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Dental Pharmacology Exam 4 > Heart Failure and Shock > Flashcards

Heart Failure and Shock Flashcards

1
Q

What is cicrulovasculatory shock?

A

Acute, life threatening condition associated w/ insufficient blood delivery to tissues

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2
Q

What are the types of circ shock?

A
  1. Hypovolemic Shock
  2. Distributive Shock
  3. Cardiogenic Shock
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3
Q

What is Hypovolemic shock?

A

Shock from blood loss

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4
Q

What is the tx of hypovolemic shock?

A

Transfusions/fluid replacement + vasoconstrictors

Restore BP through vasoconstriction while sustaining BF through key organs

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5
Q

What is used to tx hypovolemic shock?

A

Alpha 1 Receptor Agonist w/ DA and/or Beta2 agonist effects

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6
Q

What is distributive shock?

A

Intesnse vasodilation due to infection (septic shock), allergic rxn (anaphylactic shock), or brain/spinal cord injury (neurogenic shock)

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7
Q

Tx for distributive shock?

A

Manage primary cause + Vasoconstrictors

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8
Q

What is cardiogenic shock?

A

Stoppage of the heart, HF

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9
Q

Causes of Acute HF? (4)

A
  1. Acute MI
  2. Cardiac Arrhythmias
  3. Valve Issues
  4. End Stage Chronic HF
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10
Q

Treatment of Acute HF?

A

Positive ionotropic agents

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11
Q

What classes of drugs are used to treat cardiogenic shock?

A

BETA 1 RECEPTOR AGONISTS

  1. Beta 1 adrenergic receptor agonist
  2. Phosphodiesterase 3 Inhibitors
  3. Muscarinic Rec Antagonist
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12
Q

What is the beta-1 adrenergic receptor agonist drug used to treat cardiogenic shock?

A

Dobutamine

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13
Q

What is the PDE3 inhibitor used to treat cardiogenic shock?

A

Milrinone

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14
Q

What is the Musc Rec Antagonist used to treat Cardiogenic Shock and what does it do?

A

Atropine, block effects of the PSNS on heart

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15
Q

What is chronic/congestive HF and what are the causes?

A

Cardiac output is insufficient to meet the O2 demands of the body

  1. Coronary Artery Disease/MI
  2. HTN from cardiac hypertrophy
    * Valve disease/cardiomyopathy/congenital defects/endocarditis
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16
Q

What are the left ventricular symptoms of systolic HF?

A
  1. Pulmonary Edema

2. Enlarged heart = accumulation of blood in the ventricals

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17
Q

What is the right vent symptom of systolic HF?

A

Pitting Edema of the lower limbs = backup of blood w/ venous circulation

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18
Q

Signs and Symptoms of HF (7)

A
  1. Skin cyanotic and clammy
  2. Anxiety/restlessness
  3. Upright posture/forward leaning
  4. Persistent cough
  5. Rapid Breathing
  6. Fast HR
  7. Edema of lower limbs
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19
Q

What is the goal for tx of Chronic HF?

A

Increase CO

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20
Q

What are the determinants of CO? (4)

A
  1. Contractility
  2. HR
  3. Afterload
  4. Preload
21
Q

What is contractility regulated by?

A

SNS - Beta1 receptors

Calcium Dependent

22
Q

What is HR regulated by?

A

SNS - Beta 1

*Increasing HR in congestive HF is counterproductive

23
Q

What is afterload regulated by?

A

SNS - Alpha 1

Renin-Angiotensin System (angiotensin II)

24
Q

What is preload regulated by?

A 
Return of blood to heart = veins
BV - kidneys
Angiotensin system (Angiotensin II)
25
Q

With increased preload, there is _____ CO.

A

Decreased

26
Q

Viscious Cycle of HF

A
  1. Decreased CO from dysfunction
  2. Compensatory Responses : Baroreceptors and RAS
  3. Increased Cardiac Work from Increased TPR and BV
  4. Myocardial Hypertrophy
27
Q

General Therpeutic Goals of HF (2)

A
  1. Reducing symptoms and slowing disease progression during periods of stable HF
  2. Managing episodes of acute failure
28
Q

Specific Therpeutic Goals of HF (3)

A
  1. Improve mycardial contractility w/o increasing HR
  2. Reduce Afterload
  3. Reduce Preload
29
Q

Steps in treatment of CHF (3)

A
  1. Reduce workload of the heart: activity, bp, weight
  2. Reduce Sodium: diet
  3. Pharmacotherapy: multiple drugs
30
Q

Drugs to treat CHF (5)

A
  1. Ace Inhibitors/Angiotensin Receptor Blockers
  2. Beta Blockers
  3. Diuretics
  4. Vasodilators (NOT CCB)
  5. Cardiac Glycosides
31
Q

First line of drug class for CHF?

A

ACE Inhibitors + Diuretics
Reduce symptoms and Mortality
*-prils

32
Q

Therapeutic Effects of ACE inhibotrs (4)

A
  1. Relaxation of Arterial Smooth Muscle (reduce afterload)
  2. Reduce Aldosterone Production (reduce sodium reab and BV)
  3. Dilate Veins (?)
  4. Reduce Trophic Changes in the Myocardium (prevents remodeling)
33
Q

What is used when ACEi are poorly tolerated?

A

ARBs

34
Q

Efficacy of ARBs for treatment of CHF?

A

Debateable

35
Q

What ARBs are used to treat CHF?

A

Valsartan and Candesartan

36
Q

How do Beta Blockers help treat CHF?

A

Reduce CO but Improve survival

*used w/ ACEi or ARB

37
Q

What Beta blockers are used for CHF?

A
  1. Bisoprolol
  2. Carvedilol
  3. Metoprolol
    * others are not effective
    * combine w/ ACEi
38
Q

How to administer beta blockers for CHF?

A
  1. Initially slowly at low doses

2. Cautiously increase

39
Q

Which Beta Blockers are cardioselective?

A

Bisoprolol and Metoprolol

40
Q

Which Beta blocker is also an alpha1 antagonist?

A

Carvedilol

41
Q

What can be added to ACE inhibitors to reduce morbidity and mortality compared to ACEi alone?

A

Spironalactone, eplerenone

42
Q

What is an SE of using aldosterone antagonists like spironalactone?

A

Blocks receptors for sex hormones

43
Q

What cases are the classes of Diuretics used for when added to ACE inhibitors for CHF?

A
  1. Aldosterone blocking k sparing agents = first line tx
  2. Thiazides = mild failure
  3. Loop Diuretics: more sever cases
44
Q

How do vasodilators treat CHF? Other things to know too (2)

A
  1. Venous Dilators = nitrates - decrease preload
  2. Arterial Dilators = hydralazine - decrease afterload
    * Given in combo
    * Not 1st line tx
45
Q

Can you switch from digitalis glycosides to ace inhibitors?

A

Not w/o deterioration

46
Q

What drugs are (digitalis) glycosides?

A
  1. Digoxin

2. Digitoxin

47
Q

What are the beneficial effects of glycosides?

A

Increase Cardiac output by increasing myocardial contractility as a result of effects on Calsium

48
Q

Facts about glycoside effects (4)

A
  1. Reduce congestive symptoms and improved exercise tolerance
  2. Reduce lethality from progressive damage - increases sudden death
  3. Low margin of safety
  4. Treat OD w/ digitalis antibodies
49
Q

How do cardiac glycosides work? (2)

A
  1. Prevent transport of Na into cells by Na/K pump (compete w/ K for site)
  2. Increase Intracellular Na = more Ca intracellularly = more force of contraction

Dental Pharmacology Exam 4 (5 decks)

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