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Pharm Exam > Treatment of heart failure cards > Flashcards

Treatment of heart failure cards Flashcards

1
Q

What are the different types of heart failure (5)

A

Left-sided or right-sided

Systolic or diastolic

Congestive

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2
Q

What are the main drug types used to treat heart failure? 5 types

A

1 Diuretics
2 ACE inhibs/ ARBs
3 Vasodilators
4 Beta-blockers
5 Cardiac Glycosides

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3
Q

Define heart failure

A

The cardiac output is not high enough to provide the O2 and nutritional needs to the body

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4
Q

What are the causes of heart failure?

A

Myocardial damage (>80%)
Hypertension
Genetic/congenital
Chemical toxicity
Infection

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5
Q

What is systolic heart failure?

A

Heart failure caused by reduced contraction of the heart muscles

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6
Q

What is diastolic heart failure?

A

Heart failure caused by reduced filling of the heart

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7
Q

How do the cardiovascular systems compensate for reduced cardiac output?

A

Increasing SNS activity
Increased Renin-angiotensin system
Increased force of heart contractions
Ventricular hypertrophy

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8
Q

Why/how does SNS activity spike to compensate for low cardiac output?

A

The BRs detect low bp, trigger increased SNS activity.

SNS activity goes up raising heart rate, contraction force, and PVR

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9
Q

What are the symptoms of increased SNS activity when CO is low?

A

Tachycardia, sweating, and fluid retention are all side effects of the SNS activity trying to lift cardiac output

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10
Q

How does the renin-angiotensin system help counteract low cardiac output?

A

When CO drops, blood flow to the kidneys drops.

Kidneys release renin, renin turns angiotensin 1 -> angiotensin 2

Angiotensin 2 causes release of…

Aldosterone from the adrenal cortex

Antidiuretic hormone from the brain

ESSENTIALLY.

Kidneys increase fluid retention and vasoconstriction which lead to stronger heart contractions raising CO

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11
Q

What is the frank-sterling curve?

A

Graph demonstrates how end-diastolic volume interacts with stroke volume.

As the cardiac muscles are stretched by a higher “pre-load” volume, the stroke volume goes up.

As the volume gets too high, it becomes inefficient, leading to a plateau or drop in the curve.

This inefficient volume may be lower in a heart with heart failure.

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12
Q

Ventricular enlargement is…

A

When the cavities of the heart dilate in order to maintain CO (hold more blood)

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13
Q

Ventricular hypertrophy is…

A

When the cardiac muscle cells grow to compensate for increased stress or damage to the heart

They can overgrow and prevent proper CO

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14
Q

What is a compensated heart?

A

When your heart is failing to maintain CO, systems like SNS, renal angiotensin etc can compensate for it.

Usually fine during rest, compensated during exercise.

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15
Q

What is a decompensated heart?

A

When the compensatory systems can no longer bring CO back to the necessary level. The heart is severely damaged.

Heart stretching or hypertrophy damages the heart further

May cause edema

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16
Q

What is edema?

A

The excessive build-up of fluid in venous systems can cause swelling or leak into tissues like the lungs.

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17
Q

What is congestive heart failure?

A

A combination of a decompensated heart with edema.

The body can’t respond to Congestive heart failure. High mortality rate

18
Q

What are the symptoms of congestive heart failure (8)

A

Tachycardia
Shortness of breath
Sweating
Edema
Low exercise tolerance
Heart enlargement
Hyper/hypotension
Urine retention

19
Q

What are the treatment strategies of heart failure?

A

Lifestyle changes

Medications

Devices/surgical procedures

20
Q

What are the lifestyle changes used to treat heart failure? (4)

A

Diet changes (less salt, alcohol and caffeine)
Exercise (carefully)
Stress management
Quit smoking

21
Q

What are the medication types used to treat heart failure? (5)

A

Diuretics
ACE inhibs/ARBs
Cardiac glycosides
Beta-blockers
Vasodilators

*usually multiple drugs

22
Q

What are the devices/surgeries used to treat heart failure? (5)

A

Angioplasty
Bypass
Transplants
Ventricular pacemakers
Left ventricular assist devices

23
Q

What are the 4 classes of heart failure

A

Class I (Mild)
Class II (Mild)
Class III (Moderate)
Class IV (Severe)

24
Q

What are the symptoms of class I heart failure?

A

Fine during rest and normal physical activity

25
Q

What are the symptoms of class II heart failure?

A

Ordinary physical activity may show symptoms,, fine at rest

26
Q

What are the symptoms of class III heart failure?

A

Some limitations on below ordinary physical activity, comfort at rest

27
Q

What are the symptoms of class IV heart failure?

A

Cant do any physical activity without discomfort, some discomfort at rest

28
Q

What ACE inhibitor drug can be prescribed to help with heart failure?

A

Enalapril can be prescribed for mild heart failure or left ventricular dysfunction

29
Q

What ARB can be prescribed to help with heart failure?

A

Losartan can be prescribed for mild heart failure

30
Q

What medication can be prescribed to patients with edema?

A

Diuretics like furosemide are a first-line treatment for pulmonary edema

Also vasodilators

31
Q

What drugs can be prescribed to help with excessive tachycardia?

A

Low-dose beta-blockers like metoprolol

**must be done cautiously

32
Q

Why do we need to be careful in prescribing beta-blockers for heart failure?

A

They decrease heart rate and contraction. This could aggravate the disease or kill the patient

33
Q

What restores the membrane potential for a normal cardiac rhythm?

A

Na+/K+ ATPase

Sodium potassium ATPase

34
Q

What are cardiac glycosides?

A

Medications used in patients who have CHF and atrial fibrillation, or patients who have left ventricle issues, or patients who are still showing symptoms for the above conditions following treatment

35
Q

What is an example of a cardiac glycoside?

A

Digoxin is a cardiac glycoside, absorbed and distributed well.

Directly affects heart

Indirectly affects baroreceptors

36
Q

How does Digoxin work?

A

Digoxin inhibits the Na+/K+ ATPase

Increases intracellular sodium

This increases intracellular calcium

Higher calcium leads to stronger heart contractions

Stronger contractions = less baroreceptor firing = increase PSNS activity = slower heart rate

ESSENTIALLY

Digoxin increases contraction strength which indirectly reduces heart rate.

37
Q

What is the half-life of digoxin?

A

40 hours

38
Q

What is the therapeutic index of digoxin?

A

0.5-1.5 ng/ml (plasma concentration)

39
Q

When is toxicity observed with digoxin?

A

> 2 ng/ml

40
Q

How is a therapeutic dose of digoxin given quickly?

A

Start with a large dose to get blood concentration up, then give a maintenance dose

41
Q

What are the toxicities of Digoxin?

A

Arrhythmias, especially in patients with low K+

Quinidine (an anti-arrhythmic) reduces digoxin clearance which can cause overdosing

GI/CNS toxicity: nausea, vomiting, diarrhea, headaches, dizziness, vision disturbances.

Pharm Exam (11 decks)

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