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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 C & D]
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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
what are the ACEi that are used in Heart Failure?
- Enalapril [Vasotec] - Lisinopril [Zestril] - Quinapril [Accupril] - Ramipril [Altase]
26
What are the target doses for the ACEi in Heart Failure?
- Enalapril: 10-20mg PO BID - Lisinopril: 20-40mg Daily - Quinapril: 20mg BID - Ramipril: 10mg Daily
27
What are the ARBs that are used in Heart Failure?
- Losartan [Cozaar] - Valsartan [Diovan]
28
What are the target doses of ARBs in Heart Failure?
- Losartan: 50-150mg Daily - Valsartan: 160mg BID
29
What are the boxed warnings for ACEi or ARBs in Heart Failure?
- Injury or Death to fetus; DISCONTINUE ASAP
30
What are the contraindications for ACEi or ARBs in Heart Failure?
- DO NOT use with Hx of Angioedema - DO NOT use within 36h of entresto [ARBs you can]
31
What are some of the warnings for the ACEi or ARBs in Heart Failure?
- Angioedema [less with ARBs], Hyperkalemia, Renal Impairment, Hypotension
32
What are the side effects for ACEi and ARBs in Heart Failure?
- Cough [less with ARBs]
33
What are some of the drug interactions for ANRIs, ACEi, and ARBs?
- HYPERKALEMIA - DO NOT use more than one at the same time - 36h washout with ACE and ARNI - Could decrease lithium clearacne and increase toxicity
34
What is the MOA for the Beta Blockers In Heart Failure?
- Antagonize cateacholamines at Beta 1, 2 and Alpha 2 = Decrease in vasoconstriction - Decreases Mortality and Morbidity
35
What are the Beta Blockers that are used in Heart Failure?
- Metoprolol Succ [Toprol XL] - Bisprolol - Carvediolol [Coreg, Cpreg XL] ## Footnote M & B are Beta 1 and C are Nonselective
36
What are the Target doses for the Beta Blockers in Heart Failure?
Metoprolol: 200mg daily Bisoprolol: 10mg daily Carvedilol: 25 - 50mg daily [depends on weight]
37
What is the boxed warnings for the Beta Blockers in Heart Failure?
- DO NOT stop taking abruptly; taper over 1-2 weeks
38
What are the warnings for the Beta Blockers in Heart Failure?
- Caution in Diabetes; masks hypoglycemia - Caution in Asthma/COPD; broncospams - Caution with Raynauds
39
What are some of the side effects for the Beta Blockers in Heart Failure?
- Bradycardia, hypotension, fatigue, dizziness, depression, impotence
40
What are the drug interactions for the Beta Blockers in Heart Failure?
- Mask Hypoglycemic Events - Caution with other drugs that decrease HR [Digoxin, Verapimil, Diltiazem, Amiodraone]
41
What is the MOA for the Aldosterone Receptor Antagonists in Heart Failure?
- Compete with Aldosterone Receptors in the Distal/Collecting Duct; decreasing Na, H20, Cardaic Remodeling ## Footnote 1st Line
42
What are the Aldosterone Receptor Antagonist that are used in Heart Failure?
- Spironolactone [Aldactone] - Eplerenone [Inspra]
43
What is the Target dose for Spironolactone in Heart Faliure?
- 25 - 50mg daily
44
What are the Contraindications for the Aldosterone Receptor Antagonists in Heart Failure?
- DO NOT use with hyperkalemia, renal impairment, Addisons Disease
45
What are the warnings for the Aldosterone Receptor Antagonist in Heart Failure?
- DO NOT use when K > 5
46
What are the side effects for the Aldosterone Receptor Antagonist in Heart Failure?
- Hyperkalemia, Increase SCr, Dizziness - Spiro: Gynocomastia, Breast Tenderness, Impotence
47
What are some of the Drug interactions for the Aldosterone Receptor Antagonists in Heart Failure?
- Risk of Hyperkalemia - DO NOT use ACE + ARB/ARNI + ARA
48
What is the MOA for the SGLT-2 in Heart Failure?
- NOT SURE... but may decrease Na reabsorption, Diruesis, Pre-load/Afterlod
49
What are the SGLT-2 that are used in Heart Failure?
- Dapagliflozin [Farxiga] 10mg daily - Empagliflozine [Jardiance] 10mg daily
50
What is the MOA for the Loop Diuretics that are used in Heart Failure?
- 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
Whta are the Loop Diuretics that are used in Heart Failure?
