous MI, LV hypertrophy and low LVEF, asymptomatic valvular disease
Define stage C HF
structural heart disease with prior or current sxs of HF
What are patients like with stage C HF?
SOB, fatigue, reduced exercise tolerance
Define stage D HF
refractory HF requiring specialized interventions
What are pts like with stage D HF?
sxs at rest on maximum therapy, recurrent hospitalizations, require transplant
What is the proper order for staging HF?
A, B, C, I, II, III, IV, D
Describe stages I-IV of HF
I does well, II some DOE, III more DOE, IV SOB all the time
How is stage A HF treated?
Lifestyle mods (smoking cessation, no alcohol, exercise, fix lipids), Drugs: ACEi (diuretics only if obvious case of fluid problem)
How is stage B HF treated?
Lifestyle mods, ACEi + BB in appropriate pts, diuretics only if obvious fluid problem
How is stage C HF treated?
ACEi + BB + diuretic if needed, salt reduction, if refractory then digoxin or hydralazine/nitrates, aldosterone antagonists - biventricular pacing or defibrillators
How is stage D HF treated?
everything from A, B and C, end-of-life care, hospice, transplant, chronic ionotropes, permanent mechanical support
What are cautions when prescribing diuretics in HF?
doesn’t stop disease progression, don’t use alone, can overcorrect, can become resistant, thiazides don’t work
How is furosemide prescribed if pts are refractory?
continuous infusion, IV for pts in hospital (don’t forget to 1/2 the dose)
What type of HF benefits most from ACEi?
severe HF - may improve sxs in days or weeks
What is the dose for captopril and enalapril in HF?
Captopril: 50mg tid, Enalapril: 10-20mg bid
what are the benefits of using BB in HF?
decreases post-MI mortality, reverse cardiac remodeling
What are the only 3 BB that can treat HF?
metoprolol, bisprolol, carvedilol
What shold LVEF be above
40
What labs should be checked on pts taking aldosterone antagonists?
electrolytes and creatinine within 1 week of start then monthly/bimonthly until K levels are stable
In what race do vasodilators work well in?
african americans
who should take vasodilators in HF?
low CO, volume overload, renal impairment (can’t take ACEi or ARB)
What is BiDil?
hydralazine/isosorbide dinitrate, both these drugs don’t work when administered together (seperately)
how do cardiac glycosides work?
act on ATPase to increase ATP
What is the effect of cardiac glycosides?
increased force of contraction and decreased rate of contraction
What is the halflife of cardiac glycosides?
36 hours, take approximately 2 weeks for steady state to estbalish
why is it easy to d/c cardiac glycosides?
levels deplete over a long period of time
true or false: serum levels do not correlate with clinical efficacy for cardiac glycosides
TRUE
true or false: cardiac glycosides have a narrow therapeutic index
TRUE
How can you CYA with cardiac glycosides?
get serum digitalis levels, above 1 can show signs of toxicity - don’t stop, just leave it
who make good candidates for digoxin?
LVEF <40%, NYHA class II, III, and IV sxs despite optimal therapy
what is an ADR for digoxin?
bradycardia (tachycardia if toxic, HR>120)
what drugs increase digoxin levels?
antacids, Reglan, st. john’s wort
what drugs decrease digoxin levels?
amiodarone, xanax, verapamil, spironolactone
How do you decrease the lowest digoxin dose and who should do this?
take it pod, those >70y/o and who have bad kidneys
what is the MOA of dobutamine?
stimulate beta1 receptors of the heart
What are the effects of dobutamine?
chronotropic, hypertensive, arrhythmogenic, vasodilative effects
ADR for dobutamine?
tachycardia, HTN, ventricular activity, HOTN, PVC
How do BB interact with dobutamine?
BB antagonize effects of dobutamine resulting in unapposed increased vascular resistance
Who should receive dobutamine?
those waiting for transplant - doesn’t prolong life
What are the inotropes you need to know?
dobutamine and milrinone
effects of milrinone
positive ionotropic and vasodilatory effect
what is BNP
b-type natriuretic peptide
MOA of BNP?
increases cGMP resulting in SM relaxation and vasodilation
what is the effect of BNP?
reduced pulmonary capillary wedge pressure and systemic arterial pressure
ADR of BNP?
HOTN
Dosing of BNP?
bolus and then infusion up to 96 hours
Class drug for BNP?
nesiritide
Why is BNP not used?
expensive, doesn’t decrease mortality, causes renal problems
