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Pharm Unit 8 > HF > Flashcards

HF Flashcards

1
Q

ventricular filing –

A

diastolic dysfunction

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2
Q

myocardial contractility

A

systolic dysfunction

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3
Q

current understanding of HF Is described by:

A

neurohormonal model

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4
Q

neurohormone activation:

A

norepinephrine
angiotensin II
aldosteorne
proinflammatory cytokines

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5
Q

HF targeted pharmacotherapy taht antagonized ___

A

neurohormonal activation

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6
Q

diastolic dysfunction =

A

HF w/ preserved EF (HFpEF)

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7
Q

systolic dysfunction:

A

HF w/ reduced EF (HFrEF)

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8
Q

most trials include patients w/ ___

A

HFrEF

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9
Q

NYHA classification I

A

patients with cardiac disease but without limitations of physical activity

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10
Q

NYHA II

A

patients with cardiac disease that results in slight limitations of physical activity

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11
Q

NYHA III

A

patients with cardiac disease that result in marked limitation of physical activity

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12
Q

NYHA IV

A

short timepatients with cardiac disease that result in inability to carry on physical activity w/o discomfort

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13
Q

NYHA states that symptoms may change over ___

A

short time

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14
Q

ACC/AHA stage A

A

patients at risk for developing HF

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15
Q

ACC/AHA B

A

patients w/ structural heart disease but no HF signs of sx

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16
Q

ACC/AHA C

A

patients with structural heart disease and current or previous symptoms

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17
Q

ACC/AHA D

A

refractory HF requiring specialized interventions

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18
Q

in ACC/AHA stage will not change. – consistent with

A

progressive nature of HF

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19
Q

majority of trials have been geared toward

A

systolic dysfunction patients

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20
Q

new medications for systolic dysfunction

A

ivabradine (coplanar)

sacubitril/valsartan (Entresto)

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21
Q

Diuretics are indicated in all patients with ___

A

evidence of h/o fluid retention

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22
Q

monitor effect of diuretics by ___

A

daily morning weight measurements

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23
Q

thiazide diuretics are __ diuretics

A

weak

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24
Q

metolazone may be a dded to loops for ___

A

diuretic resistance

2.5-19mg once daily PLUS loop diuretic

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25
Q

most potent diuretic

A

loop

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26
Q

ceiling effect of loop diuretics

A

give ceiling dose more frequently rather than increasing dose

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27
Q

torsemide is preferred in patients with ___

A

persistent fluid retention despite high doses of other loops

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28
Q

___mg lasix = ___ mg torsemide = ___ mg bumetanide

A

40; 20; 1

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29
Q

dose of chlorthalidone and metolazone

A

daily

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30
Q

cornerstone of HF therapy

A

ACEI

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31
Q

first line therapy in patients with systolic HF

A

ACEI

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32
Q

ACEI in HF reduces mortality by ___

A

20-30% vs placebo

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33
Q

for HF, use ACEI w/ ___

A

beta blocker unless contraindicated

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34
Q

add beta blocker after ___

A

titrating maximal ACEI dose

even if ACEI dose is < recommended max

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35
Q

with ACEI, monitor ___

A

serum K and renal function

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36
Q

abrupt withdrawal of ACEI may precipitate ___

A

decompensation

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37
Q

ACEI adverse effects

A

hypotension
functional renal insufficiency
cough (dry, hacking)
angioedema

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38
Q

to combat ACEI induced hypotension:

A

spread other vasoactive meds throughout the day (not all at once)

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39
Q

to combat ACEI induced hypotension, start on

A

catopril, titrate to max, then switch to ACEI w/ once daily dosing

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40
Q

if cough using ACEI, consider ___

A

substituting ARB

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41
Q

if angioedema with ACEI,

A

lifetime avoidance of ACEI

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42
Q

use beta blockers in all ___

A

stable HF pts unless intolerant or contraindicated

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43
Q

BBs that have demonstrated decreased mortality in HF

A

bisoprolol
carvedilol
metoprolol succinate (not IR metoprolol tartare)

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44
Q

carvedilol blocks ____

A

b1, b2 and a1 receptors (nonselective)

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45
Q

carvedilol may be preferred in patients with ___

A

poorly controlled BP (due to a and b1 blockade)

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46
Q

avoid carvedilol in ___

A

asthmatics (because they use beta 2 agonists)

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47
Q

begin beta blockers at very low doses with ____

A

gradual titration to max doses

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48
Q

delay dose increase of BB until ___ have disappeared

A

AEs

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49
Q

continue long term treatment with BB , even ____

A

if symptoms do not improve

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50
Q

abrupt withdrawal of BB may cause ___

A

acute decompensation

taper if discontinued

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51
Q

BBs used for HF

A

bisoprolol
carvedilol
metoprolol

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52
Q

benefits of BB in pts with HF and reduced ejection fraction seem to be mainly due to ___

