Heart failure Flashcards
some things to tell patients about NHPs
can interact with meds could have detremental effects on the body need to be looked at seriously tell HCP about your use include on medication lists educate on reliable sources of info
what are patients with heart failure at an increased risk of
polypharmacy
have multiple comorbid conditions and prescribers and pharmacies
delicate fluid electrolyte balance
elderly have renal/hepatic impairment
are NHP taken seriously
patients dont think theyre medicine
dont tel HCP
often left out of med histories
CV benefit with which PUFA
DHA EPA
found in fish oil, flax seed, canola oil, soybeans
PUFA adverse effects
fish burp halitosis heartburn dyspnea nausea loose stools rash
omega 3 MOA
lower triglyceride levels at higher doses prevent serious arrthymias decrease platelet aggregation lower blood pressure lower resting HR
american heart association recommends daily use of omega 3 in the form of DHA and EPA for what
secondary prevention of CV disease
updated to patients with HFrEF
what cant be garunteed for omega 3
not standardized so may not be reliable
get from a reliable source
what is coenzyme q
vit compound found in the body high concentrations in mitochondria of the heart liver and kidney
coenzyme q MOA
important role in production of ATP
patients with HF have reduced levels
inhibition of ATP production can cause cell death and tissue dmaage
replacing the coenzyme q might improve cellular energy production and prevent cell death in people with HF
sources of coenzyme q
some in meats and seafood
side effects of coenzyme q
just GI no toxicity
coenzyme q drug interactions
warfarin - decreased effect becuase structurally similar to vitamin k so warfarin binds to this instead
increase the antihypertensive effects of some BP lowering drugs
bottom line for vit D supplementation in HF
seen loewr vit D levels at increased risk of CVD but supplementation does nothing
can recommend for general health doesnt cause any harm but wont dhave any benefit
vit E role in HF
advise against
increase risk of hospitalization, mortality, HF
what drug is hawthorn like
digoxin
pharmacological effects of the flavonoids in hawthorn
reduce BP and HR
positive inotroph
vasodilatory
reduce afterload
potential benefits of hawthorn
may help with symptoms but no decrease in mortality
hawthorn drug interactions
enhances digoxins activity
inhibits synthesis of thromboxane 2, increase risk of bleeding in patients on antiplatelets or anticoagulants
examples of herbal diuretics
dandelion
stinging nettle
corn silk
herbal diuretuics recommendation
advise not to use as no evidence that they reduce edema in patients with HF
what is l carnitine
amino acid cofactor in skeletal muscles and the heart
lcarnitine proposed mechanism
genereates energy within the cells causing a positive inotropic effect
HF patients have lower levels in their heart tissue
what is l-arginine do
amino acid for protein synthesis
substrate for NOS enzyme which forms nitric oxide causing vasodilation
caution for l-arginine
causes hypotension
usually safe
potential l-arginine drug interaction
may decrease the activity of ACE
what is st.johns wort used for
depression
anxiety
sleep disorders
drug interactions with st johns wort
induces cyp3A4
avoid with: amiodarone, apixiban, rivaroxaban, beta blockers, CCB, ACe, statin
induces pgp - decreases digoxin
ginseng effects
immune stimulant (stimulant = bad)
hypertensive and hypotensive effects
used in HF for CHF
ginseng drug interactions
warfarin - may decrease efficiency
digoxin - can falsely increase or decrease levels
what is saw palmetto used for
treat BPH
drug interactions with saw palmetto
antiplatelet effects
avoid with antiplatelets and anticoagulants
what is ginko biloba used for
alzheimers and dementia
ginko biloba drug interactions
inhibit platelet activating factor causing decreased platelet aggregation
bleed risk high
get patients off
garlic uses
antimicrobial, IS enhancer
lowers cholesterol
antihpertensive
inhibits platelet aggregation
drug interactions with garlic
increased risk of bleeding - ASA and warfarin
increase prothrombin time
may have hypotensive effect
discontinue supplements 10 days before surgery
use of danshen
traditional chinese medicine for treatment of CAD
danshen drug interactions
digoxin like effects dont use together
hypotensive effect
antiplatelet effect
reduced elimination of warfarin
echinacea uses
stimulate IS and prevent infections
echinacea drug interactions
may potentiate hepatotoxicity long term
increase hepatotoxic effects of other drugs - amiodarone, statin
licorice use
expectorant
licorice drug interactions
mineralcorticoid effect can causse fluid retention and increase BP
may cause hypokalemia
increased risk for ventricular arythmias
increased risk of bleeding ASA and warfarin
motherwort uses
palpitations/tachycardia
motherwort drug interactions
cardiac depressant effects
anticoagulant - decreases fibrinogen
antiplatelet effects increased risk of bleeding
amiodarone drug interactions
echinacea
kava containing products
digoxin like substances
digoxin drug interactions we talked about
hawthorn
stjohns wort
licorice
danshen
NOAC interactions with NHPs
NHPs that are strong cyp3A4 and pgp inducers can decreased the plasma concentration
what is l-arginine most likely to interact with
sildenafil
