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Cardio Exam 5 > Pharm: HF > Flashcards

Pharm: HF Flashcards

1
Q

Most effective medical therapy for patients in HF with renal insufficiency.

A

Loop Diuretics

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2
Q

Unique side effect of loop diuretics and which one is it the worst?

A

Ototoxicity

-ethacrynic acid is the worst (however only one to give in patients with sulfa allergy)

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3
Q

Most serious metabolic side effect of loop diuretics and how it is caused.

A

Hypokalemia: loop diuretics block the NKCC pump. So K and Na remain in the lumen in the thick ascending loop of henle. In the collecting duct, the sodium is reabsorbed in exchange for potassium secretion further leading to K loss.

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4
Q

Thiazide diuretic still effective in renal insufficiency.

A

metolazone - good to use with loop diuretics but monitor the potassium levels

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5
Q

Most notable metabolic side effect of thiazide diuretics.

A

Hyperlipidemia

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6
Q

What effects do the 3 types of vessel dilators have on heart performance and which drugs are included in each type?

A
  1. Venodilators: nitrates
  2. Vasodilators: hydralazine
  3. Balanced: ACE-Is, ARBs, Na Nitroprusside, Nesiritide, isosorbide dinitrate & hydralazine combo
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7
Q

Other than hypotension, headache, and flushing; what are two problems when using IV nitro or other nitrates?

A
  1. Methemoglobinemia: similar to CO poisoning

2. Tolerance

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8
Q

Why are ARBs and ACE-Is good to use in diabetics?

A

Slows progression of kidney disease

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9
Q

How do ARBs and ACE-Is lead to hyperkalemia?

A

Inhibition of aldosterone production

-no sodium reabsorption or potassium secretion in the collecting duct

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10
Q

In what two situations can ACE-Is and ARBs increase progression of renal failure?

A
  1. Hypovolemia

2. Bilateral renal artery stenosis

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11
Q

Major side effect of ACE-Is.

A

Dry cough

-due to increase bradykinin levels

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12
Q

First line treatment in patients with systolic HF.

A

ACE-Is

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13
Q

Type of HF that direct vasodilators are most effective.

A

Systolic

-the weaker contracting heart will be able to pump more blood against a lower afterload when the arteries are dilated.

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14
Q

Best drug therapy for treating systolic HF in African American patients.

A

Hydralazine + Isosorbide dinitrate

ACE-Is

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15
Q

Major side effect of Hydralazine (arteriolar dilator)

A

Lupus-Like symptoms

fever, arthritis, rash

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16
Q

Main complication of sodium nitroprusside (balanced vaso and venodilator).

A

Cyanide toxicity

17
Q

Only indication for nesiritide (balanced vaso and venodilator).

A

Acute decompensated HF

18
Q

MOA of (+) inotropic agents and describe the 3 mechanisms.

A

All increase intracellular calcium of cardiac myocytes

  1. Digoxin: inhibits Na/K pump leading to activation of a sodium calcium antiport
  2. Sympathomimetic amines: encourage cAMP formation, activating PKA which activates (opens) calcium channels
  3. Phosphodiesterase Inhibitors: prevent cAMP breakdown
19
Q

Effects of dopamine based on dose.

A

less than 2ug/kg/min: renal artery dilation
2-10ug/kg/min: (+) inotropic effects on heart
greater than 10: peripheral vasoconstriction

20
Q

Indication for all the sympathomimetics.

A

Acute decompensated HF

21
Q

Name the two PDE inhibitors.

A

Amrinone

Milrinone

22
Q

What are the 3 cardiac toxic effects of digoxin.

A
  1. Exaggerated vagal tone (AV block, bradyarrhythima)
  2. Enhanced automaticity (tachyarrhythmia)
  3. Enhanced Re-entry including most commonly DADs and seldom EADs
23
Q

Earliest side effect of Digoxin toxicity.

A

Anorexia

24
Q

Unique neuro characteristic of digoxin.

A

Yellow Vision

25
Q

What is an important test to run before prescribing digoxin?

A

Serum Electrolytes

-any imbalance increases risk of dig toxicity

26
Q

Which beta blockers have lowest chance of CNS side effects?

A 
Carteolol
Atenolol
Nadolol
Sotalol
(least lipophilic)
27
Q

Which beta blockers should be avoided in patients with renal insufficiency?

A 
Carteolol
Atenolol
Nadolol
Sotalol
(renal excretion)
28
Q

When in HF are BB used?

A

Chronic Systolic compensated HF

-depresses SANS

29
Q

Which 4 BB have intrinsic sympathomimetic activity?

A

Carteolol
Acebutolol
Penbutolol
Pindolol

30
Q

How do the aldosterone antagonists treat HF?

A

Spironolactone and Eplerenone both block aldosterone. It is thought that aldosterone enhances the progression of fibrosis and ventricular remodeling that occurs in HF.

31
Q

Major contraindications for BB use in HF.

A
  • decompensated HF
  • brittle diabetes w/ HF
  • bronchospasm
  • prinzmetal angina
32
Q

What is compensated vs. decompensated HF?

A

Compensated HF can be though of as regular HF with normal HF symptoms.

Decompensated occurs when the normal HF symptoms are exacerbated by another condition that adds stress to the heart such as infection, hyperthyroidism, pregnancy, exertion. The exacerbated symptoms must be immediately corrected or the patient dies.

Cardio Exam 5 (9 decks)

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