Term
| The 6 steps of Heart Failure (HF) assessment |
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Definition
1. Is the HF ischemic? (Angiogram [cath lab], stress test)
2. Is the HF nonischemic (ECG, HTN, Meds/drugs/alcohol)
3. Check TSH levels - The problem maybe thyroid not HF
4. Check for Viruses (HIV...)
5. If unable to determine if the problem is lung or heart, check BNP levels (normal = lung)
6. Is the problem systolic or diastolic? A systoilic problem will be indicated by LVEF <40% + signs/symptoms |
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Term
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Definition
Sleeping on pillows beacuse unable to catch breath when laying flat
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Term
| Define Paroxysmal nocturnal dypnea (PND) |
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Definition
| Waking up at night out of breath |
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Term
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Definition
| Jugular vienous pressure - Indicates pressure of the right atrium |
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Term
| What 6 symptoms are used to determine the severity of HF? |
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Definition
Orthopnea (# of pillows)
PND
JVP
Weight gain
Periphreal edema
Dyspnea/fatigue (NYHA classification) |
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Term
| Describe NYHA Classification system |
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Definition
I - No limitations
II - Dyspnea at max exertion
III - Dyspnea with min exertion
IV - Dyspnea at rest |
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Term
| What are for common "Why now" reasons for HF? |
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Definition
1. NSAIDS
2. Disease progression
3. Noncompliance (diet/meds)
4. Cocaine/alcohol |
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Term
| 5 therapeutic objectives when treating HF? |
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Definition
1. Decrease death
2. Decrease # of hospitilizations
3. Decrease symptoms
4. Decreas progression
5. Improve functional capacity |
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Term
What is more important in managin HF pts
A. BP goal
B. Drug dosing targets |
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Definition
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Term
What is the AHA BP recommendation for Left ventricular dysfunction HFrEF pts?
If a pt has a much lower BP, and was asymptomatic would you be concerned? |
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Definition
<120/80
No, target dosing saves lifes - as long as pt is asymptomatic this does not matter |
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Term
| T/F - All HFrEF pts should be on a statin? |
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Definition
| F - only atheroscerosis and diabetic pts should be on a statin |
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Term
| When should pts check their weight? |
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Definition
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Term
| What are 4 important counseling points for HF pts? |
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Definition
Disease description
Why these drugs
No sodium or potassium substitutes
Signs/symptoms of dises worsening/flare ups |
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Term
| Reduced ejection fraction (REF) HF pts should always be on which 2 drugs LONG term? |
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Definition
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Term
| Which three drugs are add on therapies for REF HF pts outside of therapeutic goals, and which one is most preferred? |
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Definition
1. aldosterone antagonists (preferred)
2. Hydralazine
3. Digoxing |
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Term
| You started an HFrEF pt on an ACEi, and their serum creatinine increased 20-30% - Are you concerned? |
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Definition
| No this is a sign the drug is working. |
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Term
| How often are ACEi doses titrated up in a hospitalized HFrEF pt? |
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Definition
| Every 2-3 days - need to reach goals to save lives |
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Term
| T/F ACEis are for HFrEF pts with stable renal function only? |
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Definition
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Term
| T/F the HFrEF pt will immediately feel better after starting an ACEi? |
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Definition
| No the effect takes 2-3 months |
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Term
| You titrated up a pts ACEi dose this morning, and now the HFrEF pt is feeling dizzy - What do you do next? |
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Definition
| Lower the dose to previous levels |
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Term
| Your HFrEF pt has a sulfur allergy - which ACEi should they avoid? |
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Definition
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Term
| HFrEF pt reports Angioedema like symptoms - what happens next? |
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Definition
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Term
| What 3 situations are contraindicated for ACEi therapy in HFrEF pts? |
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Definition
1. Pregnancy
2. Hyperkalemic
3. ACUTE kidney injury |
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Term
| T/F all HFrEF pts get started on an ACEi? |
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Definition
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Term
| One advantage catopril has over other ACEis is... |
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Definition
| A short half life (6-8hrs) |
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Term
| ACEi are better than ARBs b/c... |
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Definition
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Term
| ARBs are chosen over ACEi b/c... |
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Definition
Dry cough
Previoous rxn to an ACEi |
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Term
| What are the 3 BBs of HFrEF, and their goal dosing? |
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Definition
1. Metoprolol SUCCINATE 200mg qDAY
2. Carvedilol 25mg BID
3. Bisoprolol (least common) |
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Term
| Metoprolol is better for a HFrEF pt that also has COPD b/c... |
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Definition
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Term
| Carvedilol might be better for a HTN HFrEF pt b/c |
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Definition
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Term
| How often can a BB dose be titrated up? How long dose it take to reach goal dosing for a HFrEF pt? |
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Definition
Once every 2 weeks
Can take up to a year! |
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Term
| T/F BBs are contraindicated for diabetic HFrEF pts? |
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Definition
| False - pts just need to be counseled on the masking of diabetic indicators, and proactively manage the disease |
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Term
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Definition
