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Pharmacology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Symptoms of L-sided HF

A

dyspnea, fatigue, edema, and specifically for L: PULMONARY CONGESTION

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2
Q

Most common causes of L-sided HF

A

general: MI, atherosclerotic heart ds, hypertensive changes, valve ds, dilated cardiomyopathy, congenital heart ds. Most common: MYOCARDIAL ISCHEMIA due to coronary artery ds, followed by HTN

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3
Q

Symptoms of R-sided HF

A

dyspnea, fatigue, edema, and specifically for R: PERIPHERAL EDEMA

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4
Q

Most common causes of R-sided HF

A

general: MI, atherosclerotic heart ds, hypertensive changes, valve ds, dilated cardiomyopathy, congenital heart ds. Most common: MYOCARDIAL ISCHEMIA due to coronary artery ds, followed by HTN

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5
Q

Compensatory effects of HF

A

3 major responses: Increase sympathetic activity, activate RAS (renin-angiotensin system), myocardial hypertrophy

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6
Q

Two Pathways of SNS stimulation during HF

A

Stimulation of B-adrenergic receptors; alpha 1-adrenergic stimulation

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7
Q

Effects of alpha 1-adrenergic stimulation in HF

A

produces vasoconstriction that enhances venous return, Increase cardiac preload and afterload.

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8
Q

Effects of B-adrenergic stimulation in HF

A

Stimulation of B-adrenergic receptors in heart Increase HR, Increase force of contraction

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9
Q

Adverse Effects of SNS Stimulation as a Compensatory Measure in HF

A

Increase work-load of heart (which causes further decline in cardiac function)

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10
Q

Mechanism of Renin-Angiotensin System Activation due to HF

A

Decrease in CO leads to Decrease renal blood flow that triggers release of renin to both: Increase formation of angiotensin II (vasoconstrictor that Increase peripheral resistance); and release aldosterone

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11
Q

Effects of Renin-Angiotensin System Activation in HF

A

Release of aldosterone promotes retention of Na & water thus Increase blood vol and amount of blood returned to heart

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12
Q

Adverse Effects of Renin-Angiotensin System Activation in HF

A

edema because of Increase venous pressure due to inability of heart to pump extra vol

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13
Q

Effects of Myocardial Hypertrophy in HF

A

Myocardial Hypertrophy: heart Increase size via: chambers dilate; initial stretching leads to more forceful, stronger contraction, but excessive elongation of fibers and thus weaker contractions (ultimately Decrease ejection ability - systolic failure); a

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14
Q

Compensated HF

A

compensatory mechanisms (myocardial hypertrophy, RAS activation, SNS stimulation0 are restoring ADEQUATE CARDIAC OUTPUT

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15
Q

Decompensated HF

A

mechanisms eventually Increase overall workload on heart and lead to furhter decline in cardiac functio; compensatory mechanisms FAIL TO MAINTAIN ADEQUATE CO

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16
Q

Drug classes used to treat HF

A

Inhibitors of renin-angiotensin-aldosterone system (RAAS); β-blockers; diuretics; inotropic agents; direct vasodilators; aldosterone antagonists

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17
Q

Types of RAAS Inhibitors

A

ACE inhibitors; Angiotensin-Receptor Blockers (ARBs)

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18
Q

Indications for ACEIs

A

MONOTHERAPY (pts with mild DOE and no apparent signs of vol overload); ASYMPTOMATIC PTS WITH EJECTION FRACTION <35% (left ventricular dysfunction); PTS WITH RECENT MI; all stages LEFT VENTRICULAR FAILURE with or w/o symptoms

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19
Q

Indications for ARBs

A

Angiotensis-Receptor Blockers (ARBs): HTN, SUBSTITUTES FOR ACEI (esp. when ACEI associated with cough &/or angioedema)

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20
Q

Indications for B-Blockers

A

Unless BB therapy contraindicated, BB should be used in management of HF

21
Q

Indications for Loop Diuretics

A

provide relief of volume overload symptoms (dyspnea and peripheral edema)

