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Naplex 2025 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What does it mean when someone has heart failure?

A
  • Heart is not able to supply oxygen rich blood to the body, due to left ventricle not filling or ejecting
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2
Q

What are the 2 classifications of Heart Failure?

A
  • Ischemic [MI] or Non-Ischemic [Uncontrolled HTN]
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3
Q

What are some of the more common symptoms of Heart Failure?

A
  • Fluid Overload [SOB or Edema]

why we give diuretics

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4
Q

What is one thing that we can do to help with the diagnosis of Heart Failure?

A
  • Echocardiography [Echo] –> helps show the LVEF
  • EF < 40 = HFrEF
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5
Q

What are the Stages of the ACC/AHA for HF?

A
  • A: Risk of HF w/o symptoms [HTN, ASCVD, Diabetes]
  • B: Structural Heart Disease w/o symptoms
  • C: Structural Heart Disease w/ symptoms [SOB, Fatigue, reduced exercise ability]
  • D: Advanced Heart Disease [severe symptoms or recurrent hospitalizations]
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6
Q

What are the stages of NYHF in HF and where do they link up with the ACC/AHA stages>

A
  • Class I: NO Limitations [Stage A & B]
  • Class II: Slight Limitations, ordinary physical activity [Stage B]
  • Class III: Marked Limitations, minimal exertion [Stage B]
  • Class IV: Unable to do anything without HF symptoms or Symptoms at rest [Class B & C]
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7
Q

What is cardiac output

A
  • Volume of blood that is pumped by the heart in one minute
  • CO = HR x SV
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8
Q

What is the compensatory mechanism for HFrEF?

A
  • HFrEF is low cardiac output by activating neurohormonal pathway to increase blood volume or contraction force
  • Increase CO = Cardiac Remodeling
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9
Q

What are the main pathways that lead to the Compensatory mechanisms in HFrEF?

A
  • Activates RAAS, SNS, and Vasopression
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10
Q

What is important to know about RAAS and Vasopression Activation with HF?

A
  • Ang II causes Vasoconstriction [releases aldosterone from adrenal & Vasopressin from pituitary]
  • Aldosterone = Na and H20 retention
  • Vasopression = Vasoconstriction & H20 Retention
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11
Q

What is important to know about SNS activation with HF?

A
  • Norepi increases HR, Contractility, Vasoconstriction
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12
Q

What is some important Lifestyle Management for HF?

A
  • Monitor and Document body wieght
  • Notify if weight increase by 2-4 lbs
  • AVOID excessive sodium [< 1500]
  • Restrict fluid on Stage D
  • Stops smoking… Limit Alcohol
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13
Q

What are some natural products that could be used in HF?

A
  • Omega 3: Decrease mortality
  • Hawthorn & Coenzyme Q10: Improve HF symtpoms
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14
Q

What are some drugs that can worsen HF by causing Fluid Retention, Edema, Increase BP or Negative Inotropic Effects?

A
  • DDP-4: Alogliptin, Saxagliptin
  • Immunosuppressants: TNF inhibitors, interferons
  • Non-DHP CCBs: Diltiazem, Verapamil
  • Antiarrhythmics: Class I, Dronedarone, Amiodarone, Dofetilide
  • Thiazolidinediones
  • Itraxonazole
  • Oncology Drugs
  • NSAIDS

Drug Information NATION

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15
Q

What are the 4 drugs classes for HFrEF that decrease morbidity and mortality?

A
  • RAAS Inhibitor [ARNI, ACEi, ARB]
  • Beta Blocker
  • Aldosterone Receptor Antagonist
  • SGLT-2 Inhibtors

These should all be titrated to target doses

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16
Q

What are some of the additional treatment options that can be used as add-on therapy in HF?

A
  • Loop Diuretics
  • Hydralazine & Nitrate [BiDil]
  • Ivabradine
  • Digoxin
  • Vericigant
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17
Q

What are the RAAS inhibitors that are used in HF and what is important to know about then?