| Negative ionotropic effect = decreased HR |
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Term
| Your HFrEF pt calls, and reports feeling bad over the last two weeks since the started the BB you prescribed - what next? |
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Definition
Do nothing! They will begin to feel better than ever over the next week
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Term
| Your new HFrEF pt has depression. Should they receive a BB script? |
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Definition
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Term
| T/F A HFrEF pt will immediately feel better when starting a loop diuretic? |
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Definition
| True - effect is immediate unlike ACEi/BB |
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Term
Accessing a HFrEF pt they have
- dry mucus membrane
- skin tinting
- dizziness
What next? |
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Definition
| Toom much diuretic - not enough volume |
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Term
List the 5 diurectic agents of HFrEF,
which is most common,
which is give to pts with a sulfa allergy, and
which is an add on therapy to the others |
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Definition
1. furosemide (common)
2. Beumetanide
3. Turosemide
4. Metolazone (add on)
5. Archraothinic (sp) Acid (allergy) |
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Term
| T/F Furosemide should be given as a drip |
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Definition
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Term
| Which HFrEF pts should not receive an aldosterone agent |
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Definition
| Those with compliance issues! |
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Term
| Major concern when using an aldosterone antagonist? |
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Definition
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Term
What two aldosterone agents are approved for HFrEF pts?
When is each one used |
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Definition
Spironolactone 25mg/qDAY (preferred b/c cost)
eplerenone 50mg/qDAY (expensive, for men who grow breasts on spironolactone)
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Term
| Aldosterone monitoring schedule |
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Definition
| 3 days, 1 week, every month thereafter |
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Term
| When is hydralazine used as an add on therapy in HFrEF? |
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Definition
| African american males (NYHA III/IV) who can not reach therapeutic goals on ACEi and BB alone |
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Term
| When is hydralizine used as a primary therapeutic agent in HFrEF? |
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Definition
| In pts with AKI and/or ACEi intolerance |
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Term
| How is hydralazine dosed for HFrEF? |
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Definition
75mg hydralazine/40mg Nitrate TID
Daily total: 225/120 |
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Term
| T/F Pts can use PDE-5s while on hydralazine? |
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Definition
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Term
| T/F - Hydralazine effects BP and BNP hormone levels? |
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Definition
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Term
| Digoxin is best suited for a pt with HFrEF and what other heart disorder? |
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Definition
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Term
Digoxin dosing goals for
1. Normal HFrEF pt
2. Reduced renal function pt
3. ESRD pt |
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Definition
Normal HF pt - 125mcg qDAY
PT with CrCl <50 - 125mcg q48h
Pt with ESRD - 125mcg on Dialysis days
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Term
| What is amioderone's effect on digoxin? |
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Definition
| Decreases elimination rate by half. Therefore you should reduce the dose by half |
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Term
Which classification is ideal?
[image] |
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Definition
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Term
Which classification requires the use of both a diuretic, and an ionotrope?
[image] |
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Definition
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Term
Which classification requires the use of only a diuretic?
[image] |
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Definition
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Term
What are CI and PCWP goals in HFrEF?
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|
Definition
CI above 2.2
PCWP less than 18 |
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|
Term
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Definition
| Cardiac index = Cardiac Output ÷ BSA |
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Term
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Definition
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Term
| What two categories of HFrEF pts are best suited for long-term ionotrope use? |
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Definition
1. Hospice
2. Transplant waiting list |
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Term
| What should be monitored during ionotrope therapy? |
|
Definition
1. HR
2. BP
3. PCWP - if possible
4. CO
5. Volume |
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Term
| What is the problem with long-term ionotrope use? |
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Definition
1. Ventricular arrhythmias
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Term
| What are the 4 ionotropes of HFrEF? |
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Definition
Milrinone
Dobutamine
Nitroprusside
Nitroglyceride |
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Term
| Should milrinone be given as a bolus dose? |
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Definition
| No - it has a quick onset (30 min) |
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Term
| Dobutamine, and milrinone what type of drugs? |
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Definition
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Term
| What is the half life of dobutamine? |
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Definition
| Extremely short - Only minutes |
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Term
| What is the most efficent way to test for cyanide activity in realation to Nitroprusside? |
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Definition
| Look for symptoms of meatbolic acidosis - lab test take 2-3 Days |
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Term
| Under what cicumstance is nitroglycerine best used in a HFrEF pt |
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Definition
| Pt with an acute MI + HF - It reduces preload |
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Term
| What two antiarrhythmic drugs are okay for HFrEF pts, and which is most common? |
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Definition
Amiodorone (common)
Dofetilide |
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Term
| What two CCB drugs are okay for HFrEF pts? |
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Definition
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