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Heart Failure Flashcards

1
Q

Inability of the heart to maintain adequate cardiac output (CO) to meet the body’s metabolic demands

A

Heart Failure

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2
Q

Most common causes of Heart Failure

A

HTN or CAD

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3
Q

Chronotropy refers to

A

HR

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4
Q

Inotropy refers to

A

strength of contraction

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5
Q

the distending force in diastole (resting force, myocardial compliance, fill vol)

A

Preload

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6
Q

Systemic vascular resistance and capacitance

A

Afterload

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7
Q

____ heart failure occurs when ventricles fill a lot (dilated) but are too weak to contract to pump out enough
results in low ejection frxn

A

Systolic Heart Failure aka Reserved Ejection Frxn (HFrEF)

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8
Q

_____ heart failure occurs when heart muscle is stiff and can’t relax normally. Ventricular hypertrophy results in less blood filling the ventricles but it’s pumped out pretty well
Results in normal ejection frxn

A

Diastolic Heart Failure aka Preserved Ejection Frxn (HFpEF)

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9
Q

Is Reduced Ejection Frxn (HFrEF) systolic or diastolic dysfunction?

A

HFrEF = systolic dysfunction

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10
Q

Is Preserved Ejection Frxn (HFpEF) systolic or diastolic dysfunction?

A

HFpEF = diastolic dysfunction

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11
Q

Ejection frxn </= 40% is what type of heart failure?

A

Reduced Ejection Frxn (HFrEF)

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12
Q

Ejection frx >/= 50% is what type of heart failure?

A

Preserved Ejection Fraction (HFpEF)

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13
Q

Ejection frxns 41-49% are the weird middle ground referred to as borderline ____

A

HFpEF

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14
Q

what is an “improved HFpEF” pt?

A

Someone that shows EF of Preserved but has had Reduced in the past. We treat these ppl as Reduced

EF>/= 50% who has had a prior EF of </= 40%

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15
Q

Alternative to Loop Diuretic for pt with Sulfa Allx

A

Ethacrynic acid

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16
Q

Diogixin Antidote

A

Digibind

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17
Q

Potential alternative in HFrEF if unable to tolerate ACE/ARB/ARNI

A

Hydralazine/Isosorbide

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18
Q

Use ____ adjunct to standard therapy in African Americans with HFrEF

A

Hydralazine/Isosorbide

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19
Q

Hydralazine/Isosorbide should not be used with _____ due to the isosorbide component

A

PDE-5 inhibitors

Meds for: Erectile dysfn, pulm HTN

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20
Q

Hydralazine/Isosorbide MOA

A

Hydralazine: selective arteriolar vasodilator with coronary artery vasodilator properties
- Decr BP & afterload

Isosorbide: nitrate which causes vasodilation of veins (predominate) and arteries via release of nitric oxide
- Decr prelaod

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21
Q

Only used as add-on therapy in HF and atrial fibrillation

A

Cardiac glycoside

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22
Q

Digoxin MOA

A

Inhibits Na+/K+ ATPase in the cardiac tissue. Also has parasympathomimetic activity and prolongs the refractory period of the SA node

(+) Inotrope
(-) Chronotrope
Decr sympathetic tone

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23
Q

Initial vs Secondary Pharm trmnts for HF

A
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24
Q

Which pharm HF trmnts need titrated?

