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SPR2015 > Treatment of HF > Flashcards

Treatment of HF Flashcards

1
Q

Goals of HF treatment

A

1) Correct underling cause of HF (revascularization for ischemia)
2) Eliminate precipitating factor (infection/anemia)
3) reduce congestion
4) improve blood flow- modulate neurohormonal or devices

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2
Q

Purpose of diuretics

A

Reverse fluid rentention (Na loss)

most common HF therapy

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3
Q

Dosing of diuretics

A

Used chronically + acutely
PO at baseline
IV in hospital (higher dose for renal problem)

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4
Q

Side effects of diuretics

A

dehydration
hypokalemia
sulfa
tinnitus

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5
Q

loop diuretics

A

furosemide
torsemide
bumetanide

non-sulfa = ethacrinic acid

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6
Q

Mechanism of diuretics

A

1) incr salt + water excretion
2) decr intravasc fluid volume
3) decr venous congestion
4) decr dyspnea/edema

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7
Q

Effect of diuretics on Starling curve

A

slight decr in SV for LV end diastolic presure

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8
Q

Furosemide vs. Bumetanide vs. Torsemide

location of metabolism

A 
furo= renal
bumet = hepatic
torsemide = hepatic
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9
Q

ACE inhibitors

A
  • prils (lisinopril, enalapril, benazepril)
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10
Q

what do ACE inhibitors do?

A

inhibit ACE (block AT1 to ATII)

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11
Q

Effects of ACE inhibitors

A

1) direct vasodilation

2) decr aldosterone activation

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12
Q

Side effects of ACE inhibitors

A

1) hypotension
2) worsening renal function (afferent vasconstriction)
3) hyperkalemia
4) cough (kinin)
5) angioedema

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13
Q

ARB = angiotensin receptor blockers

A
  • sartans (valsartan, candesartan, losartan)
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14
Q

what do ARB do?

A

block receptor of angiotensin II

vasodilation
salt/water excretion
K+ retention

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15
Q

ARBs equivalent to ___

A

ACE inhibitor

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16
Q

When do you choose ARB vs. ACE inhibitors

A

when patients develop cough to ACE inhibitor

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17
Q

side effects of ARBs

A

similar to ACE inhibitor BUT NO COUGH

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18
Q

Neprilysin inhibitor

A

New drug = valsartan (ARB)+ socubutril

superior to enalapril (ACE inhibitors)

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19
Q

Names of mineraocorticoid receptor antagonists

A

spironolactone

eplernone

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20
Q

function of MRA

A

block aldosterone receptor

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21
Q

Side effects of MRA

A

hyperkalemia (K+ retention)

gynecomastia (spironolactone only)

22
Q

Beta blockers name

A

-olols (metoprol, carvedilol, bisoprolol)

23
Q

effect of beta blockers

A

antagonize effects of sympathetic system (NE/epi)
blocks beta1 and a1 receptor

decr HR, decr arrhythmia, decr metab demand

24
Q

Side effects of beta blockers

A

1) negative inotrope (short term loss for long-term gain)
- fluid retention
- hypotension
- decr CO –> cardiogenic shock

2) bronchoconstriction by blocking beta2

25
Q

which type of beta blockers to use for asthma

A

specific beta1 blockers

26
Q

3 major drugs for heart failure

A

1) ACE inhibitor
2) Beta blockers
3) angiotensin receptor blockers

27
Q

why use vasodilators for HF?

A

1) arterial vasodilation (antihypertensives)
- decr LV afterload
- decr cardiac work
- less mitral regurg

2) venous vasodilation
- decr preload

3) pulm arterial vasodilation
- decr RV afterload

28
Q

Which GDMT drug plan for NYHA class 1?

A

1) ACE inhibitor or ARB

2) Beta blocker

29
Q

Which GDMT drug plan for volume overload, NYHA Class 2-4

A

1) ACE inhibitor or ARB
2) Beta blocker
3) Loop diuretics

30
Q

Which GDMT plan for african americans, NYHA Class 3-4

A

1) ACE inhibitor or ARB
2) Beta blocker
3) Hydral isosorbide dinitrate

31
Q

Which GDMT for class 2-4 with creatinine >30 mL/min and K+ < 5.0 mEq/dL

A

1) ACE inhibitor or ARB
2) Beta blocker
3) aldosterone antagonist

32
Q

when do you use ICD?

A

1) patients with LVEF <35% or prior dangerous arrhythmia

33
Q

what is the purpose of ICD?

A

abort sudden cardiac death from v-tach or v-fib

34
Q

What is a biventricular pacemaker

A

Leads attach to

1) RA
2) Septum
3) lateral wall of LV

35
Q

when do you use biventricular pacemaker

A

for patients with QRS > 120 msec (BBB)

causes LV wall and septum to contract together to incr SV

36
Q

What drugs do you use for chronic HFrEF to improve symptoms?

A

1) diuretics (furosemide)

2) digitalis (HFrEF with shock- dobutramine, milronone)

37
Q

What treatments do you use for chronic HFrEF to prolong survival

A

1) ACE inhibitors/ ARB
2) Beta blockers
3) Aldosterone receptor antagonists
4) other vasodilators (hydralazine + nitrate)
5) biventricular pacer (CRT)
6) ICD

38
Q

If patient comes in warm and wet how do you treat them?

A

1) dry out with diuretic to decr congestion

2) +/- vasodilate

39
Q

if patient comes in cold and wet how do you treat them?

A

1) warm up (inotrope) –> incr ejection fraction
2) dry out with diuretic
3) +/- vasodilate

40
Q

if patient comes in cold and dry how do you treat them?

A

bad situation
LVAD
transplant
hospice

41
Q

How do you treat acute HF?

A

1) IV diuretics
2) IV vasodilators (nitrates if BP allows)
3) Positive pressure (CPAP/BiPAP) for hypoxia (also reduce preload)
4) IV inotropes for shock only

42
Q

What are positive inotropic agents?

A

1) digoxin (PO) K+/Na+ blocker
2) Dobutamine (IV) - beta agonist
3) milrinone (IV) PDE inhibitor (simil to dobutamine)

43
Q

when do you use positive inotropic agents?

A

acute = reverse shock (long term worsen remodeling)

chronic = Digoxin has no effect on mortality but decr symptoms and hospitalization (decr HR in AFib

44
Q

Effect of positive inotropic agents on Starling curve

A

shift upward,
incr HR incr SV incr CO

improve shorterm

45
Q

For asymptomatic HF what do you use

A

ACE inhibitor/ARB

Beta blocker

46
Q

for chronic stable HF what do you use

A

guideline therapy for HFrEF stable

47
Q

for acute HF what do you use

A

decr beta blocker or stop it

48
Q

for end stage heart failure options?

A

1) transplant
2) LVAD
3) inotrope infusion - hasten death
4) hospice

49
Q

how to treat HFpEF chronic

A

1) treat undelrying disorder (HTN, diabetes, renal)
2) diuretics to keep volume normal (Na retention common)
3) vasodilators to maintain normal BP

50
Q

how to treat HFpEF acute

A

1) IV diuresis
2) nitrates (if BP allows)
3) CPAP/BiPAP

SPR2015 (23 decks)

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