A

class effect

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53
Q

Major AE of BB used for HF

A

fluid retention
fatigue
bradycardia
hypotension

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54
Q

Minor AE of BB used for HF

A

bronchospasm (in asthma pts)
worsening glucose tolerance
sexual dysfunction in males

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55
Q

BB worsen glucose tolerance in diabetics and may mask sx of

A

tachycardia
tremor
BUT NOT SWEATING

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56
Q

ARBs inhibit ___ at its receptor

A

angiotensin II

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57
Q

ARBs do not inhibit _____

A

bradykinin metabolism (so no increase in bradykinin)

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58
Q

ARBs produce less ___ and __

A

cough and angioedema

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59
Q

combined use of ace and arb is potentially ___

A

harmful – no longer recommended

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60
Q

when using ARBs, ___ may still occur but less than with ACEs

A

angioedema

61
Q

angioedema using ARBs happens more frequently in ___

A

blacks

62
Q

as with ACEI’s, start ___ before reaching max ARB dose

A

BB

63
Q

starting requirement for an aldosterone receptor antagonist (ARA)

A

SCr of <2.5 mg/dl (M)
SCr <2 mg/dl (F)
CrCl >30
Serum K <5

64
Q

Aldosterone Receptor Antagonists (ARA)

A

spironolactone (aldactone)

Eplerenone (Inspra)

65
Q

discotinue ___ after starting an ARA

A

potassium supplements

66
Q

counsel patients to stop ARAs during episodes of:

A

diarrhea
dehydration
interruptions of diuretic therapy

67
Q

AE of Spironolactone

A

gynecomastia

hyperkalemia

68
Q

up t o 35% of patients in the general population are

A

hyperkalemic

69
Q

AE of epleronone

A

hyperkalemia

gynecomastia

70
Q

serious hyperkalemia using epleronone

A

serum k >6 (discontinue ARA)

71
Q

mild hyperkalemia using

A

serum K >5.5 (discontinue ARA or decrease dose)

72
Q

only orally active positive cardiac inotrope

A

digoxin

73
Q

digoxin does not ____

A

decrease mortality in HF

74
Q

digoxin may improve:

A

LVEF
quality of life
exercise tolerance and
HF sx

75
Q

loading dose of ___ for A-fib is not recomended

A

digoxin

76
Q

target plasma levels when using digoxin

A

0.5-1.0 ng/mL

higher levels off plasma increase mortality

77
Q

toxicity with digoxin occur earlier with :

A

hypokalemia, hypomagnesemeia, hypothyroidism

78
Q

obtain first dose of digoxin ____

A

3-5 days after starting therapy

79
Q

check plasma levels _____ after dosage of digoxin changes

A

5-7 days

80
Q

draw plasma levels ___ after previous dose of digoxin

A

6-8 hours

81
Q

adverse effects of digoxin for HF

A

cardiac arrythmias
GI sx
neurological coplaints

82
Q

neurological complaints using digoxin

A

visual disturbance

altered color perception (blue/green & yellow halos)

83
Q

hydralazine is a potent ____

A

arterial vasodilator

84
Q

hydralazine is an ___

A

afterload reducer

85
Q

isosorbide dinitrate is a potent ___

A

venous vasodilator

86
Q

isosorbide dinitrite is an ___

A

preload reducer

87
Q

H/ISDN is demonstrated to be especially useful in ___

A

AA with HF

88
Q

start H/IDSN on all ___

A

AA on optimum therapy w/ ACEI & BB unless contraindicated

89
Q

start H/ISDN on non AA’s intolerant to/ or contraindicated for ___

A

ACEI/ARB

90
Q

unique MOA for Ivabradine

A

deceases HR by inhibiting If pacemaker current in SA Node

91
Q

Ivabradine reduces risk fo ___

A

hospitalization for worsening HF

92
Q

class for Sacubitril/Valsartan

A

new class – angiotensin receptor-Neprilysin inhibitor (ARNI

93
Q

entrust lowered CV mortality by ___

A

20%

94
Q

AMI medications

A 
Oxygen
Nitrates
Analgesia
BB
CCB
Other anti-ischemic 
cholesterol lowering agents 
RAAS inhibitors 
anti-platelet agents
parenteral anticoagulation
95
Q

administer supplemental o2 to AMI patients with

A

o2 sat <90%
respiratory distress
other high-risk features of hypoxemia

96
Q

oxygen may have negative effects in ___

A

coronary patients

97
Q

oxygen can cause ___ in coronary patients

A

increased coronary vascular resistance
reduced coronary blood flow
increased risk of mortality
significantly LARGER infarct sizes than non-oxygen group

98
Q

administer supplemental o2 to AMI pts with ___

A

o2 sat <90%
respiratory distress
other high-risk features of hypoxemia

99
Q

oxygen may have negative effects in ___

A

coronary patients

100
Q

o2 can cause increased ___

A

coronary vascular resistance

101
Q

o2 can cause reduced ___`

A

coronary blood flow

102
Q

o2 has increased risk of mortality in ___

A

coronary patietns

103
Q

o2 can cause significantly larger ___

A

infarct sizes

104
Q

MOA of nitrates

A

dilate capacitance vessels (decrease preload)

