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Fall 2014 - Pharm Cardio > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define Heart Failure

A

-clinical syndrome or condition caused by heart’s inability to generate enough cardia output to meet body’s metabolic demands

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2
Q

Pathophysiology (Signs and Sxs) of HF

A
  • intravascular and interstitial volume overload: SOB, rales, edema
  • manifestations of inadequate tissue perfusion (fatigue, poor exercise tolerance)
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3
Q

5 Year Mortality Rate HF

A

> 50%

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4
Q

Causes of HF

A
  • coronary artery disease
  • HTN
  • idiopathic dilated cardiomyopathy
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5
Q

Preload

A

amount of venous return to heart

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6
Q

Afterload

A

resistance against which the ventricle must pump

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7
Q

Contractility

A

force of contraction

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8
Q

What effect do positive inotrope medications have on contractility?

A

positive inotropes increase contractility

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9
Q

Sxs of Heart Failure

A
  • dyspnea, orthopnea, SOB, PND, exercise intolerance, tachypnea
  • cough
  • fatigue, weakness, lethargy
  • nocturia, polyuria
  • hemoptysis
  • abdominal pain, anorexia, nausea, bloating, ascites
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10
Q

Signs of Heart Failure

A
  • rales, S3 gallop
  • pleural effusion
  • tachycardia
  • cardiomegaly
  • peripheral edema
  • JVD
  • hepatojugular reflex, hepatomegaly
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11
Q

Lab Tests for HF

A
  • BNP > 100 pg/mL
  • EKG
  • SCr
  • CBC
  • CXR
  • echocardiogram
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12
Q

Stage A HF

A
  • pts at high risk of developing HF but w/o structural heart dz or sxs of HF
  • eg pts w/ HTN, DM, obesity, metabolic syndrome, atherosclerotic dz
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13
Q

Stage B HF

A
  • pts with structural heart dz but w/o signs or sxs of HF

- eg pts w/ previous MI, LVH, low EF

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14
Q

Stage C HF

A
  • pts with structural heart dz with current or prior sxs of HF
  • eg pts w/ known structural heart dz and SOB, fatigue, reduced exercise tolerance
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15
Q

Stage D HF

A
  • pts with refractory HF requiring specialized interventions

- eg pts with marked sxs at rest despite maximal medical therapy

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16
Q

NY Functional Class I

A

-pts w/ cardiac dz but w/o limitations of physical activity

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17
Q

NY Functional Class II

A

-pts with cardiac dz that results in slight limitations of physical activity (ordinary activity results in fatigue, palpitation, dyspnea and angina)

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18
Q

NY Functional Class III

A

-pts with cardiac dz that results in marked limitation of physical activity

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19
Q

NY Functional Class IV

A

-pts with cardiac dz that results in an inability to carry on physical activity without discomfort

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20
Q

Drugs that May Precipitate/Exacerbate HF

A
  • negative inotropic effect (anti-arrhythmics, BB, CCB, terbinafine)
  • cardiotoxic: doxorubicin, daunomycin, imatinib, ethanol, amphetamines
  • Na and water retention: NSAIDs, COX2 inhibitors, glucocorticoids, androgens, estrogens, salicylates (ASA)
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21
Q

Treatment Principles for HF

A
  • optimize preload
  • reduce afterload
  • increase contractility
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22
Q

ACE-I Effect on Ventricular Workload

A

-decrease preload and afterload

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23
Q

ACE-I Benefits for HF

A
  • reduce morbidity and mortality
  • reduce hospitalizations in HFrEF
  • slow dz progression: decrease or prevent ventricular remodeling
24
Q

ACE-I Recommended for which HF Pts?

A
  • all pts with reduced EF to prevent HF

- all pts with HFrEF unless CI (2/3 tri preg, angioedema, renal artery stenosis, hyperkalemia)

25
Q

Beta Blockers that Are Used in HF

A

-carvedilol, metoprolol, bisoprolol

26
Q

BBs Effect on Ventricular Workload

A

-decrease preload and afterload; decrease HR and antiarrhythmic

27
Q

Benefits of BBs in HF

A
  • reduce morbidity and mortality
  • reduce hospitalizations
  • cause “reverse modeling” of L ventricle; return heart to more normal size, shape, function
28
Q

BBs Recommended for which HF Pts?

