Heart Failure 2 Flashcards

1
Q

Which drug?

  • Competitively blocks B1 receptors and alpha 1 receptors
  • Slows HR
  • Reduces HF mortality
  • Used in Chronic HF (to slow progression)
  • Should be taken w/ food
  • HTN and CHF med
A

Carvedilol (beta blocker)

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2
Q

Which BB is effective in both systolic and diastolic HF?

(HFrEF & HFpEF)

A

Nebivolol

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3
Q

Which drug?***

  • MOA: releases nitric oxide (NO)
  • Effects: Venodilation - reduces preload and ventricular stretch
  • Used in: acute and chronic HF (angina)
  • Toxicity: postural hypotension, tachycardia, HA
  • Synergistic w/ phosphodiesterase type 5 inhibitors
A

Isosorbide dinitrate

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4
Q

Which drug?***

  • Used for chronic HF in African Americans
  • Indicated in conjunction w/ standard HF therapy to improve survival/reduce hospitalizations in self identified African American pts
A

Hydralazine Isosorbide Dinitrate (Bidil)

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5
Q

***Which drug?*****

  • MOA: probably increases Nitric Oxide (NO) synthesis in endothelium
  • Reduces BP and afterload
  • Results in increased CO
  • W/ nitrates has reduced mortality
  • Toxicity: tachycardia, fluid retention, lupus like syndrome
A

Hydralazine (arteriolar dilator)

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6
Q

Which drug?

  • Rapid, powerful vasodilation which reduces preload/afterload
  • Used in acute severe decompensated HF
  • Toxicity: excessive hypotension, thiocyanate and cyanide toxicity
A

Nitroprusside (vasodilator)

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7
Q

Which drug?

  • Cardiac glycoside
  • MOA: Na/K ATPase inhibition results in reduced Ca expulsion and increased Ca stored in sarcoplasmic reticulum
  • Effects: increases contractility, cardiac parasympathomimetic effect (slowed sinus HR, slowed atrioventricular conduction)
  • Used in: chronic symptomatic HF and rapid ventricular rate in atrial fibrillation
  • REDUCE dose in elderly
  • Nausea, vomiting, diarrhea
  • Cardiac arrhythmias
A

Digoxin

(not show to reduce mortality w/ HFrEF)

(Digibind: dig antibodies)

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8
Q

Diuretics used in acute or chronic HF?

A

Both

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9
Q

Beta Blockers used in acute or chronic HF?

A

Chronic HF

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10
Q

Vasodilators used in acute or chronic HF?

A

Both

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11
Q

Used in acute or chronic HF?

  • Cardiac glycosides
  • Angiotensin receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Aldosterone receptor antagonists
A

Chronic HF

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12
Q

**Used in acute or chronic HF?****

  • Bipyridines
  • Natriuretic peptide
  • HCN, /f current inhibitor
A

Acute HF

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13
Q

Which drug?***

  • MOA: Beta-selective agonist (increases cAMP synthesis)
  • Increases cardiac contractility, output
  • Used in acute decompensated HF
  • Intermittent therapy in chronic failure reduces sxs
  • IV only!!!
A

Dobutamine

(Beta adrenoceptor agonists)

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14
Q

Which drug?***

  • MOA: Dopamine receptor agonist
  • Higher doses activate Beta and alpha adrenoceptors
  • Increases renal blood flow
  • Higher doses increase cardiac force and BP
  • Used in acute decompensated HF and shock
  • IV only!!
  • no renin release
A

Dopamine

(Beta adrenoceptor agonists)

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15
Q

Which drug?

  • MOA: Phosphodiesterase type 3 inhibitors (decrease breakdown of cAMP)
  • Vasodilators; lower periph vasc resistance
  • Increase contractility
  • Used in acute decompensated HF
  • Increase mortality in chronic HF
  • IV only!!
  • Toxicity: arrhythmias
A
  • Inamrinone
  • Milrinone

(Bipyridines)

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16
Q

Which drug?

  • MOA: activates BNP receptors, increases cGMP
  • Vasodilation (diuresis)
  • Used in acute decomp failure
  • NOT shown to reuce mortality
  • IV only!!
  • Toxicity: renal damage***
A

Nesiritide

(Naturiuretic Peptide)

17
Q

Which drug?

  • MOA: prolongs diastolic time by inhibiting f current within HCN channel (reducing HR)
  • Indication: sxs of HF that are stable
  • **Hopefully reduces risk of being hospitalized for worsening HF***
A

Ivabradine

(HCN f Current Inhibitor)

18
Q

What are the 4 SE of Ivabradine?

A
  • Dizziness
  • Fatigue
  • Less common: increased BP and A. fib
19
Q
  • Ivabradine can be used in people w/ HR of at least ___ BPM.
  • Only used for stable HF
  • Don’t use in people w/ HR
A
  • at least 70
  • Not under 60
20
Q

3 toxicities of Ivabradine

A
  • SSS (sick sinus syndrome)
  • 3rd degree AV block
  • Severe hepatic impairment
21
Q

In patients w/ NYHA class 2 and 3 heart failure and iron deficiency, what might be reasonable to give for improvement of functional status?

A

IV iron replacement

22
Q

In patients w/ HF, the optimal BP in those with HTN should be less than ____ mmHg

A

130 / 80

23
Q

In patients w/ CVD and obstructive sleep apnea, what may be reasonable to improve sleep quality and daytime sleepiness?

A

CPAP (Continuous positive airway pressure)

24
Q

Case:

  • 65 yr male, w/ SOB on exertion several weeks after viral illness
  • Swelling of feet/ankles and increasing fatigue
  • PE: mild SOB lying down, better upright
    • Pulse 105/regular
    • BP: 90/60
    • Crackles bilateral bases
    • JVP elevated
    • Liver enlarged
    • 3+ edema of anles/feet
  • Echo: dilated, poorly contracting, Left EF reduced
  • Dx: cardiomyopathy secondary to viral infection (stage C class 3 HF)
  • Do you tx HF or HTN first?
  • Steps of therapy?
A
  • Tx HF first! Then carefully control HTN
  • Initially tx w/ diuretic: Furosemide
    • this improved SOB on exertion/orthopnea
  • ACE-I was added
    • felt better
  • Digoxin added to improve exercise tolerance
  • BP stabilized at 150/90
  • Educate pt on HTN and HF and BP control
  • Consider adding BB (metoprolol)
  • Monitor blood lipids