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Pharm I Fall 2016 NUNM Jensen > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What are the recommendations regarding Na+ intake for patients in A/B heart failure vs. C/D heart failure stages?

A

A/B <1.5g per day

C/D <3g per day

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2
Q

What class of drugs is indicated in patients with current or prior symptoms of HF and reduced LVEF who have evidence of fluid retention?

A

Diuretics

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3
Q

What is the MOA for loop diuretics?

A

Blocks Na+-K+-Cl- cotransporter thus increasing their excretion

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4
Q

Why may it be necessary to switch from oral to IV loop diuretics, use alternative forms, or initiate combination therapy in patients with HF?

A

Diuretic resistance

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5
Q

What are three vasodilators used for HF?

A

Nitroglycerine
Nitroprusside
Nersirtide

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6
Q

All three vasodilators for HF decrease preload. Two of them also reduce afterload, which one doesn’t?

A

Nitroglycerine

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7
Q

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?

A

Nitroprusside and Nersirtide

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8
Q

Beside hypotension, what are the side effects of nitroprusside?

A

Cyanide or thiocyanate toxicity

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9
Q

What are the two inotropes for HF?

A

Dobutamine and milrinone

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10
Q

Dobutamine: MOA?

A

B 1 agonist

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11
Q

Dobutamine: indications?

A

ADHF: cold and wet or cold and exacerbation

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12
Q

Dobutamine: side effects?

A

Proarrhythmia, tachycardia, hypokalemia, myocardial ischemia, tachyphylaxis, increased mortality

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13
Q

Milrinone: MOA?

A

PDE inhibitor increases CO by decreasing preload and afterload

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14
Q

Milrinone: indications?

A

ADHF: cold and wet or cold and exacerbation

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15
Q

Milrinone: side effects?

A

Proarrhythmia, hypotension, tachycardia, thrombocytopenia, increased mortality with long term use

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16
Q

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?

A

ACE-I

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17
Q

What are ACE-I side effects?

A

Hypotension, cough, renal effects, angioedema, teratogenic, hyperkalemia, rash, taste disturbances

18
Q

What should be used in patients with HFrEF who are ACE-I intolerant?

A

ARBs

19
Q

Is it a good idea to routinely combine an ACE-I, ARB, and aldosterone antagonist?

A

No, it’s potentially harmful

20
Q

What are the indications for aldosterone antagonists?

A

HF w/ LVEF <35%

Following acute MI w/ LVEF <40% w/symptoms of HF or DM

21
Q

What are side effects of aldosterone antagonists?

A

Hyperkalemia (needs close monitoring)
Gynaecomastia
dizziness, worsening renal function

22
Q

What are the two aldosterone antagonists?

A

Eplerenone

Spironolactone

23
Q

What is the place of aldosterone antagonists in the order of therapies for HF?

A

Third-line

24
Q

What are the indications for beta blockers in regard to HF?

A

MI, reduced EF

25
Q

Which lecture notes are the worst?

A

These lecture notes (I’m doing my best here people)

26
Q

What is the outcome of adrenergic activation in patients with chronic HF?

A

Lethal

27
Q

Beta blockers shield the myocardium from the chronically toxic effects of what?

A

High norepinephrine levels (leading to improved beta stimulation and LV systolic function)

28
Q

What are contraindications for beta blockers?

A

Cardiogenic shock, bradycardia, 2nd/3rd degree heart block w/o pacemaker, reactive airway disease, hypotension, asthma

29
Q

Isosorbide dinitrate MOA?

A

Nitric oxide donor
Large and small artery dilator
Venous dilator

30
Q

Hydralazine MOA?

A

Antioxidant (inhibits destruction of NO)

Arteriolar dilator

31
Q

BiDil MOA?

A

Fixed dose I/H (I don’t know what any of this means)

NO enhancer

32
Q

What are the side effects of hydralazine?

A

Hypotension, HA, tachycardia, lupus like syndrome

33
Q

What is Digoxin likely MOA?

A

Neurohormonal inhibition

  • decreased sympathetic outflow
  • improved baroreceptor function and increased vagal tone
34
Q

Why give digoxin to HF patients?

A

Improved symptoms, exercise tolerance, quality of life, and fewer hospitalizations, but there is no survival benefit

35
Q

Digoxin side effects?

A

HA, dizziness, halos, change in colors, anorexia, N/V, diarrhea, constipation, bradycardia, PVCs, arrhythmias

36
Q

What are the risk factors for digoxin toxicity?

A

Renal insufficiency
Hypokalemia/hyperkalemia
Drug interactions

37
Q

Digoxin interactions?

A

Increased serum concentrations: Amiodarone, Erythromycin, Itraconazole, Omeprazole
Decreased serum concentration: altered absorption of antacids, colestipol, laxatives

38
Q

Hawthorn indications?

A

CHF, angina, arrhythmias, hyperlipidemia, Buerger’s disease

39
Q

Hawthorne side effects?

A

Hypotension, palpitations, progression of HF

40
Q

St. John’s wort indications?

A

Depression, anxiety, sleep disorders, HIV

41
Q

St. John’s wort side effects?

A

Arrhythmia and HTN

Pharm I Fall 2016 NUNM Jensen (11 decks)

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