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Pharm > HF > Flashcards

HF Flashcards

1
Q

Factors leading to HF

A

Muscular dysfunction, Mechanical disorder, combo

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2
Q

Risk factors of HF

A

HTN, Obesity, prediabetes/DM, ASCVD

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3
Q

NYHA classes

A

I: no limitation of physical activity
II: comfortable at rest, but ordinarily activity results in symptoms
III: comfortable at rest, but less than ordinary activity results in symptoms
IV: unable to carry on any physical activity with symptoms

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4
Q

Inotropic agents have not shown _____

A

improved survival survival in patients with HF

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5
Q

Cardiac glycosides MOA

A

Inhibition of NA/K atpase so less Ca is removed from the cell resulting in increased intracellular Ca/ increased contractile force

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6
Q

oral availability of cardiac glycosides

A

60-75%, half life 36-40H

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7
Q

cardiac glycoside elimination

A

renal excretion 60%, hepatic metabolism 40%

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8
Q

cardiac glycoside effects

A

decrease in compensatory sympathetic and renal responses
- increase contractility
- decreased end-systolic/ diastolic size
- increased CO
- increased renal perfusion

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9
Q

cardiac glycoside monitoring

A

Serum digoxin levels
HF symptoms
renal funciton
electrolytes (hypercalcemia, hypokalemia, hypomagnesemia)

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10
Q

digoxin toxicity signs and symptoms

A

cardiac: arrhythmias
noncardiac: anorexia, nausea, vomiting, abd pain, fatigue, weakness, dizziness, headache, neuralgia, confusion, delirium, psychosis
visual disturbances (halos, photophobia, color perception issues)

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11
Q

digoxin toxicity serum level

A

> 2 ng/ml

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12
Q

digoxin toxicity treatment

A
  • stop digoxin
  • oral/parenteral K supps
  • lidocaine for ventricular arrhythmias
  • propranolol for supraventricular arrhythmias
  • atropine for AV block and bradycardia
  • digoxin antibody if life threatening
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13
Q

digoxin toxicity ECG

A
  • Decreased QT interval (shortened ventricular action potential)
  • Increased PR interval (decreased AV conduction velocity)
    ST segment depression
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14
Q

Sympathomimetic Amines aka

A

Adrenergic Agonists (dopamine and dobutamine)

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15
Q

Sympathomimetic Amines useful for:

A

Acute failure (diminished systolic function)

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16
Q

sympathomimetic amines not appropriate for

A

Chronic failure (tolerance, lock of oral efficacy, arrhythmogenic effects)

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17
Q

dobutamine vs dopamine

A

dobutamine preferred when there is need to improve low CO (no effect on alpha2-adrenergic receptors)

18
Q

Phosphodiesterase inhibitor name

A

Milrinone

19
Q

Phosphodiesterase Inhibitor MOA

A

Increase cAMP by inhibiting breakdown by phosphodiesterase = increase intracellular calcium = vasodilation

20
Q

Drug reserved for severe decompensated heart failure

A

Milrinone

21
Q

Drug shown to reduce risk of death and the combined risk of death or hospitalization in patients with HFrEF

A

Beta blockers

22
Q

Shown to be effective in reducing risk of death in pts with HFrEF:

A

Bisoprolol, metoprolol (succinate), carvedilol

23
Q

BB should be used in stable patients with:

A

no inotropic support
(negative intropic effect = symptomatic worsening/ acute decompensation)

24
Q

BB monitoring

A

bradycardia, hypotension, fatigue, fluid retention/ worsening symptoms

25
Q

Which drug class for the following?
- Prevent death
- Improved survival by 20-30%
- slows progression
- Reduced hospitalization with current or prior symptoms

A

ACE/ARB

26
Q

ACE/ARB monitoring

A
  • Hypotension
  • Hyperkalemia
  • Dry cough
  • Angioedema
  • Pregnancy
27
Q

_____ is recommended to reduce morbidity and mortality

A

ARNi (Valsartan + Sacubitril)

28
Q

ARNi MOA

A

Inhibiting neprilysin reduces breakdown of beneficial peptides (i.e. natriuretic peptides)

29
Q

ARNi should not be co-administered with______

A

ACEi or within 36 hours of ACE because of risk of angioedema

30
Q

Mediates major effects of RAAS (myocardial remodeling and fibrosis, sodium retention and K loss at distal tubules

A

Aldosterone Antagonist (K sparing diuretics)

31
Q

Most effective for moderate to severe heart failure with dyspnea, and fluid overload

A

Diuretic therapy

32
Q

_____ are preferred over thiazide & have a rapid onset and relatively short duration of action

A

Loop diuretics

33
Q

For patients with HF and congestive symptoms, addition of _______ to a loop should be reserved for patients who do not respond to moderate-or high-dose loop diuretics to minimize electrolyte abnormalities

A

thiazide diuretic

34
Q

Diuretic Therapy Monitoring
Considerations

A
  • Volume depletion
  • Prerenal azotemia
  • Hypotension
  • Hypokalemia (particularly with accompanying digoxin therapy)
  • less common: skin rashes, GI distress, ototoxicity (loop)
35
Q

Substantially reduce risk of CV death and hospitalization for HF for pts with reduced LVEF, with or without diabetes

A

SGLT2 inhibitors

36
Q

_________ and _______ reduce cardiovascular death and heart failure hospitalization, and they have been approved for treating heart failure with reduced LVEF irrespective of the presence of type 2 diabetes

A

Dapagliflozin / empagliflozin

37
Q

SGLT2 inhibitors also reduce ______

A

kidney disease progression

38
Q

SGLT2 inhibitor monitoring

A
  • genetic mycotic infections
  • UTI
  • polyuria
  • risk of hypotension and hypovolemia due to osmotic diuresis
  • euglycemic ketoacidosis
39
Q

For patients self-identified as African American with NYHA class III/IV HFrEF who are receiving optimal medical therapy, the combination of _____ and ______ is recommended to improve symptoms and reduce morbidity and mortality

A

hydralazine/ isosorbide dinitrate

40
Q

Nitrites

A

Intravenous vasodilators: sodium nitroprusside or nitroglycerin

41
Q

Nitrite use

A

Acute/ Severely decompensate chronic heart failure, especially with HTN or MI

42
Q

________ have no sustained effect in pts with heart failure and should not be used for this indication

A

Transdermal nitroglycerin patches

Pharm (3 decks)

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