Heart Failure

Front 1

HF definition?

Back 1

heart unable to fill or eject blood, does not meet the needs of the body

Front 2

what are the cardinal symptoms of HF?

Back 2

fatigue and dyspnea, also edema which can manifest as periph edema and pulm congestion

Front 3

CO def?

Back 3

HR X SV

Front 4

what is SV?

Back 4

amount ejected per systolic contraction

Front 5

what is preload?

Back 5

forces acting on the venous side of circulation

Front 6

afterload def?

Back 6

tension in ventricular wall as systole occures

Front 7

diastolic HF vs systolic HF?

Back 7

dia is inability of ventricle to relax (diastole) normally

Front 8

what is the consequence of HF on renal system?

Back 8

decreased renal blood flow...therefore an increase in angio II ..vasocontriction and aldosterone release increases along with sodium and water retention

Front 9

what is the consequence of HF on the sympathetic nervous system?

Back 9

the decreases oxygen causes an increase in Nepe and epi

Front 10

what does an increase in Nepi and epi release cause?

Back 10

increase in HR and contractility

Front 11

what is the consequence of the increase in HR and contracitlity on the hear?

Back 11

increased heart workload ...stiffening and increased vent size

Front 12

muscular hypertrophy in HF?

Back 12

l.

Front 13

what condition accounts for 2/3 of all sytolic HF? Other etiology or RF of HF?

Back 13

MI/CAD....hypertension, cardiomyopathy, heart valve defect, congenital defects, alcohol, drugs

Front 14

what are some of the drugs that could be a RF fro HF?

Back 14

daunorubicin, glitazone, doxorubinen, etc

Front 15

Look into some of the differences in L and R HF?

Back 15

.

Front 16

define the 4 ACC/AHA classes of HF

Back 16

class A: has risk factors (DM, met syndrome, FH, htn, CHD) but no structural or symptoms...class B: structural disease (lowered EF, valve disease, previous MI) but no symtpoms...class C: structue issues and symtpoms....class D: symptoms at rest

Front 17

how do you manage Class A?

Back 17

treat the other conditions...encourage changing some lifestyle things (stop smoking, alcohol, illicit drugs, exercise)...when appropriate use an ACE or ARB (hx of valsular disease, DM, htn, MI etc

Front 18

how to manage class B?

Back 18

all in class A plus BB in appropirat epts (h of MI or low EF)

Front 19

How to manage class C?

Back 19

dietary restrictions, diuretics, BB, ACE usually....use ald antag, arbs, digoxin, hydralazine/nitrates when appropriate

Front 20

what meds to avoid in class C?

Back 20

nsiads, non dhp CCB, most antiarrhhythmics

Front 21

how to treat class D? this is for the ACC/AHA

Back 21

all above plus....mechanical assiste devices, heart ransplantatoin, continiusou inotropic infusion, hospice

Front 22

diuretic role in NYHA classification?

Back 22

volume control and symptom relief

Front 23

ACE role in NYHA?

Back 23

reduce mortality by 25%, maximize the dose, for class II-IV

Front 24

BB role inm NYHA?

Back 24

reduse mortality by 30%, slow disease progressoin, NYHA class II-IV

Front 25

what is dog role in NYHA? who should not have it?

Back 25

does not reduce mortality, improves S&S, increase exercie intolerance...renal pts

Front 26

who is spironolactone?

Back 26

HF pts who remain symptomatic, decreases mortality by 30%, monitor K, for NYHA class III-IV

Front 27

what can be used in spironoactones place?

Back 27

eplerenone

Front 28

what is the thing involved in ACE cough?

Back 28

bradykinin

Front 29

what is the 2 primary SE responsible for all of the AE of Loop diuretics?

Back 29

decrease in BP and electrolyte issues

Front 30

what is the oral equivazlency among loop diuretics for furosemide, bumetanide, torsemide?

Back 30

fur 40, bumetanid 1, torsemide 10

Front 31

what are some of the SE of the loop diuretics

Back 31

hypOkalemia, hyOcalcemia, hypERglycemia, hypOmag/natremia, ototoxicity, photosensitive

Front 32

what is the effect of the loops that will predispose these pts to dig toxicity?

Back 32

hypokalemia

Front 33

what is a drug inxn of torsemide/bumetanide/furosemide?

Back 33

sulfa

Front 34

torsemide brand?

Back 34

demadex

Front 35

bumetanide brand?

Back 35

bumex

Front 36

what is a dosing issue with spironolactone?

Back 36

titrate to target

Front 37

spironolactone brand?

Back 37

aldactone

Front 38

spironolactone CI?

Back 38

CrCl under 10, hyperkalemia over 5.5, anuria, PREGNANCY

Front 39

what are a couple of the interesting SE of spirono?

Back 39

gynecomastia, mentstrual irregul, hirsutism

Front 40

what is the CrCl cutoff for eplerenone?

Back 40

30

Front 41

what are the cype inxns of eplerenone?

Back 41

3A4...decrease starting dose when starting cyp3a4 inh

Front 42

what are the 3a4 inh named for eplerenone?

Back 42

verapamil, fluconazole, erythromycin

Front 43

can eplerenone be used in pregnancy, what class is eplerenone in and what is the alternative?

Back 43

yes, K sparing diuretic (ald rec antac)..spironolactone

Front 44

what are thiazide diuretics role in HF?

Back 44

only effective for very early HF

Front 45

what are the SCr and K guidelines for ald antag per ACC/AHA?

