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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
With increased preload, there is _____ CO.
Decreased
26
Viscious Cycle of HF
1. Decreased CO from dysfunction 2. Compensatory Responses : Baroreceptors and RAS 3. Increased Cardiac Work from Increased TPR and BV 4. Myocardial Hypertrophy
27
General Therpeutic Goals of HF (2)
1. Reducing symptoms and slowing disease progression during periods of stable HF 2. Managing episodes of acute failure
28
Specific Therpeutic Goals of HF (3)
1. Improve mycardial contractility w/o increasing HR 2. Reduce Afterload 3. Reduce Preload
29
Steps in treatment of CHF (3)
1. Reduce workload of the heart: activity, bp, weight 2. Reduce Sodium: diet 3. Pharmacotherapy: multiple drugs
30
Drugs to treat CHF (5)
1. Ace Inhibitors/Angiotensin Receptor Blockers 2. Beta Blockers 3. Diuretics 4. Vasodilators (NOT CCB) 5. Cardiac Glycosides
31
First line of drug class for CHF?
ACE Inhibitors + Diuretics Reduce symptoms and Mortality *-prils
32
Therapeutic Effects of ACE inhibotrs (4)
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
What is used when ACEi are poorly tolerated?
ARBs
34
Efficacy of ARBs for treatment of CHF?
Debateable
35
What ARBs are used to treat CHF?
Valsartan and Candesartan
36
How do Beta Blockers help treat CHF?
Reduce CO but Improve survival | *used w/ ACEi or ARB
37
What Beta blockers are used for CHF?
1. Bisoprolol 2. Carvedilol 3. Metoprolol * others are not effective * combine w/ ACEi
38
How to administer beta blockers for CHF?
1. Initially slowly at low doses | 2. Cautiously increase
39
Which Beta Blockers are cardioselective?
Bisoprolol and Metoprolol
40
Which Beta blocker is also an alpha1 antagonist?
Carvedilol
41
What can be added to ACE inhibitors to reduce morbidity and mortality compared to ACEi alone?
Spironalactone, eplerenone
42
What is an SE of using aldosterone antagonists like spironalactone?
Blocks receptors for sex hormones
43
What cases are the classes of Diuretics used for when added to ACE inhibitors for CHF?
1. Aldosterone blocking k sparing agents = first line tx 2. Thiazides = mild failure 3. Loop Diuretics: more sever cases
44
How do vasodilators treat CHF? Other things to know too (2)
1. Venous Dilators = nitrates - decrease preload 2. Arterial Dilators = hydralazine - decrease afterload * Given in combo * Not 1st line tx
45
Can you switch from digitalis glycosides to ace inhibitors?
Not w/o deterioration
46
What drugs are (digitalis) glycosides?
1. Digoxin | 2. Digitoxin
47
What are the beneficial effects of glycosides?
Increase Cardiac output by increasing myocardial contractility as a result of effects on Calsium
48
Facts about glycoside effects (4)
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
How do cardiac glycosides work? (2)
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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