A

BB, ACE/ARB, ARNI, Aldo antag

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25
Loop Diuretics MOA
Inhibits Na+, K+, Cl- co-transport in ascending limb of Loop of Henle - incr Na+ and H2O excretion - Decr preload/afterload
26
Loop Diuretics SE
- E- abnorm -> decr K+, Na+, Mg2+, Ca2+ - Dehydration - Nephrotoxicity (Elevated BUN/SCr) - Ototoxicity
27
Loop Diuretics BBW
risk of profound diuresis and electrolyte depletion
28
Beta-Blockers MOA
Beta-adrenergic blocker; inhib of B1 receptors slows conduction through AV node * (-) chronotrope & Inotrope * Supress renin activity (mild) * Lowers BP (mild if PO) * B2 blockade crossover may cause bronchoconstriction
29
furosemide, torsemide, bumetanide, ethacrynic acid
Loop diuretics
30
metoprolol succinate, carvedilol, bisoprolol
Beta Blockers "-lol"
31
Beta Blockers SE
Fatigue, bradycardia, hypoTN, depression, dyspnea, sexual dysfn
32
Beta Blockers Warnings
* Avoid in pts w/ 2nd or 3rd degree heart block * Caution in acute HF -> (-) inotrope may decr CO. Dose is usually cut in ½ for this * Caution in pts with hepatic insufficiency * May mask symp of hypoglycemia. May block endogenous effect of epi
33
Where are Beta Blockers Metab
liver
34
Which Beta Blocker is non-cardioselective and dosed twice daily
35
Why do Beta Blockers require taper down over 1-2wks
Avoid abrupt disruption -> rebound tachycardia -> MI or acute ischemia
36
Ivrabridine MOA
Reduces spon cardiac pacemaker activity at the sinus node To reduce risk of hosp in patients who: Have HF w/ EF <35% HR > 70 bpm on max titrated dose of Beta Blockers
37
Ivrabridine SE
Afib Bradycardia ## Footnote bc it literally inhibits funny current receptors on SA node & causes latent depolarization
38
Effects of Aldosterone
* Na+ & water retention * K+ Excretion * Volume incr * Vasoconstriction * LV dysfunction
39
What does Antiotensin II do to the heart during HF
* Promotes Na+ and water retention (incr preload) * Direct vasoconstrictor (incr afterload) * Cardiac remodeling
40
benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, quinapril, ramipril, trandolapril, perindopril
ACE Inhibitors "-pril"
41
ACE Inhib MOA
prevent the conversion of ANG I -> II by inhib ANG converting enzyme (ACE) - Prevents the negative effects of ANG II - Results in lower levels of ANG II
42
____ are preferred over ARBs as initial therapy in HFrEF trmnt
ACE Inhib
43
ACE Inhib SE
HyperK+ (inhibition of RAAS) HypoTN/orthostatic Dizziness Elev serum creatinine Cough (buildup of bradykinin) Severe: Angioedema
44
ACE Inhib BBW
injury/death to fetus; avoid in pregnancy
45
ACE Inhib considerations
- Do not use in pts with hx of angioedema - Should not be combo with an ARB or renin inhibitor. Increased risk of angioedema and hyperK+ - Caution in renal artery stenosis - Caution in renal impairment - Enalaprilat is an IV which may be considered in hypertensive crisis
46
losartan, olmesartan, valsartan, candesartan, irbesartan, telmisartan
Angiotensin Receptor Blockers (ARBs)
47
ARBs MOA
blocks ANG II from binding to ANG II type 1 (AT1) receptors - Prevents negative effects of ANG II - Blocks ANG II from its site of action
48
ARBs SE compared to ACE-I
Mostly similar Decreased incidence of cough and angioedema Increased incidence of hypotension ***Olmesartan: enteropathy -> severe, chronic diarrhea***
49
ARBs BBW
injury/death to fetus; avoid in pregnancy
50
Sacubitril/Valsartan
ARNI = ARB/Neprilysin Inhibitor
51
ARNI MOA
Sacubitril is a prodrug whose active metabolite inhibits neprilysin. Neprilysin breaks down BNP. BNP is released in response to cardiac distension. BNP causes vasodilation and inhibits renin secretion (inhibits RAAS). BNP decr BP. ARNI inhibits Neprilysin. BNP is safe to do its job and decr BP ## Footnote Vasodilation Decreased sympathetic tone (prevents cardiac remodeling) Decreased aldosterone levels Natriuresis/diuresis
52
When to use ARNI
For patients with HFrEF in place of ACE or ARB
53
ARNI should not be given within ___ hrs of ACE therapy
36
54
Aldosterone Antag MOA
* Aldosterone receptor comp inhibitor * Antagonizes effects of Aldosterone * Na+ & H2O excretion K+ saving decr BP
55
Dose limiting effect of Aldosteorne Antagonists
Hyperkalemia
56
When to use Aldosterone Antagonist
* Used as add-on therapy to ACE/ARB in HFrEF with EF <35% * Used in HFpEF with elevated BNP
57
Which HF med can cause incr male breast tissue (gynecomastia) due to imbalance of estrogen and testosterone
Aldosterone Antagonists (spironolactone, eplerenone)
58
For Aldosterone Antagonists, don't titrate up if K+ > ____
4.5 ## Footnote if K+ is >/= 5: decrease dose
59
SGLT2 Inhibitors MOA
Inhibits sodium-glucose cotransporter 2 (SGLT2) in proximal renal tubules
60
Dapagliflozin, empagliflozin
SGLT2 Inhibitors - Increased urinary excretion of glucose - Reduces sodium reabsorption - Downregulates sympathetic activity
61
Which HF meds were actually made for DM?
SGLT2 Inhibitors (Dapagliflozin, empagliflozin)
62
SGLT2 Inhibitors SE
- Common: UTI, genitourinary fungal infection, nausea, nasopharyngitis, weight loss - Severe: diabetic ketoacidosis, necrotizing fasciitis, hypovolemia, hypersensitivity reactions, bone fractures, acute kidney injury
63
SGLT2 Inhibitors Contraindications
Type I DM
64
When to use SGLT2 Inhibitors
Add-on to optimized “initial” pharmacologic therapy
65
# SGLT2 Inhibitors Caution with use in ____disease pts
Chronic Kidney Disease ## Footnote Dapagliflozin eGFR needs to be >30 mL/min Empagliflozin eGFR needs to be >20 mL/min
66
Typical HF med order
1. ACE/ARB 2. Beta Blocker 3. Loop Diuretic 4. Aldosterone Antagonist 5. SGLT2
67
What do ACE Inhibitors do to Bradykinin
it may incr Bradykinin -> vasodilate -> decr BP
68
Which HF med requires a 36hr washout prior to administering
ARNIs require a 36hr washout before adminstering after ACE therapy

Pharmacology (14 decks)

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