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Cardio Final > Heart Failure Treatment 1 > Flashcards

Heart Failure Treatment 1 Flashcards

1
Q

Define Heart Failure

A

Pathological state when the heart is unable to pump blood (reduce stroke volume & cardiac output) at a rate that meets the requirements of tissue

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2
Q

Normal conditions = dynamic relationship between

A

venous capacitance, ventricular preload, CO, afterload, peripheral resistance

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3
Q

Define Acute Hemodynamic Stress

A

Sharp decrease in blood volume –> decreased cardiac output –> activation of compensatory mechanisms to support the circulation

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4
Q

RAS –> BP and CO

A

Increased AngII which leads to peripheral resistance and increased sodium and water which allows recovery of BP and CO

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5
Q

SNS –> BP and CO

A

Increased myocardial contractility and increased heart rate via beta 1
Increased peripheral resistance via alpha 1 and 2

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6
Q

Therapy for HF involves:

A

Reduction of preload and/or afterload

Enhancement of inotropic state (contraction force)

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7
Q

Vasodilators

A

ACEi

Direct vasodilators

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8
Q

Positive inotropic drugs

A

Cardiac glycosides
Adrenergic/dopaminergic receptor agonists
Phosphodiesterase inhibitors

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9
Q

Diuretics in HF work on

A

Vasoconstriction and sodium/water retention

- Long term effects via: decrease peripheral resistance

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10
Q

Loop Diuretics are

A

Furosemide
Dumetanide
Torsemide

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11
Q

Loop Diuretics MOA

A

Inhibit NKCC symporter

Act in the thick ascending limb of loop of Henle

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12
Q

Loop Diuretics Main effects

A 
Profound diuresis (25%) which increases urine flow
Increased excretion of Na, Cl, K, Ca and Mg
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13
Q

Loop diuretics Main Adverse Effects

A

Ototoxicity
Hypokalemia
Hyperglycemia

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14
Q

Thiazide diuretics main representatives

A

HCTZ (microzide)
Chlorthalidone (Hygroton)
Indapamide (Lozol)
Metolazone (zaroxolyn)

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15
Q

Thiazide diuretics MOA

A

Act in the distal convoluted tubule (5% of Na reabsorption)

Inhibit Na Cl symporter

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16
Q

Thiazide diuretics effects on urine flow and ion excretion

A

Moderate increase in urine flow

Increased excretion of Na, Cl and increased excretion of K

17
Q

Chronic use of thiazide diuretics

A

Decreased excretion of Ca and uric acid

18
Q

Thiazide Main Adverse Effects

A

Hypokalemia
Increased risk of gout
Hyperuricemia

19
Q

Aldosterone antagonists drugs

A

Spironolactone and eplerenone

20
Q

Aldosterone antagonists MOA

A

Aldosterone (steroid hormone) binds to receptors then are translocated to the nucleus where it binds DNA and stimulates expression of aldosterone induced proteins

21
Q

ACEi drugs

A

End in -pril

22
Q

ACEi MOA

A

Reduction of Ang II which is involved in vasoconstriction, increased peripheral resistance, decreased sodium and water, slight decrease in aldosterone secretion and decreased sympathetic tone

23
Q

Alternative MOA of ACEi

A

Increased bradykin which decreased peripheral resistance via vasodilation and Ang 1-7 which is an antagonists of Ang II and natriuresis

24
Q

ACEi side effects

A

Dry cough, angioedema

25
Q

Direct vasodilators

A

Nitroglycerin
Nitroprusside (Nipride)
Nesiritide (Natrecor)

26
Q

Direct vasodilators MOA

A

Nitropresside and nitroglycerin either breakdown into NO or are NO and stimulate the process

27
Q

Nitroglycerin

A

Prodrug metabolized into NO
Infused IV
Selective for venous capacitance vessels (reduction of left ventricular filling pressure)

28
Q

Limitations of Nitroglycerin

A

Severe headache
Have to taper off
Development of resistance with chronic use
Long infusion + increased EtOH

29
Q

Na nitroprusside

A

Metabolized into cyanide and NO
IV administered
Dilates both arteries and veins so it can reduce ventricular filling pressure and peripheral restance

30
Q

Na nitroprusside Limitations

A

Hypotension
Cyanide toxicity
Can cause tissue hypoxia, decreased oxidative metabolism, and liver or renal toxicity

31
Q

Cyanide toxicity causes

A

Altered mental status
CV instability
Anion gap metabolic acidosis

32
Q

Nesiritide

A

Recombinant brain natiuretic peptide
Causes vasodilation of arteries and veins, nauresis and diuresis
IV administration

33
Q

Nesiritide Limitations

A

Hypotension
Expensive
Debatable effectiveness

Cardio Final (12 decks)

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