A
  • all pts with reduced EF to prevent HF

- all STABLE pts with HF unless CI (eg asthma)

29
Q

How should pharm therapy be initiated with BB for HF?

A
  • start at low doses

- titrate slowly up to target dose and monitor closely

30
Q

Monitoring for BB for HF

A
  • BP
  • HR
  • fluid status
31
Q

Aldosterone Antagonists MOA

A

-decrease sodium retention

32
Q

Aldosterone Antagonists Effect on Ventricular Workload

A

decrease preload

33
Q

Aldosterone Antagonists Benefits in HF

A
  • reduce morbidity and mortality

- reduce hospitalizations

34
Q

Aldosterone Antagonists Recommended for which HF Pts?

A
  • patients with NYHA class II-IV who have LVEF < 35%

- pts after acute MI with LVEF <40% w/ sxs of HF or DM

35
Q

Aldosterone Antagonists Monitoring

A
  • BP
  • K+
  • renal function (baseline, 3 days, 1 week, qmonth x3 for spironolactone)
36
Q

Diuretics Effect on Ventricular Workload

A

-decrease preload

37
Q

Diuretics Benefit in HF

A

-relieve congestive sxs (systemic edema)

38
Q

Diuretics Recommended in which HF Pts?

Also say which diuretic for mild, mod, severe

A

-pts with HFrEF with fluid retention
+mild overload = thiazide
+moderate = loop
+severe = IV furosemide

39
Q

Diuretics Monitoring

A
  • BP

- serum K+

40
Q

ARBs MOA

A
  • block angiotensin II receptor, but do not affect bradykinin
  • effect is vasodilation and inhibition of ventricular remodeling
41
Q

ARBs Recommended for which HF Pts?

A
  • pts w/ HFrEF who are ACE-I intolerant
  • alternative to ACE-I as first line therapy in HFrEF
  • consider in persistently symptomatic pts with HFrEF on guideline directed med therapy
42
Q

Hydralazine/Isosorbide MOA

A
  • hydralazine: direct acting vasodilator = decrease SVR, increase SV and CO
  • nitrates: venodilation = decreased preload, may inhibit ventricular remodeling
43
Q

Hydralazine/Isosorbide Recommended for Which HF Pts?

A
  • African Americans with NYHA class III-IV HFrEF

- pts with HFrEF who cannot have ACE-I or ARBs

44
Q

Hydralazine/Isosorbide AEs

A
  • HA
  • palpitations
  • nasal congestion
45
Q

Digoxin MOA

A

-positive inotrope = increase contractility

46
Q

Digoxin Benefits in HF

A
  • antiarrhythmic for pts with afib

- alleviates sxs and improves clinical status in pts with HFrEF (decrease hospitalizations)

47
Q

When should dig be used in HF pts?

A

-add for pts who remain symptomatic despite optimized tx

48
Q

Signs of Digoxin Toxicity

A
  • anorexia
  • N/V/D
  • tiredness, weakness
  • decrease HR
  • yellow/green halo vision
  • confusion, HA
49
Q

Digoxin Drug Interactions

A
  • verapamil
  • captopril
  • diuretics
  • amiodarone, dronedarone
  • clarithromycin, erythromycin
50
Q

Managing Decompensated HF

A
  • hospitalize
  • IV loop diuretic for pts w/ sig fluid overload
  • IV dobutamine to increase renal blood flow and diuresis
  • if symptomatic HoTN is absent, IV NTG, nitroprusside or nesiritide may be considered
51
Q

B-type Natriuretic Peptide Indication

A

-IV tx of pts with acutely decompensated HF with dyspnea at rest or with minimal activity

52
Q

B-type Natriuretic Peptide MOA

A
  • smooth muscle relaxation
  • dilates veins and arteries
  • dose dependent decrease in wedge pressure and systemic arterial pressure
53
Q

B-type Natriuretic Peptide Half Life

A

18 minutes

54
Q

B-type Natriuretic Peptide Elimination

A
  • cell surface clearance receptors
  • proteolytic cleavage
  • renal filtration
  • clearance proportional to body weight
55
Q

B-type Natriuretic Peptide Monitoring

A

-monitor BP and decrease dose if HoTN develops

Fall 2014 - Pharm Cardio (9 decks)

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