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Pharmacology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is the definition of heart failure?

A

Failure of the heart to pump blood to tissues

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2
Q

What positive feedback system occurs w/ heart failure?

A

Structural remodeling

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3
Q

What is the #1 cause of LT-HF? What are the two different types of this cause?

A

Ischemic heart disease

Coronary artery disease
Myocardial infarction

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4
Q

What is the #1 cause of RT-HF?

A

LT-HF

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5
Q

What can cause isolated chronic RT-HF? Acute RT-HF?

A

COPD

PE

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6
Q

What is another name for isolated Rt-HF? What does it mean?

A

Cor pulmonale

Lung disease that leads to RT-HF

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7
Q

What is the duty of the RT side of the heart?

A

Receive blood from systemic circulation

Pump blood to lungs

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8
Q

What is the duty of the LT side of the heart?

A

Receive oxygenated blood

Pump blood out to systemic circulation

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9
Q

What is another name for HF? (CHF)

A

Congestive Heart Failure

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10
Q

What are the Sx of LT-HF? What is it caused by?

A
  • paroxysmal nocturnal dyspnea
  • orthopnea
  • tachycardia
  • fatigue
  • SOB/dyspnea

pulmonary edema

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11
Q

What are the Sx of RT-HF? What is it caused by?

A
  • JVD
  • ascites
  • hepatomegaly/splenomegaly
  • weight gain
  • dependent edema “pitting edema”

Systemic edema

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12
Q

What are the 3 different types of HF? What do they each stand for?

A

HFpEF(HF w/ preserved EF)

HFrEF(HF w/ reduces EF)

HFmrEF(HF w/ mid range EF)

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13
Q

What is normal EF?

A

50-65%

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14
Q

What is the equation for figuring out EF%?

A

SV/ EDV= EF%

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15
Q

What is the EF for a pt w/ HFrEF?

A

<40%

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16
Q

What is the EF for a pt w/ HFpEF? How is this possible?

A

> 50%

SV is normal but EDV is low b/c of ventricular hypertrophy

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17
Q

What is the general protocol for Tx of HF? How do each of them help w/ Sx of the pt?

A
  1. diuretics-decrease edema
  2. vasodilators-decrease workload on heart and redistribute edema
  3. beta blockers-decrease tachycardia
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18
Q

When are cardiac glycosides used?

A

When other medications for HF don’t work

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19
Q

What are the 3 goals of drugs when Tx HF?

A
  • improve Sx
  • slow deterioration
  • reduce mortality
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20
Q

What are the 3 homeostatic mechanisms to maintain fluid balance in the lungs?

A

Preload
LT ventricular contractility
Afterload

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21
Q

What is the goal of drug therapy in Acute HF?

A

Optimize volume status

22
Q

What is euvolemic?

A

Dehydrated body fluid level

23
Q

What is the goal of diuretics in HF? What does this decrease?

A

Decrease the excess fluid by peeing it out?

Decreases preload

24
Q

What are the 3 types of diuretics used for CHF?

A

Thiazides
Loops
K+ sparing

25
Q

Why is there delayed diuretics w/ furosemide(Lasix)? What is given to increase the diuretics?

A

B/c the diuretics are emptying the edema from the body instead of the lung edema

Give a vasodilator

26
Q

What type of drugs are balance vasodilators?

A

ACEIs and ARBs

27
Q

What effect is nitroglycerin going to have on pts preload and afterload? What route and dose is going to be best to cause these results?

A

Decrease preload and afterload

High dose IV nitroglycerin

28
Q

What does PDE5 and nitroglycerin cause in the body when taken together?

A

Severe drop in BP

29
Q

What is the general protocol for Tx of pts w/ acute HF?

A

Vasodilator first (fluid redistribution)

Diuretics next (fluid removal)

30
Q

What is the goal of beta blockers for HF in the heart? In the kidneys?

A

Decrease BP
Decrease workload on heart

Decrease renin release

31
Q

What does neprilysin breakdown?

A

ANP/BNP
Bradykinin
AT-2

32
Q

What is digoxin(Lanoxin) used for? What are the 2 effects it causes on the heart?

A

HF
A-fib

Positive inotropic effect
Negative chonotropic effect

33
Q

What does digoxin(Lanoxin) cause positive inotropic effect?

A

Because of the blocked Na/K pump which increases Ca2+ in the heart=increasing contractility force

34
Q

Why does digoxin(Lanoxin) cause a negative chronotropic effect?

A

Because it stimulates the vagus nerve which has more parasympathetic nerves=decreasing HR

35
Q

What is another name of digitalization?

A

Loading dose

36
Q

How is digoxin(Lanoxin) given?

A

Digitalization then maintenance

37
Q

What is the normal levels of digoxin(Lanoxin) in the body?

A

0.5-2.0 nanograms/ml

38
Q

What electrolyte levels increases the effect of digoxin(Lanoxin)?

A

Hypokalemia

Hypercalcemia

39
Q

What is the normal levels for K+?

A

3.5-5.0mEq/L

40
Q

What type of drugs should a pt increase their K+ intake?

A

Diuretics

Digoxin

41
Q

What are the ADR of cardiac glycosides?

A

N/V
Cardiac arrhythmia
Disturbances in color (blurred and yellow fields of vision)

42
Q

What levels should you monitor when a pt is on digoxin(Lanoxin)?

A 
Serum digoxin (0.5-2.0ng/ml)
K+ levels(3.5-5.0mEq/L)
Apical pulse(above 60HR)
43
Q

Why is beta-blockers given at low doses to pts in HF?

A

Because the decrease in SV and HR can increase the rate of HF

44
Q

Why is hyperkalemia a ADR of ARNi drugs?

A

Because of the ARB that blocks aldosterone increase to get rid of K+

45
Q

Why is Hypotension a ADR of ARNi drugs?

A

Because of the neprilysin inhibitor that drains a lot of fluid out of the body

46
Q

What do SGLT-2 inhibitors end in?

A

-gliflozin

47
Q

What is the MOA of SGLT-2 inhibitors? SOA? Indications?

A

Inhibits reabsorption of Na and glucose

PCT

HFrEF and DM

48
Q

Before giving any dose of drug for HF, what must be done?

A

Count apical pulse for 1 min

49
Q

What are the contraindications for HF drugs?

A 
<60HR
>100HR
anorexia
N/V
Diarrhea
Visual disturbances
-yellow and green halos
50
Q

What physical findings show positive therapeutic effects to drug Tx for HF?

A

Increased urine output
Improved peripheral pulses, skin color and temperature
Decrease dyspnea, SOB and edema

Pharmacology (27 decks)

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