HF rx

Question 1

Specific HF Goals of Rx

Answer 1

1. Treat cause of HF
2. Elimination of precipitating factors
   e. g. infection, anemia, etc
3. Reduction of congestion
4. Improve blood flow
   a. Modulate neurohormal activation
   b. Devices / transplantation

Question 2

number one thing for heart failure is to

Answer 2

optimize patients on the frank starling curve, this means that you optimize their volume status

Question 3

Regardless of HF Type,

Answer 3

give diuretics

Question 4

Diuretics function to

Answer 4

Reverses fluid retention (Na loss)

Question 5

diuretic: classes

Answer 5

1. Loop diuretics preferred due to potency
   (furosemide [Lasix], torsemide, bumetanide, ethacrinic acid)
2. Can be augmented with a thiazide diuretic

Question 6

what is the most common HF therapy?

Answer 6

diuretics

Question 7

diuretic side effects

Answer 7

1. dehydration
2. hypokalemia
3. sulfa
4. tinnitis

Question 8

ACE Inhibitors block

Answer 8

conversion of ATI to ATII

Question 9

ACE inhibitor effects

Answer 9

Direct vasodilation
Decreased aldosterone activation
Other effects beyond ATII?

Question 10

ARB effect

Answer 10

block receptor of angiotensin II

Question 11

ARB clinical use:

Answer 11

In studies have been equivalent to ACEI
Controversial whether use in combination (ARB + ACEI) provides added benefit
Generally used when patients develop cough to ACEI

Question 12

ARB side effects

Answer 12

1. ARBs do not produce kinin potentiation (no cough)

2. Otherwise side effects are similar to ACEI

Question 13

MRA acts to

Answer 13

block mineralocorticoid receptor

Question 14

MRA other effects

Answer 14

antifibrotic

Question 15

MRA side effects

Answer 15

1. hyperkalemia (requires close monitoring)

2. gynecomastia (spiro only)

Question 16

B blocker function is to

Answer 16

Antagonize effect of sypathetic system (epinephrine/norepinephrine)

Question 17

B blockers block

Answer 17

B1 blockage

a1 blockade

Question 18

B- blocker: B1 blockade results in

Answer 18

1. Negative chronotrope (slow heart rate, less arrhythmia)

2. Negative inotrope (decreased metabolic demand)

Question 19

B blocker: a1 blockade results in

Answer 19

vasodilation

Question 20

blocker side effects

Answer 20

1. Negative inotrope: short-term loss for long-term gain
   a. Fluid retention
   b. Hypotension
   c. Decreased cardiac output, even cardiogenic shock
2. Bronchoconstriction