Heart Failure Flashcards
What are the recommendations regarding Na+ intake for patients in A/B heart failure vs. C/D heart failure stages?
A/B <1.5g per day
C/D <3g per day
What class of drugs is indicated in patients with current or prior symptoms of HF and reduced LVEF who have evidence of fluid retention?
Diuretics
What is the MOA for loop diuretics?
Blocks Na+-K+-Cl- cotransporter thus increasing their excretion
Why may it be necessary to switch from oral to IV loop diuretics, use alternative forms, or initiate combination therapy in patients with HF?
Diuretic resistance
What are three vasodilators used for HF?
Nitroglycerine
Nitroprusside
Nersirtide
All three vasodilators for HF decrease preload. Two of them also reduce afterload, which one doesn’t?
Nitroglycerine
All three vasodilators for HF are indicated for warm and wet ADHF. Which one(s) are an alternative to inotropes in cold and wet ADHF?
Nitroprusside and Nersirtide
Beside hypotension, what are the side effects of nitroprusside?
Cyanide or thiocyanate toxicity
What are the two inotropes for HF?
Dobutamine and milrinone
Dobutamine: MOA?
B 1 agonist
Dobutamine: indications?
ADHF: cold and wet or cold and exacerbation
Dobutamine: side effects?
Proarrhythmia, tachycardia, hypokalemia, myocardial ischemia, tachyphylaxis, increased mortality
Milrinone: MOA?
PDE inhibitor increases CO by decreasing preload and afterload
Milrinone: indications?
ADHF: cold and wet or cold and exacerbation
Milrinone: side effects?
Proarrhythmia, hypotension, tachycardia, thrombocytopenia, increased mortality with long term use
What class of drugs should be used in all patients with a reduced EF to prevent HF and is recommended for all patients with HFrEF?
ACE-I
What are ACE-I side effects?
Hypotension, cough, renal effects, angioedema, teratogenic, hyperkalemia, rash, taste disturbances
What should be used in patients with HFrEF who are ACE-I intolerant?
ARBs
Is it a good idea to routinely combine an ACE-I, ARB, and aldosterone antagonist?
No, it’s potentially harmful
What are the indications for aldosterone antagonists?
HF w/ LVEF <35%
Following acute MI w/ LVEF <40% w/symptoms of HF or DM
What are side effects of aldosterone antagonists?
Hyperkalemia (needs close monitoring)
Gynaecomastia
dizziness, worsening renal function
What are the two aldosterone antagonists?
Eplerenone
Spironolactone
What is the place of aldosterone antagonists in the order of therapies for HF?
Third-line
What are the indications for beta blockers in regard to HF?
MI, reduced EF
Which lecture notes are the worst?
These lecture notes (I’m doing my best here people)
What is the outcome of adrenergic activation in patients with chronic HF?
Lethal
Beta blockers shield the myocardium from the chronically toxic effects of what?
High norepinephrine levels (leading to improved beta stimulation and LV systolic function)
What are contraindications for beta blockers?
Cardiogenic shock, bradycardia, 2nd/3rd degree heart block w/o pacemaker, reactive airway disease, hypotension, asthma
Isosorbide dinitrate MOA?
Nitric oxide donor
Large and small artery dilator
Venous dilator
Hydralazine MOA?
Antioxidant (inhibits destruction of NO)
Arteriolar dilator
BiDil MOA?
Fixed dose I/H (I don’t know what any of this means)
NO enhancer
What are the side effects of hydralazine?
Hypotension, HA, tachycardia, lupus like syndrome
What is Digoxin likely MOA?
Neurohormonal inhibition
- decreased sympathetic outflow
- improved baroreceptor function and increased vagal tone
Why give digoxin to HF patients?
Improved symptoms, exercise tolerance, quality of life, and fewer hospitalizations, but there is no survival benefit
Digoxin side effects?
HA, dizziness, halos, change in colors, anorexia, N/V, diarrhea, constipation, bradycardia, PVCs, arrhythmias
What are the risk factors for digoxin toxicity?
Renal insufficiency
Hypokalemia/hyperkalemia
Drug interactions
Digoxin interactions?
Increased serum concentrations: Amiodarone, Erythromycin, Itraconazole, Omeprazole
Decreased serum concentration: altered absorption of antacids, colestipol, laxatives
Hawthorn indications?
CHF, angina, arrhythmias, hyperlipidemia, Buerger’s disease
Hawthorne side effects?
Hypotension, palpitations, progression of HF
St. John’s wort indications?
Depression, anxiety, sleep disorders, HIV
St. John’s wort side effects?
Arrhythmia and HTN