A
  • ARNI, ACE, ARB
  • Decrease Cardiac Remodeling = Decrease Morbidity and Moralaity
  • Titrate to target doses
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18
Q

What is the MOA for ARNIs?

A
  • ARB: Blocks Ang II from binding = decrease in vasopression and aldosterone
  • Neprilysin: Stops degradation of vasodilaitory peptides
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19
Q

What is the ARNI that is used and what is the target dose for it?

A
  • Sacubitril/Valsartan [Entresto]
  • Target Dose = 97/103mg BID
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20
Q

What are the boxed warning for Entresto?

A
  • Injury or death to fetus; stop ASAP if pregnant
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21
Q

What are the contraindications for Entresto?

A
  • DO NOT use with or within 36h of ACEi
  • DO NOT use if Hx of Angioedema
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22
Q

What are teh warnings for Entresto?

A
  • Angioedema, Hyperkalemia, Renel Impairment, Hypotension
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23
Q

What is the main side effect for Entresto?

A
  • Dry cough
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24
Q

What are some things that we should monitor with Entresto?

A
  • BP, K, Renal Function, S/Sx of HF
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25
Q

what are the ACEi that are used in Heart Failure?

A
  • Enalapril [Vasotec]
  • Lisinopril [Zestril]
  • Quinapril [Accupril]
  • Ramipril [Altase]
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26
Q

What are the target doses for the ACEi in Heart Failure?

A
  • Enalapril: 10-20mg PO BID
  • Lisinopril: 20-40mg Daily
  • Quinapril: 20mg BID
  • Ramipril: 10mg Daily
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27
Q

What are the ARBs that are used in Heart Failure?

A
  • Losartan [Cozaar]
  • Valsartan [Diovan]
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28
Q

What are the target doses of ARBs in Heart Failure?

A
  • Losartan: 50-150mg Daily
  • Valsartan: 160mg BID
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29
Q

What are the boxed warnings for ACEi or ARBs in Heart Failure?

A
  • Injury or Death to fetus; DISCONTINUE ASAP
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30
Q

What are the contraindications for ACEi or ARBs in Heart Failure?

A
  • DO NOT use with Hx of Angioedema
  • DO NOT use within 36h of entresto [ARBs you can]
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31
Q

What are some of the warnings for the ACEi or ARBs in Heart Failure?

A
  • Angioedema [less with ARBs], Hyperkalemia, Renal Impairment, Hypotension
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32
Q

What are the side effects for ACEi and ARBs in Heart Failure?

A
  • Cough [less with ARBs]
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33
Q

What are some of the drug interactions for ANRIs, ACEi, and ARBs?

A
  • HYPERKALEMIA
  • DO NOT use more than one at the same time
  • 36h washout with ACE and ARNI
  • Could decrease lithium clearacne and increase toxicity
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34
Q

What is the MOA for the Beta Blockers In Heart Failure?

A
  • Antagonize cateacholamines at Beta 1, 2 and Alpha 2 = Decrease in vasoconstriction
  • Decreases Mortality and Morbidity
35
Q

What are the Beta Blockers that are used in Heart Failure?

A
  • Metoprolol Succ [Toprol XL]
  • Bisprolol
  • Carvediolol [Coreg, Cpreg XL]

M & B are Beta 1 and C are Nonselective

36
Q

What are the Target doses for the Beta Blockers in Heart Failure?

A

Metoprolol: 200mg daily
Bisoprolol: 10mg daily
Carvedilol: 25 - 50mg daily [depends on weight]

37
Q

What is the boxed warnings for the Beta Blockers in Heart Failure?

A
  • DO NOT stop taking abruptly; taper over 1-2 weeks
38
Q

What are the warnings for the Beta Blockers in Heart Failure?

A
  • Caution in Diabetes; masks hypoglycemia
  • Caution in Asthma/COPD; broncospams
  • Caution with Raynauds
39
Q

What are some of the side effects for the Beta Blockers in Heart Failure?

