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Board Review > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

the equation for cardiac output

A

CO = SV x HR

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2
Q

HF patients should limit sodium intake to ______ unless they also have HTN then they should limit it to _________.

A

2 grams/day
1.5 grams/day

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3
Q

how often should HF patients monitor their weight?

A

every morning before eating and after peeing

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4
Q

when should apatient be concerned when their weight increases?

A

if within 24 hours they gain 3 pounds or more than 5 pounds in 1 week. They need to see the doctor for decompensation

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5
Q

What pain medication should be avoided Heart failure?

A

NSAIDs due to risk of renal insufficiency and fluid retention, should asof avoid ephedrine because of increased morbidty and mortality

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6
Q

What 2 vaccines are recommended with CHF?

A

pneumococcal and annual influenza

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7
Q

What drugs can worsen heart failure?

A

Verapamil/diltiazem, class 1 anti-arrhythmic, NSAIDs, Triptan migraine drugs, thiazolinediones, excessive alcohol

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8
Q

what ejection franction defines systolic heart failure (ventricles failiing)?

A

systolic = < 40%, diastolic > 40%

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9
Q

What are the 2 mainstays of therapy for HF if not contraindicated?

A

ACE + BB

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10
Q

what other classes are added to therapy to the mainstay therapy in HF when needed?

A

ARBS
aldosertone antagonists
Hydralazine + a nitrate , sometimes digoxin

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11
Q

Pts with congestive heart failue will also need what?

A

diuretic - probably loop

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12
Q

Some pts may receive both ACE and ARB. Whats the problem with this?

A

both can increase K

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13
Q

Pts on ACE or ARB should not be using Ms. _____?

A

Dash - salt substitutes - have more K

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14
Q

ARBs block the AT II receptors on the ___________________-

A

smooth muscle wall of the vessel

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15
Q

candesartan - brand, dosing

A

Atacand - target dose: 32 mg/day

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16
Q

DIovan dosing?

A

Target dose: 160 mg BID (Di=2 = BID)

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17
Q

Eplerenone is a selective aldosterone blocker therefore it __________________-

A

has less side effects than spironolactone

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18
Q

What are the contraindications for K sparing diuretics?

A

K+ > 5.0 meq/L
Scr > 2.5 mg/dL
CrCl < 30

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19
Q

what are the 3 most commonly used ACEs for HF? Starting dose and target dose?

A

Lisinopril 5mg po daily , target: 20 daily
Ramipril 2.5mg daily , t: 10 mg dailiy
Enalaprilat 5 mg t: 10 BID

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20
Q

when should you DC/ Ace’s arbs?

A

Pregnancy, angioedema, cough for ace, hyperkalemia

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21
Q

two most commo n RBs for HF, doses and target doses?

A

losartan 25mg daily to target 150mg daily
valsartan 40mg bid to 160mg bid

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22
Q

A triple combo of ACE + ARB + aldosterone antagonist is not recommended because of _____________

A

high risk of hyperkalemia

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23
Q

What BB should be avoided in heart failure?

A

ISA Beta Blockers - CAPP - carteolol, acebutolol, penbutolol, pindolol

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24
Q

bisoprolol - brand and HF dosing

A

Zebeta - target dose: 10 mg/d

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25
Q

counseling pearl for coreg

A

take with food, all forms

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26
Q

hydralazine is a direct ________ vasodilator which reduces ________.

A

arterial , afterload

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27
Q

Nitrates are ________ vasodilators which reduce ________.

A

venous, preload

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28
Q

Hydralazine and nitrates are used in what HF pt group?

A

those that cannot tolerate ACE / ARB therapy b/c of renal insuff., angioedema, or hyperkalemia

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29
Q

when should nitrates be used alone in tx for HF?

A

Never! hydralazine is used to improve efficacy and reduce nitrate tolerance

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30
Q

what are side effects of hydralazine?

A

lupus like syndrome - (report fever, joint/muscle ache, fatigue)
reflex tachycardia

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31
Q

what is the role of aldoserterone receptor antagonists in HF?

A

tx for class 3 or class 4 hf in addition to standard therapy

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32
Q

aldactone

A

spirionolactone

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33
Q

spironolactone dose and targed dose for HF

A

12.5 daily goal: 25 daily

34
Q

contraindiation to sprionolactone

A

Clcreatienin <30ml/in, hyperkalemia, cyp 34 INHIBITORS

35
Q

spironolactone side effects?

A

hyperkalemia, increase SCr, gynecomastia, tenderness, impotence, hirusutism

36
Q

BBW spironolactone

A

risk of tumors based on rat models

37
Q

inspra

A

eplerenone

38
Q

how can u reduce the riks of hyperkalemia with potassium sparing diuretics

A

dont start if potassium is > 5, patient has clcr <30, dont use with NSAIDs

39
Q

two most commone beta blockers used for hf with doses and target doses?

A

metoprolol succinate (XL) 12.5 daily t: 200 daily
carvedilol start IR 3.125 bid or cr 10mg daily
t: IR: 25 bid or 50 bid if > 85, ER: 80mg daily

40
Q

coreg conversion factor

A

ir 25mg bid = CR 80mg daily

41
Q

MOA hydralzaine

A

arterial vasodilator which decreases after load

42
Q

MOA of nitrates in HF?