- Furosemide [Lasix] - Bumetanide [Bumex] - Torsemide
52
What are the warnings for the Loop Diuretics in Heart Failure?
- Sulfa Allergy - Ototoxicity [more with ethacrynic acid] - Acute kidney injury [becuase of fluid loss]
53
What are some of the side effects for the Loop Diuretics in Heart Failure?
- Decreased K, Mg, Cl, Ca - Increased HCO3, UA, BG, TGs, TC - Orthostatic hypotension, photosensitivity
54
What are some of the important monitoring for Loop Diuretic in Heart Failure?
- Renal function, fluid status, BP, Electrolytes, S/Sx of HF
55
56
What is the Dosing Equivalents of the Loop Diuretics in Heart Failure?
- Furo 40mg = Tors 20mg = Bumeta 1mg = Etha Acid 50mg - Furosemide IV:PO = 1:2
57
What are some of the drug interactions with the loop diurectics in Heart Failure?
- Avoid NSAIDS - Could change Lithium levels = toxicity
58
What is the MOA for Hydralazine/Nirtate [BiDil] in Heart Failure?
- Hydralazine: arterial vasodilator = decrease afterload - Nitrates: increase NO = decrease preload
59
When should BiDil [Hydralazine/Nitrates] be used during Heart Failure?
- When ARNI, ACE, or ARB are not tolerated - In Black Patients
60
What are the Warnings to know about the Hydralazine component in Heart Failure?
- Drug Induced Lupus Erythematosus [DILE]
61
What are the side effects of the Hydralazine componenet in Heart Failure?
- Peripheral Edema, Headache, Flushing, Palpatiation, Reflex Tachycardia
62
What are the contraindictions of the Nitrate component in Heart Failure?
- DO NOT use with PDE-5 Inhibitor [Severe hypotension]
63
What are that side effects of the Nitrate component in Heart Failure?
- Hypotension, Headachem Dizziness, Tachyphylaxis
64
What is the MOA of Ivabradine in Heart Failure?
- "Hyperpolarization Activated Cyclic Nucleotide Gated Channel Blocker" - Block **I**f in the SA node = decreased HR
65
When shouild Ivabradine be used in Heart Failure?
- When patient is getting GDMT, and resting HR > 70 ## Footnote GDMT = Beta Blockers, ARNI/ACE/ARB, SGLT2, ARA [At max or target dose]
66
67
What are the Warnings for Ivabradine in Heart Failure?
- Can cause Bradycardia - Increased risk of AFib
68
What are the side effects of Ivabradine in Heart Failure?
- Bradycardia, Hypertension
69
What ist eh MOA of Digoxin in Heart Failure?
- 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
What is the important to know about the dosing for digoxin in Heart Failure?
- 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
What are some of the important things to monitor for Digoxin in Heart Failure?
- Eletrolytes, Renal function, Hr
72
What are some of the toxicites of Digoxin in Heart Failure?
- N/V, Loss of Appetite, Blurred/Double Vision, Greenish-Yellow Halos, Life Threatening Arrhythmias - Increase risk of Hypokalemia, Hypomagnesemia, Hypercalcmia
73
What is the antidote for Digoxin?
- Digifab
74
What are some of the drug interactions for Digoxin in Heart Failure>
- P-gp & 3A4 = Reduce dose by 50% when starting amiodarone & caution with drugs that decrease HR [BB, Clonidine, Non-DHP, Amiodarione]
75
What is the MOA of Vericiguat in Heart Failure?
- Solube guanylate cyclase stimulator that increases cyclic GMP = smooth mucsle relaxation and vasodilation
76
What are the contraindications for Vericiguat in Heart Failure?
- DO NOT use with Riociguat [same class]
77
What are the side effects for Vericiguat in Heart Failure?
- Hypotension - Anemia, Dyspepsia
78
What are the drug interctions for Vericiguat in Heart Failure?
- PDE-5 Inhibitor = Hypotension effects - Those taking Long acting nitrates [Hypotension]
79
Why is it important to maintain Potassium level, Especially in those that have Heart Failure?
- reduce Arrhythmia risks
80
When should Potassium be check and what else should be checked with it
- K should be checked after a change in ARNI, ACE, ARB, ARA - Also check Mg
81
What is the most commonly used supplement when potassium levels are wack in Heart Failure?
- Potassium Choride [Tablet or Capsule] - IV Potassium Chloride is a high alert med
82
What is the 10% oral solution of Potassium?
- 20mEq/15ml

Naplex 2025 (48 decks)

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