A
  • Bradycardia, hypotension, fatigue, dizziness, depression, impotence
40
Q

What are the drug interactions for the Beta Blockers in Heart Failure?

A
  • Mask Hypoglycemic Events
  • Caution with other drugs that decrease HR [Digoxin, Verapimil, Diltiazem, Amiodraone]
41
Q

What is the MOA for the Aldosterone Receptor Antagonists in Heart Failure?

A
  • Compete with Aldosterone Receptors in the Distal/Collecting Duct; decreasing Na, H20, Cardaic Remodeling

1st Line

42
Q

What are the Aldosterone Receptor Antagonist that are used in Heart Failure?

A
  • Spironolactone [Aldactone]
  • Eplerenone [Inspra]
43
Q

What is the Target dose for Spironolactone in Heart Faliure?

A
  • 25 - 50mg daily
44
Q

What are the Contraindications for the Aldosterone Receptor Antagonists in Heart Failure?

A
  • DO NOT use with hyperkalemia, renal impairment, Addisons Disease
45
Q

What are the warnings for the Aldosterone Receptor Antagonist in Heart Failure?

A
  • DO NOT use when K > 5
46
Q

What are the side effects for the Aldosterone Receptor Antagonist in Heart Failure?

A
  • Hyperkalemia, Increase SCr, Dizziness
  • Spiro: Gynocomastia, Breast Tenderness, Impotence
47
Q

What are some of the Drug interactions for the Aldosterone Receptor Antagonists in Heart Failure?

A
  • Risk of Hyperkalemia
  • DO NOT use ACE + ARB/ARNI + ARA
48
Q

What is the MOA for the SGLT-2 in Heart Failure?

A
  • NOT SURE… but may decrease Na reabsorption, Diruesis, Pre-load/Afterlod
49
Q

What are the SGLT-2 that are used in Heart Failure?

A
  • Dapagliflozin [Farxiga] 10mg daily
  • Empagliflozine [Jardiance] 10mg daily
50
Q

What is the MOA for the Loop Diuretics that are used in Heart Failure?

A
  • Block Na & Cl reabsorption in ascending loop of henle [increasing excreation of Na, K, Cl, Mg, Cl, H20] = decrease in fluid volume
  • DO NOT help with survival
51
Q

Whta are the Loop Diuretics that are used in Heart Failure?

A
  • Furosemide [Lasix]
  • Bumetanide [Bumex]
  • Torsemide
52
Q

What are the warnings for the Loop Diuretics in Heart Failure?

A
  • Sulfa Allergy
  • Ototoxicity [more with ethacrynic acid]
  • Acute kidney injury [becuase of fluid loss]
53
Q

What are some of the side effects for the Loop Diuretics in Heart Failure?

A
  • Decreased K, Mg, Cl, Ca
  • Increased HCO3, UA, BG, TGs, TC
  • Orthostatic hypotension, photosensitivity
54
Q

What are some of the important monitoring for Loop Diuretic in Heart Failure?

A
  • Renal function, fluid status, BP, Electrolytes, S/Sx of HF
55
Q
A
56
Q

What is the Dosing Equivalents of the Loop Diuretics in Heart Failure?

A
  • Furo 40mg = Tors 20mg = Bumeta 1mg = Etha Acid 50mg
  • Furosemide IV:PO = 1:2
57
Q

What are some of the drug interactions with the loop diurectics in Heart Failure?

A
  • Avoid NSAIDS
  • Could change Lithium levels = toxicity
58
Q

What is the MOA for Hydralazine/Nirtate [BiDil] in Heart Failure?

A
  • Hydralazine: arterial vasodilator = decrease afterload
  • Nitrates: increase NO = decrease preload
59
Q

When should BiDil [Hydralazine/Nitrates] be used during Heart Failure?