Back 45

2.5 in men, 2 in women, 5.0 K

Front 46

what is the inxn of diuretics and nsaids?

Back 46

decrease hypotensive effect

Front 47

brand of benazepril?

Back 47

lotensin

Front 48

brand of enalapril?

Back 48

vasotec

Front 49

brand of lisinopril

Back 49

prinvil, zestril

Front 50

brand of ramipril

Back 50

altace

Front 51

what to do with ACE and pregnancy?

Back 51

D/C..preg Cat C 1st trimest, preg cat D 2nd and 3rd trimest

Front 52

major SE of ace,

Back 52

cough, hyperkalemai, palp, increase in Scr

Front 53

what is the SCr increase that you need to be concerned with ACE?

Back 53

increase of 0.8 or more

Front 54

what is the pneumogram for ace SE?

Back 54

captopril...cough, angioedema, proetinurea, tast disturbance, ortho hypo, preg cat D, rash/renal failure, increase K, lithium INcrease

Front 55

what is the difference in captopril and the other ACE?

Back 55

take capto 1 hour prior to meals

Front 56

is the angioedema in ACE cross sensitive to ARBs?

Back 56

yes

Front 57

brnad of candesartan?

Back 57

atacand

Front 58

brnad of valsartan?

Back 58

diovan

Front 59

CI to isosorbide dinitrat/hydralazine?

Back 59

concurrent use of PDE-i sild

Front 60

what is the interesting SE of isosorb/dinitrate

Back 60

lupus like syndrome

Front 61

what is lupus like syndrome

Back 61

Drug-induced lupus erythematosus can arise months to years after exposure to drugs prescribed to treat various medical conditions (eg, antihypertensives, antibiotics, anticonvulsants). The most common drugs that cause drug-induced lupus erythematosus are hydralazine, procainamide, quinidine, isoniazid, diltiazem, and minocycline..For proper diagnosis, the following factors should be preliminarily confirmed:

The patient has one or more clinical symptoms of SLE (eg, arthralgias, lymphadenopathy, rash, fever).
Antinuclear antibodies are present.
The patient had no history of SLE prior to using the culprit drug.
The drug was taken anytime from 3 weeks to 2 years prior to the appearance of symptoms.
Clinical improvement is rapid when the drug is discontinued, whereas antinuclear antibodies and other serologic markers slowly decrease toward more normal levels.

Front 62

when is it indicated to take bidil for HF?

Back 62

class III for black patients

Front 63

How is carvedilol dosed?

Back 63

titrated up, starting with 3.125 bid to target 25bid...

Front 64

how is metoprolol succ dosed?

Back 64

start 12.5-25 to target 200mg/day

Front 65

CI to BB in HF?

Back 65

asthma, 2nd or 3rd degree heart block, bradycardia, shock, severe hepatic impairment

Front 66

How should BB withdrawal be handled?

Back 66

do not abruptly withdrawal

Front 67

inxnx of the BB?

Back 67

mask hypoglycemia, increase antihyper effecs with some BP and arrhythmia meds, asa/nsiad and thier change in hypotensiz

Front 68

what is the initial effect of BB on HF?

Back 68

initially symptoms will not improve, tell pts it may be a couple of weeks, more tired or dizzy at first

Front 69

pt counseling for BB?

Back 69

take asap if yo miss a dose, no double dose...swollow the CR whole, feel more tired at first...hypoglycemia mask, change in epipens,

Front 70

moa of digoxin?

Back 70

inh Na/K atpas pump, increasing intercellular Ca which leads to contractility (+ inotrope) and CO

Front 71

what is digoxins effect on the refractory period?

Back 71

prolongs it by suppressing the AV node

Front 72

when should digoxin by dose changed?

Back 72

renal funciton low

Front 73

when is digoxin CI?

Back 73

2nd or 3rd degree heart block, wpw with afib

Front 74

what is the first sign of elevated digoxin levels?

Back 74

nausea and vomitin and loss of appetite

Front 75

what are the signs of severe toxicity?

Back 75

visual disturbances, confusion, HA, dizzy, arrhythmia problems

Front 76

digoxin antidote?

Back 76

digibind or digifab

Front 77

waht are the inxns of dig?

Back 77

BB andCCB additive HR effects...

Front 78

what would increase levels

Back 78

amiodarone, azole antifungals, quinidine, verapamil, erythromycin, cyclosporine, PI's....low K will increase toxicity...cholestyramine, colestipol, spironolactone, st johns wort can decrease absorption

Front 79

what is an additional indication for digoxin?

Back 79

afib

Front 80

what is the primary clearance of digoxin?

Back 80

renal

Front 81

what is the half life of digoxin?

Back 81

1.5-2 days

Front 82

wha tis the counseling of digoxin?

Back 82

this medication will make your heart beat stronger...do not stop suddnely....avoid being overheated or dehydrated....symptoms of overdose...lots of inxns, monitor HR....

Front 83

Heart failure counseling in general?

Back 83

monitor body weight...sodium restriction....avoid cigs, slcohol, illicit drug use....no nsaids or cox-2...stay medication compliant

Front 84

waht drugs to avoid in HF? (4 general classes)

Back 84

antiarrhythmics (exept amiodarone)....nsaids, most CCB, routine combined use of ACE, ARB, ald antag

Front 85

what is a lab for HF?

Back 85

BNP (B type natriuretic peptide), produced by ventricular myocardium in respone to stretch,90% sensitive for HF patients, will not distinguish between sys and diast, the level correlates with HF

Front 86

what is nesiritide?

Back 86

k