22
Q

Primary Inotropic Drug

A

Digoxin

23
Q

Indications for Direct Vasodilators

A

Add on therapy

24
Q

Aldosterone Antagonists

A

Spironolactone; eplerenone

25
Q

Indications for Aldosterone Antagonists

A

aldosterone antagonists: spironolactone: reserved for most severe HF cases; eplerenone: REDUCES MORTALITY in L VT SYSTOLIC DYSFUNCTION, HF AFTER ACUTE MI

26
Q

Which B-blockers are indicated for HF

A

CARVEDILOL (COREG) - non-selective B-blockade, also alpha -blockade. METOPROLOL (LOPRESSOR); Long-Acting variant (Toprol)- B1 selective (cardioselective), immediate or extended release

27
Q

When B-blockers are indicated for HF

A

used for structural heart ds, no symptoms in selected pts with ACEI; structural heart ds with previous or current symptoms in all pts with ACEI

28
Q

3 Stages of HF

A

Stage A: High Risk, No Symptoms Stage B: Structure HD, No Symptoms Stage C: Structure HD, previous or current symptoms

29
Q

Treatment Regimen for Stage A HF (Lowest Level)

A

Risk-factor reduction; patient education

30
Q

Treatment Regimen for Stage A (2nd tier) HF

A

Treat HTN, DM, dyslipidemia; ACEIs or ARBs in SOME patients

31
Q

Treatment Regimen for Stage B HF

A

ACEIs or ARBs in ALL patients; B-blocker in selected patients

32
Q

Treatment Regimen for Stage C HF

A

ACEIs and B-Blockers in ALL patients

33
Q

Treatment Regimen for Stage C HF (Highest Level)

A

ACEIs and B-Blockers in ALL patients; dietary Na+ restriction; diuretics & digoxin

34
Q

Use of digoxin

A
  1. increase cardiac contractility
  2. improve ejection fraction
  3. lower diastolic volume,
  4. improved circulation
35
Q

MoA of digoxin

A

promotes calcium entry into the cell and causees retention of calcium in the cell

36
Q

Indication for digoxin

A

in severe left ventricular systolic dysfunction - after initiation of a ACE inhibitor and diuretic

37
Q

Half-life of digoxin

A

36 hours (very long)

38
Q

Side effects of digoxin

A

GI effects: anorexia (due to N/V), N/V; CNS effects: headache, fatigue, confusion, blurred vision, alteration of color perception and halos

39
Q

Use of spironolactone

A

direct antagonist of aldosterone

40
Q

MoA of spironolactone

A

prevents salt retention, myocardial hypertrophy and hypokalemia due to elevated aldosterone levels and angiotensin II stimulation and reduced hepatic clearence

41
Q

Indication for for spironolactone

A

Reserved for the most severe heart failure cases

42
Q

Half-life of spironolactone (active metabolites)

A

14-22 hr

43
Q

Side effects of spironolactone

A

GI disturbances, lethargy and confusion, gynecomastia;progestational and antiandrogenic adverse effects due to its nonspecific binding to various steroid receptors

44
Q

Use of eplerone

A

competitive antagonist of aldosterone

45
Q

MoA of eplerone

A

lower incidence of endocrine related side effects because of reduced affinity for glucocorticoid, andogen and progesterone receptors

46
Q

Indications for eplerone

A

left ventricular systolic dysfunction and heart failure after acute myocardial infarction

47
Q

Half-life of eplerone

A

4-6 hr

48
Q

Side effects of eplerone

A

Reduced compared to spironolactone

49
Q

Treatment for overt HF

A

loop diuretics are initated first to provide relief of volume overload; then an ACE inhibitor or ARB is induced; third, beta blockers are started after the patient is stable on ACE and finally digoxin is added if needed (symptoms remain)

Pharmacology (12 decks)

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