A
  • When ARNI, ACE, or ARB are not tolerated
  • In Black Patients
60
Q

What are the Warnings to know about the Hydralazine component in Heart Failure?

A
  • Drug Induced Lupus Erythematosus [DILE]
61
Q

What are the side effects of the Hydralazine componenet in Heart Failure?

A
  • Peripheral Edema, Headache, Flushing, Palpatiation, Reflex Tachycardia
62
Q

What are the contraindictions of the Nitrate component in Heart Failure?

A
  • DO NOT use with PDE-5 Inhibitor [Severe hypotension]
63
Q

What are that side effects of the Nitrate component in Heart Failure?

A
  • Hypotension, Headachem Dizziness, Tachyphylaxis
64
Q

What is the MOA of Ivabradine in Heart Failure?

A
  • “Hyperpolarization Activated Cyclic Nucleotide Gated Channel Blocker”
  • Block If in the SA node = decreased HR
65
Q

When shouild Ivabradine be used in Heart Failure?

A
  • When patient is getting GDMT, and resting HR > 70

GDMT = Beta Blockers, ARNI/ACE/ARB, SGLT2, ARA [At max or target dose]

66
Q
A
67
Q

What are the Warnings for Ivabradine in Heart Failure?

A
  • Can cause Bradycardia
  • Increased risk of AFib
68
Q

What are the side effects of Ivabradine in Heart Failure?

A
  • Bradycardia, Hypertension
69
Q

What ist eh MOA of Digoxin in Heart Failure?

A
  • Inhibits Na-K-ATPase Pump; causing positive inotropic effect [increase CO] and negative chronotropic effect [decrease HR]
  • DOES NOT help with survival but may help with hospitalization
70
Q

What is the important to know about the dosing for digoxin in Heart Failure?

A
  • Typical Dose: 0.125 - 0.25mg PO Daily
  • CrCl < 60 = decreased dose
  • PO -> IV = decreased dose by 20-25%
  • Therapeutci Range: 0.5-0.9
71
Q

What are some of the important things to monitor for Digoxin in Heart Failure?

A
  • Eletrolytes, Renal function, Hr
72
Q

What are some of the toxicites of Digoxin in Heart Failure?

A
  • N/V, Loss of Appetite, Blurred/Double Vision, Greenish-Yellow Halos, Life Threatening Arrhythmias
  • Increase risk of Hypokalemia, Hypomagnesemia, Hypercalcmia
73
Q

What is the antidote for Digoxin?

A
  • Digifab
74
Q

What are some of the drug interactions for Digoxin in Heart Failure>

A
  • P-gp & 3A4 = Reduce dose by 50% when starting amiodarone & caution with drugs that decrease HR [BB, Clonidine, Non-DHP, Amiodarione]
75
Q

What is the MOA of Vericiguat in Heart Failure?

A
  • Solube guanylate cyclase stimulator that increases cyclic GMP = smooth mucsle relaxation and vasodilation
76
Q

What are the contraindications for Vericiguat in Heart Failure?

A
  • DO NOT use with Riociguat [same class]
77
Q

What are the side effects for Vericiguat in Heart Failure?

A
  • Hypotension
  • Anemia, Dyspepsia
78
Q

What are the drug interctions for Vericiguat in Heart Failure?

A
  • PDE-5 Inhibitor = Hypotension effects
  • Those taking Long acting nitrates [Hypotension]
79
Q

Why is it important to maintain Potassium level, Especially in those that have Heart Failure?

A
  • reduce Arrhythmia risks
80
Q

When should Potassium be check and what else should be checked with it

A
  • K should be checked after a change in ARNI, ACE, ARB, ARA
  • Also check Mg
81
Q

What is the most commonly used supplement when potassium levels are wack in Heart Failure?

A
  • Potassium Choride [Tablet or Capsule]
  • IV Potassium Chloride is a high alert med
82
Q

What is the 10% oral solution of Potassium?

A
  • 20mEq/15ml
83
Q
A

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