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86 Cards in this Set

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HF definition?
heart unable to fill or eject blood, does not meet the needs of the body
what are the cardinal symptoms of HF?
fatigue and dyspnea, also edema which can manifest as periph edema and pulm congestion
CO def?
HR X SV
what is SV?
amount ejected per systolic contraction
what is preload?
forces acting on the venous side of circulation
afterload def?
tension in ventricular wall as systole occures
diastolic HF vs systolic HF?
dia is inability of ventricle to relax (diastole) normally
what is the consequence of HF on renal system?
decreased renal blood flow...therefore an increase in angio II ..vasocontriction and aldosterone release increases along with sodium and water retention
what is the consequence of HF on the sympathetic nervous system?
the decreases oxygen causes an increase in Nepe and epi
what does an increase in Nepi and epi release cause?
increase in HR and contractility
what is the consequence of the increase in HR and contracitlity on the hear?
increased heart workload ...stiffening and increased vent size
muscular hypertrophy in HF?
l.
what condition accounts for 2/3 of all sytolic HF? Other etiology or RF of HF?
MI/CAD....hypertension, cardiomyopathy, heart valve defect, congenital defects, alcohol, drugs
what are some of the drugs that could be a RF fro HF?
daunorubicin, glitazone, doxorubinen, etc
Look into some of the differences in L and R HF?
.
define the 4 ACC/AHA classes of HF
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
how do you manage Class A?
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
how to manage class B?
all in class A plus BB in appropirat epts (h of MI or low EF)
How to manage class C?
dietary restrictions, diuretics, BB, ACE usually....use ald antag, arbs, digoxin, hydralazine/nitrates when appropriate
what meds to avoid in class C?
nsiads, non dhp CCB, most antiarrhhythmics
how to treat class D? this is for the ACC/AHA
all above plus....mechanical assiste devices, heart ransplantatoin, continiusou inotropic infusion, hospice
diuretic role in NYHA classification?
volume control and symptom relief
ACE role in NYHA?
reduce mortality by 25%, maximize the dose, for class II-IV
BB role inm NYHA?
reduse mortality by 30%, slow disease progressoin, NYHA class II-IV
what is dog role in NYHA? who should not have it?
does not reduce mortality, improves S&S, increase exercie intolerance...renal pts
who is spironolactone?
HF pts who remain symptomatic, decreases mortality by 30%, monitor K, for NYHA class III-IV
what can be used in spironoactones place?
eplerenone
what is the thing involved in ACE cough?
bradykinin
what is the 2 primary SE responsible for all of the AE of Loop diuretics?
decrease in BP and electrolyte issues
what is the oral equivazlency among loop diuretics for furosemide, bumetanide, torsemide?
fur 40, bumetanid 1, torsemide 10
what are some of the SE of the loop diuretics
hypOkalemia, hyOcalcemia, hypERglycemia, hypOmag/natremia, ototoxicity, photosensitive
what is the effect of the loops that will predispose these pts to dig toxicity?
hypokalemia
what is a drug inxn of torsemide/bumetanide/furosemide?
sulfa
torsemide brand?
demadex
bumetanide brand?
bumex
what is a dosing issue with spironolactone?
titrate to target
spironolactone brand?
aldactone
spironolactone CI?
CrCl under 10, hyperkalemia over 5.5, anuria, PREGNANCY
what are a couple of the interesting SE of spirono?
gynecomastia, mentstrual irregul, hirsutism
what is the CrCl cutoff for eplerenone?
30
what are the cype inxns of eplerenone?
3A4...decrease starting dose when starting cyp3a4 inh
what are the 3a4 inh named for eplerenone?
verapamil, fluconazole, erythromycin
can eplerenone be used in pregnancy, what class is eplerenone in and what is the alternative?
yes, K sparing diuretic (ald rec antac)..spironolactone
what are thiazide diuretics role in HF?
only effective for very early HF
what are the SCr and K guidelines for ald antag per ACC/AHA?
2.5 in men, 2 in women, 5.0 K
what is the inxn of diuretics and nsaids?
decrease hypotensive effect
brand of benazepril?
lotensin
brand of enalapril?
vasotec
brand of lisinopril
prinvil, zestril
brand of ramipril
altace
what to do with ACE and pregnancy?
D/C..preg Cat C 1st trimest, preg cat D 2nd and 3rd trimest
major SE of ace,
cough, hyperkalemai, palp, increase in Scr
what is the SCr increase that you need to be concerned with ACE?
increase of 0.8 or more
what is the pneumogram for ace SE?
captopril...cough, angioedema, proetinurea, tast disturbance, ortho hypo, preg cat D, rash/renal failure, increase K, lithium INcrease
what is the difference in captopril and the other ACE?
take capto 1 hour prior to meals
is the angioedema in ACE cross sensitive to ARBs?
yes
brnad of candesartan?
atacand
brnad of valsartan?
diovan
CI to isosorbide dinitrat/hydralazine?
concurrent use of PDE-i sild
what is the interesting SE of isosorb/dinitrate
lupus like syndrome
what is lupus like syndrome
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.
when is it indicated to take bidil for HF?
class III for black patients
How is carvedilol dosed?
titrated up, starting with 3.125 bid to target 25bid...
how is metoprolol succ dosed?
start 12.5-25 to target 200mg/day
CI to BB in HF?
asthma, 2nd or 3rd degree heart block, bradycardia, shock, severe hepatic impairment
How should BB withdrawal be handled?
do not abruptly withdrawal
inxnx of the BB?
mask hypoglycemia, increase antihyper effecs with some BP and arrhythmia meds, asa/nsiad and thier change in hypotensiz
what is the initial effect of BB on HF?
initially symptoms will not improve, tell pts it may be a couple of weeks, more tired or dizzy at first
pt counseling for BB?
take asap if yo miss a dose, no double dose...swollow the CR whole, feel more tired at first...hypoglycemia mask, change in epipens,
moa of digoxin?
inh Na/K atpas pump, increasing intercellular Ca which leads to contractility (+ inotrope) and CO
what is digoxins effect on the refractory period?
prolongs it by suppressing the AV node
when should digoxin by dose changed?
renal funciton low
when is digoxin CI?
2nd or 3rd degree heart block, wpw with afib
what is the first sign of elevated digoxin levels?
nausea and vomitin and loss of appetite
what are the signs of severe toxicity?
visual disturbances, confusion, HA, dizzy, arrhythmia problems
digoxin antidote?
digibind or digifab
waht are the inxns of dig?
BB andCCB additive HR effects...
what would increase levels
amiodarone, azole antifungals, quinidine, verapamil, erythromycin, cyclosporine, PI's....low K will increase toxicity...cholestyramine, colestipol, spironolactone, st johns wort can decrease absorption
what is an additional indication for digoxin?
afib
what is the primary clearance of digoxin?
renal
what is the half life of digoxin?
1.5-2 days
wha tis the counseling of digoxin?
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....
Heart failure counseling in general?
monitor body weight...sodium restriction....avoid cigs, slcohol, illicit drug use....no nsaids or cox-2...stay medication compliant
waht drugs to avoid in HF? (4 general classes)
antiarrhythmics (exept amiodarone)....nsaids, most CCB, routine combined use of ACE, ARB, ald antag
what is a lab for HF?
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
what is nesiritide?
k