105
Q

for continued chest pain, administer

A

SL nitroglycerin
0.3-0.4 mgQ5 min x 3
then assess for IV NTG

106
Q

do not give nitrates if pt is on ___

A

phosphodiesterase inhibitors (ED med)

107
Q

do not give nitrates if pt was on ____ over the last 24 hours

A

sildenafil, vardeniafil

108
Q

do not give nitrates if pt was on ___ over last 48 hrs

A

tadalafil

109
Q

reason you cannot give nitrates to patients on phosphodiesterase inhibitors

A

potential marked decrease in BP

110
Q

____ may be given IVP for continued chest pain if already on max tolerated NTG

A

morphine sulfate

111
Q

analgelsia for HF

A 
morphine sulfate
traditional NSAIDs (NOT aspirin) &amp; COX-2 inhibitors
112
Q

NSAIDs actually enhance platelet aggregation by ___

A

inhibiting PG synthesis

113
Q

NSAIDs should be ___ in AMI patients

A

avoided

114
Q

__ is ok for anti-platelet effects in AMI pts

A

aspirin (low-dose)

115
Q

begin ___ within 24h in all AMI pts

A

BBs PO

116
Q

AMI pts with stable HF should be continued on:

A

metoprolol succinate, carvedilol, bisprolol

117
Q

why avoid IV BBs?

A

may increase risk of shock

118
Q

give CCB to ischemic patients:

A

with contraindications to BB
unacceptable side-effects of BBs
with continued pain after appropriate use of BBs and nitrates

119
Q

use non-dihydropyridin CCBs as initial therapy

A

ORAL verapamil

ORAL diltiazem

120
Q

Immediate release nifedipine should nOT be used due to ___

A

causes dose-related increase in mortality in CAD and harm in ACS pts

121
Q

abtianginal with minimal effects on HR and BP

A

ranolazine

122
Q

A/E of Ranolazine

A

constipation

dose-related QT prolongation (not sufficient for dose reduction in RCTs)

123
Q

high intensity statin therapy

A

atorvastatin titrate 10-80mg PO once daily

rosuvastatin titrate 5-40mg PO once daily

124
Q

start ACE-I in all pts w/ LVEF < __

A

40% – continue indefinitely

125
Q

start ACEI in hospital with __ or ___ and switch to long acting ACE-I at max

A

catopril (TID)or enalapril (BID)

126
Q

use ___ in those intolerant or those with c/I to ACEI

A

ARB

127
Q

use ___ to those on therapeutic doses of ACE-I and BB

A

ARAs

128
Q

acute need for anti-platelet agents:

A

give non-enteric-coated chewable aspirin (162-324mg)

129
Q

do not order enteric-coated ASA acutely because…

A

delays absorption

130
Q

in patients who acutely need anti-platelt therapy and are intolerant to aspirin, give:

A

clopidogrel

131
Q

for chronic anti platelet:

A

give aspirin 81-325mg PO daily indefinitely PLUS

up to 12 mo, either p2y12 aspirin receptor inhibitor

132
Q

p2y12 aspirin receptor inhibitors

A

clopidogrel (daily)

ticagrelor (BID)

133
Q

___ is not recommended for chronic anti-platelet therapy

A

prasugrel

134
Q

prasugrel increases risk of :

A

spontaneous bleeding, life -threatening bleeding and fatal bleeding

135
Q

parenteral anticoag

A

in addition to anti platelet therapy, anticoagulation is recommended for all pts

136
Q

enoxaprin is preferred ___

A

LMWH for ACS

137
Q

avoid LMWH in ___

A

dialysis pts w/ ACS

138
Q

bivalrudin is usually used in ___

A

Cath labs

139
Q

potential advantages of bivalrudin

A

will bind to clot - bound thrombin

no significant protein binding (more predictable anticoagulant response)

140
Q

synthetic pentasaccharide (selective xa inhibitor)

A

fondaparinux

141
Q

fondaparinux shows little risk for __

A

HITT

142
Q

fondaparinux is c/I for ___

A

CrCl <30 mL/min (increased risk of bleeding)

use w/ caution for CrCl 30-50 mL/min

143
Q

UFH has a relatively short half life:

A

~1.5h

144
Q

can d/c IV heparin for ___

A

urgent interventions

145
Q

____ recommended over fixed dose of heparin

A

weight-based regimen

146
Q

max initial bolus of IV heparin

A

4,000 units

147
Q

max initial maintenance infusion of heparin

A

1,000 units/h

148
Q

parenteral anticoagulation used in pts w h/o HITT undergoing PCI

A

argatroban

Pharm Unit 8 (3 decks)

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