A

venous vasodilators wihich decrease the preload

43
Q

what combination of therapy is indicated for AF Am patients w/ class II / IV hf

A

African Am who are symptomatic despite ACE and BB optimiation : the comb rec is BiDil

44
Q

Bidil

A

isosorbide dinitrate and hydralazine

45
Q

SE of bidily?

A

Lupus- lik sysndrome : report fever, joint-muscle aches, -Has, reflex tach, dizziness

46
Q

can you used just hydralazine by itself for therapy w/ hF?

A

no you must use it with nirtates because using hydralazine with nitrates reduces tolerance of nitrates

47
Q

what is a major contrainidation of isosorbide mononitrate?

A

PDE-5 inhibtoors

48
Q

imdur

A

isosoribide mononitrate

49
Q

monoket

A

isosorbide mononitrate

50
Q

what is the role of diuretics in HF?

A

used for symptomatic treatment of fludi overload. Try to avoid side effects, can incerase the dose, swith to IV or add metolzaone for better control

51
Q

Lasix

A

furosemide

52
Q

hydralazine - brand

A

Apresoline

53
Q

what are some side effects of isosorbide mononitrate?

A

HA, dizziness, tachyphylaxis (need 10-12 hour nitrate free interval)

54
Q

dose equivalencey of furosemide, bumetanide, torsemide

A

bumetinide 1mg
torsemide 20mg
furosmeide 40mg

55
Q

major side effects of loop diuretics

A

hypokalemia,
dec NA, CA, Cl, MG, Ca
orthostatic Hypo

56
Q

what main side effect is important to monitor at high doses of loop diuretics esp ethacryrnic acid?

A

cuases ototoxicity esp at high doses or rapid IV administration

57
Q

furosemid IV PO conversion

A

IV 1 PO 2x the dos e of IV

58
Q

in what setting can AMG + Loops be dangerous?

A

in patients w/ impaired renal function, increase risk of ototoxicty so avoid this combo. (unless it is a life threatening situation

59
Q

What is digoxins role in HF?

A

symptom improvement, increase exercise tolerance, increase QOL

60
Q

Digoxin acts as a ____________inotrope and ___________chronotrope.

A

inotrope (increase contractility and cardiac output) positve
chronotrope (decrease HR) negative

61
Q

what is the most commone digoxin dose? What thereapuetic range?

A

0.125 mg daily, 0.5 to 0.9 ng/mL

62
Q

decrease the dose of digoxin by _____% when going from oral to IV

A

20-25%

63
Q

what is the antidote for digoxin?

A

digibind or digiFab

64
Q

what are the signs of digoxin toxicity?

A

first - NV, loss of appetitie, bradycardia
others - blurred or “yellow” vision, abd pain, confusion, delirium,

65
Q

hypokalemia, hypercalcemia and digoxin, whats the scoop?

A

HYPOkalemia and HYPERcalcemia may increase risk of digoxin toxicity

66
Q

What is a good marker to help identify whether a person is having an acute exacerbation of HF?

A

BNP : B-type natriuretic peptide
and Pro-BNP

67
Q

For an acute exacerbation of HF, what agents to use?

A

if fluid overload: IV loop diuretics, can ad metolazone 30 min before loop
If congestive sx: can add IV vasodilators-nitroglycerin, nitorpursside or nesiritide. Make sure patient not hypotensive
If los bp or sx of low CO (low perfusion) : inotropig drugs dobutamine or milrione to be used

68
Q

nitroprusside acts where? Brand name? storage?

A

is an arterial and venous vasodilator = more pronounced effects on blood pressure
Nipride
protect from light

69
Q

nesiritide brand name

A

Natrecor

70
Q

what does a blue colored solution of nitroprusside indicate?

A

the drug has degraded to cyanide - do not use

71
Q

what can you do if you cannot take coreg po easily ?

A

sprinkle the capsule beads over applesauce and eat right away

72
Q

MOA of nitroglycerin?

A

venous dilator

73
Q

mOA of nesiritide?

A

it is BNP causese smooth muscle cell relaxation, dec arterial BP

74
Q

MOA of nitroprusside?

A

Venous and arterial vasodialtor : stronger effect of nBP

75
Q

Contraindiation of Nitroglycerin?

A

SBP < 90mmgHG,
PDE5 inhibitos,
Increased intracranial pressure

76
Q

what is advantage of nesiritide?

A

no developemnt of tolerance to increasing dose

77
Q

nitroglycerin side effects?

A

hyotension, HA, dizzy, tachycardia, tachyphylaxis

78
Q

ci for nitorpursside?

A

same as nitroglycerin

79
Q

CI for nesiritide?

A

SBP < 90 mm HG

80
Q

Nonpharm rec for HF?

A

[-monitor weight daily
-sodium restriction
-avoid alcohol, smoking, drugs
-avoid NSAIDS
-compliance is KEY

81
Q

why must coreg be taken with food?

A

delays absorption so less dizziness

82
Q

counseling for digoxin

A

makes heart beat stronger and more regularly
keep normal hydration cuz can affect levels
N, V, D, loss of appetiet, seeing halos, blurred vission, feeling like passing out: call doctor right away

Board Review (65 decks)

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