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Pharmacology quiz 2 > Heart failure > Flashcards

Heart failure Flashcards

1
Q

How is diastolic HF treated?

A

diuretics, vasodilators, inotropic drugs, BB, hydralazine/nitrates

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2
Q

What care the common signs of HF?

A

systolic: cough, diastolic: jugular distention

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3
Q

Which stages of HF are at risk for HF?

A

A and B

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4
Q

Which stages of HF are in HF?

A

C and D

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5
Q

If in systolic HF, what is the first choice of drug therapy?

A

diuretic + ACEi, add BB if needed

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6
Q

If in systolic HF and ACEi + diuretic + BB isnt working, what should you add?

A

aldosterone antagonist or switch to ARB

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7
Q

If in systolic HF and diuretic + ACEi + BB + aldosterone antagonist arent working how should you treat?

A

digoxin, LVAD, transplant

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8
Q

define stage A HF

A

at risk for developing HF without structural heart disease or sxs

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9
Q

What are pts like with stage A HF?

A

HTN, atherosclerosis, diabetes, obesity, metabolic syndrome OR using cardiotoxins, FH

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10
Q

Define stage B HF

A

structural heart disease without sxs of heart failure

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11
Q

What are pts like with stage B HF?

A

previous MI, LV hypertrophy and low LVEF, asymptomatic valvular disease

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12
Q

Define stage C HF

A

structural heart disease with prior or current sxs of HF

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13
Q

What are patients like with stage C HF?

A

SOB, fatigue, reduced exercise tolerance

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14
Q

Define stage D HF

A

refractory HF requiring specialized interventions

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15
Q

What are pts like with stage D HF?

A

sxs at rest on maximum therapy, recurrent hospitalizations, require transplant

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16
Q

What is the proper order for staging HF?

A

A, B, C, I, II, III, IV, D

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17
Q

Describe stages I-IV of HF

A

I does well, II some DOE, III more DOE, IV SOB all the time

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18
Q

How is stage A HF treated?

A

Lifestyle mods (smoking cessation, no alcohol, exercise, fix lipids), Drugs: ACEi (diuretics only if obvious case of fluid problem)

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19
Q

How is stage B HF treated?

A

Lifestyle mods, ACEi + BB in appropriate pts, diuretics only if obvious fluid problem

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20
Q

How is stage C HF treated?

A

ACEi + BB + diuretic if needed, salt reduction, if refractory then digoxin or hydralazine/nitrates, aldosterone antagonists - biventricular pacing or defibrillators

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21
Q

How is stage D HF treated?

A

everything from A, B and C, end-of-life care, hospice, transplant, chronic ionotropes, permanent mechanical support

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22
Q

What are cautions when prescribing diuretics in HF?

A

doesn’t stop disease progression, don’t use alone, can overcorrect, can become resistant, thiazides don’t work

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23
Q

How is furosemide prescribed if pts are refractory?

A

continuous infusion, IV for pts in hospital (don’t forget to 1/2 the dose)

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24
Q

What type of HF benefits most from ACEi?

A

severe HF - may improve sxs in days or weeks

25
Q

What is the dose for captopril and enalapril in HF?

A

Captopril: 50mg tid, Enalapril: 10-20mg bid

26
Q

what are the benefits of using BB in HF?

A

decreases post-MI mortality, reverse cardiac remodeling

27
Q

What are the only 3 BB that can treat HF?

A

metoprolol, bisprolol, carvedilol

28
Q

What shold LVEF be above

A

40

29
Q

What labs should be checked on pts taking aldosterone antagonists?

A

electrolytes and creatinine within 1 week of start then monthly/bimonthly until K levels are stable

30
Q

In what race do vasodilators work well in?

A

african americans

31
Q

who should take vasodilators in HF?

A

low CO, volume overload, renal impairment (can’t take ACEi or ARB)

32
Q

What is BiDil?

A

hydralazine/isosorbide dinitrate, both these drugs don’t work when administered together (seperately)

33
Q

how do cardiac glycosides work?

A

act on ATPase to increase ATP

34
Q

What is the effect of cardiac glycosides?

A

increased force of contraction and decreased rate of contraction

35
Q

What is the halflife of cardiac glycosides?

A

36 hours, take approximately 2 weeks for steady state to estbalish

36
Q

why is it easy to d/c cardiac glycosides?

A

levels deplete over a long period of time

37
Q

true or false: serum levels do not correlate with clinical efficacy for cardiac glycosides

A

TRUE

38
Q

true or false: cardiac glycosides have a narrow therapeutic index

A

TRUE

39
Q

How can you CYA with cardiac glycosides?

A

get serum digitalis levels, above 1 can show signs of toxicity - don’t stop, just leave it

40
Q

who make good candidates for digoxin?

A

LVEF <40%, NYHA class II, III, and IV sxs despite optimal therapy

41
Q

what is an ADR for digoxin?

A

bradycardia (tachycardia if toxic, HR>120)

42
Q

what drugs increase digoxin levels?

A

antacids, Reglan, st. john’s wort

43
Q

what drugs decrease digoxin levels?

A

amiodarone, xanax, verapamil, spironolactone

44
Q

How do you decrease the lowest digoxin dose and who should do this?

A

take it pod, those >70y/o and who have bad kidneys

45
Q

what is the MOA of dobutamine?

A

stimulate beta1 receptors of the heart

46
Q

What are the effects of dobutamine?

A

chronotropic, hypertensive, arrhythmogenic, vasodilative effects

47
Q

ADR for dobutamine?

A

tachycardia, HTN, ventricular activity, HOTN, PVC

48
Q

How do BB interact with dobutamine?

A

BB antagonize effects of dobutamine resulting in unapposed increased vascular resistance

49
Q

Who should receive dobutamine?

A

those waiting for transplant - doesn’t prolong life

50
Q

What are the inotropes you need to know?

A

dobutamine and milrinone

51
Q

effects of milrinone

A

positive ionotropic and vasodilatory effect

52
Q

what is BNP

A

b-type natriuretic peptide

53
Q

MOA of BNP?

A

increases cGMP resulting in SM relaxation and vasodilation

54
Q

what is the effect of BNP?

A

reduced pulmonary capillary wedge pressure and systemic arterial pressure

55
Q

ADR of BNP?

A

HOTN

56
Q

Dosing of BNP?

A

bolus and then infusion up to 96 hours

57
Q

Class drug for BNP?

A

nesiritide

58
Q

Why is BNP not used?

A

expensive, doesn’t decrease mortality, causes renal problems

Pharmacology quiz 2 (6 decks)

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