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Cardiovascular II > Treatment of HF > Flashcards

Treatment of HF Flashcards

1
Q

Class I HF according to NYHA classification

A

No limitation of physical activity

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2
Q

Class II HF according to NYHA classification

A

Slight limitation of physical activity
Comfortable at rest

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3
Q

Class III HF according to NYHA classification

A

Marked limitation of physical activity

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4
Q

Class IV HF according to NYHA classification

A

Unable to perform physical activity
Symptoms at rest

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5
Q

Class I HF based on EF value

A

HF with LVEF of 40% or less

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6
Q

Class II HF based on EF value

A

HF with LVEF of 41-49%

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7
Q

Class III HF based on EF value

A

HF with LVEF of 50% or more

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8
Q

Signs and symptoms of LHF

A

Dyspnea
Orthopnea
PND
Diaphoresis
Cool extremities
S3 heart sound

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9
Q

Signs and symptoms of RHF

A

Fluid retention –> pitting edema, ascites, and hepatomegaly
JVD
Epistaxis

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10
Q

General goals in treatment of HF

A

Increase contractility
Decrease preload and afterload
Reduce edema

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11
Q

Direct effects of digoxin on the heart

A

Inhibits Na/K ATPase resulting in increased force of contraction and decreased conduction velocity at AV node

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12
Q

Indirect effects of digoxin

A

Inhibition of neuronal Na/K ATPase activates cholinergic and sympathetic systems

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13
Q

Result of activation of cholinergic and sympathetic systems on the heart from digoxin

A

Cholinergic –> decrease HR
Sympathetic –> increase contractility

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14
Q

Positively inotropic drugs for HF

A

Digoxin
Sympathomimetic - adrenoceptor agonists
Phosphodiesterase inhibitors (bipyridines)

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15
Q

Clinical used of digoxin

A

CHF
SVT, except in WPW

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16
Q

Half-life of digoxin

A

24-36 hrs

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17
Q

Drugs that displace digoxin

A

Amiodarone
Propafenone
Quinidine
Verapamil

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18
Q

GI adverse effects of digoxin

A

Anorexia
N/V/D

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19
Q

CNS adverse affects of digoxin

A

HA
Disorientation
Visual halos

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20
Q

Is digoxin metabolized by liver or kidneys?

A

Kidneys

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21
Q

CVS adverse effects of digoxin

A

PVCs
AV block
Sinus bradycardia
Inverted T waves on ECG

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22
Q

Triggers of digitalis toxicity

A

Hypokalemia
Hypomagnesemia
Hypercalcemia

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23
Q

Drugs that may cause digitalis toxicity if taken with digoxin

A

Loop and thiazide diuretics
Quinidine
Verapamil
NSAIDs
Amiodarone
Erythromycin

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24
Q

Antidote for digitalis toxicity

A

DigiFab/digiband
Supportive therapy –> electrolytes and anti-arrhythmics

25
Q

Adrenoceptor agonists used in HF as inotropic drugs

A

Dobutamine
Dopamine

26
Q

Phosphodiesterase inhibitors used in HF as inotropic drugs

A

Inamrinone
Milrinone

27
Q

Mechanism of phosphodiesterase inhibitors used in HF

A

Inhibits PDE
Increase cAMP to increase contractility
Increase cGMP to cause vasodilation

28
Q

Clinical use of phosphodiesterase inhibitors

A

Short-term for CHF

29
Q

Adverse effects of phosphodiesterase inhibitors

A

Hypotension
Thrombocytopenia –> inamrinone

30
Q

Vasodilators used in HF

A

ACE inhibitors
Angiotensin receptor blockers (ARB)
Hydralazine
Isosorbide
Nesiritide

31
Q

Aldosterone antagonists used in HF

A

Spironolactone
Eplerenone

32
Q

Beta-adrenoceptors blockers used in HF

A

Carvedilol
Metoprolol
Bisoprolol

33
Q

Diuretics used in HF

A

Furosemide
Bumetanide
Torsemide

34
Q

ER combination treatment for HF

A

Sympathomimetic –> dobutamine
Diuretic
ACE inhibitor
Ca channel blocker
Beta blocker
Nesiritide

35
Q

Diuretic proven to reduce mortality from HF when combined with ACE inhibitor

A

Spironolactone

36
Q

Drug indicated for use in acute decompensated HF

A

Dobutamine

37
Q

Recombinant B type natriuretic peptide used for HF

A

Nesiritide

38
Q

Mechanism of nesiritide

A

Increases cGMP –> smooth muscle relaxation
Increase natriuresis –> decrease preload

39
Q

Clinical use of nesiritide

A

Relieve dyspnea at rest in severe decompensated CHF

40
Q

Group 1 WHO classification of pulmonary HTN

A

Idiopathic

41
Q

Group 2 WHO classification of pulmonary HTN

A

Secondary to LHF

42
Q

Group 3 WHO classification of pulmonary HTN

A

Secondary to hypoxemia of lung diseases

43
Q

Group 4 WHO classification of pulmonary HTN

A

Secondary to chronic thromboembolism

44
Q

Group 5 WHO classification of pulmonary HTN

A

Secondary to other causes not covered by first for classifications

45
Q

Management of pulmonary HTN

A

Treat underlying condition, if present
Ca channel blocker

46
Q

Endothelin receptor antagonists used in pulmonary HTN

A

Bosentan (both ETa and ETb)
Ambrisentan (ETa)

47
Q

Condition where use of endothelin receptor antagonist is contraindicated

A

Pregnancy

48
Q

Adverse effects of endothelin receptor antogonists

A

Hypotension
Flushing

49
Q

PDE5 inhibitors used in pulmonary HTN

A

Sildenafil
Tadalafil

50
Q

Mechanism of PDE5 inhibitors for pulmonary HTN

A

Increase cGMP to cause vasodilation

51
Q

Prostacyclin analogs used in pulmonary HTN

A

Epoprostenol (IV)
Iloprost (inhaled)
Treprostinil (inhaled)

52
Q

Oral soluble guanylate cyclase inhibitor used in pulmonary HTN and its effect

A

Riociguat –> vasodilation

53
Q

Drugs used for acute HF

A

Carvedilol
Furosemide
Dobutamine
Lisinopril

54
Q

Newly approved drug for HF for use in pts with EF <35% and sinus rhythm with HR >70. Reduces hospitalization.

A

Ivabradine

55
Q

Mechanism of Ivabradine, used for HF

A

Inhibits F channels in SA node to decrease ions and reduce HR

56
Q

Combination drug with neprilysin inhibitor and ARB used in HF in place of ACE inhibitor or ARB.

A

Sacubritril/Valsartan

57
Q

Mechanism of sacubritil

A

Inhibits nephrilysin, an endopeptidase, to increase natriuretic peptide

58
Q
A

Cardiovascular II (29 decks)

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