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UMB Heart Failure - PHAR550
Heart Failure - PHAR550
68
Pharmacology
Professional
01/15/2014

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Cards

Term
The 6 steps of Heart Failure (HF) assessment
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

Term
Define orthopnea
Definition

Sleeping on pillows  beacuse unable to catch breath when laying flat

 

Term
Define Paroxysmal nocturnal dypnea (PND)
Definition
Waking up at night out of breath
Term
What is JVP?
Definition
Jugular vienous pressure - Indicates pressure of the right atrium
Term
What 6 symptoms are used to determine the severity of HF?
Definition

Orthopnea (# of pillows)

PND

JVP

Weight gain

Periphreal edema

Dyspnea/fatigue (NYHA classification)

Term
Describe NYHA Classification system
Definition

I - No limitations

II - Dyspnea at max exertion

III - Dyspnea with min exertion

IV - Dyspnea at rest

Term
What are for common "Why now" reasons for HF?
Definition

1. NSAIDS

2. Disease progression

3. Noncompliance (diet/meds)

4. Cocaine/alcohol

Term
5 therapeutic objectives when treating HF?
Definition

1. Decrease death

2. Decrease # of hospitilizations

3. Decrease symptoms

4. Decreas progression

5. Improve functional capacity

Term

What is more important in managin HF pts

A. BP goal

B. Drug dosing targets

Definition
Drug dosing targets
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?

Definition

<120/80

 

No, target dosing saves lifes - as long as pt is asymptomatic this does not matter

Term
T/F - All HFrEF pts should be on a statin?
Definition
F - only atheroscerosis and diabetic pts should be on a statin
Term
When should pts check their weight?
Definition
Same time every day
Term
What are 4 important counseling points for HF pts?
Definition

Disease description

Why these drugs

No sodium or potassium substitutes

Signs/symptoms of dises worsening/flare ups

Term
Reduced ejection fraction (REF) HF pts should always be on which 2 drugs LONG term?
Definition

1. ACEi

2. BB

Term
Which three drugs are add on therapies for REF HF pts outside of therapeutic goals, and which one is most preferred?
Definition

1. aldosterone antagonists (preferred)

2. Hydralazine

3. Digoxing

Term
You started an HFrEF pt on an ACEi, and their serum creatinine increased 20-30% - Are you concerned?
Definition
No this is a sign the drug is working.
Term
How often are ACEi doses titrated up in a hospitalized HFrEF pt?
Definition
Every 2-3 days - need to reach goals to save lives
Term
T/F ACEis are for HFrEF pts with stable renal function only?
Definition
True
Term
T/F the HFrEF pt will immediately feel better after starting an ACEi?
Definition
No the effect takes 2-3 months
Term
You titrated up a pts ACEi dose this morning, and now the HFrEF pt is feeling dizzy - What do you do next?
Definition
Lower the dose to previous levels
Term
Your HFrEF pt has a sulfur allergy - which ACEi should they avoid?
Definition
Catopril
Term
HFrEF pt reports Angioedema like symptoms - what happens next?
Definition
Straight to the ER
Term
What 3 situations are contraindicated for ACEi therapy in HFrEF pts?
Definition

1. Pregnancy

2. Hyperkalemic

3. ACUTE kidney injury

Term
T/F all HFrEF pts get started on an ACEi?
Definition
True
Term
One advantage catopril has over other ACEis is...
Definition
A short half life (6-8hrs)
Term
ACEi are better than ARBs b/c...
Definition
Cost/Clinical data
Term
ARBs are chosen over ACEi b/c...
Definition

Dry cough

Previoous rxn to an ACEi

Term
What are the 3 BBs of HFrEF, and their goal dosing?
Definition

1. Metoprolol SUCCINATE 200mg qDAY

2. Carvedilol 25mg BID

3. Bisoprolol (least common)

Term
Metoprolol is better for a HFrEF pt that also has COPD b/c...
Definition
Beta 1 selective
Term
Carvedilol might be better for a HTN HFrEF pt b/c
Definition
Alpha agonist properties
Term
How often can a BB dose be titrated up?  How long dose it take to reach goal dosing for a HFrEF pt?
Definition

Once every 2 weeks

 

Can take up to a year!

Term
T/F BBs are contraindicated for diabetic HFrEF pts?
Definition
False - pts just need to be counseled on the masking of diabetic indicators, and proactively manage the disease
Term
BB MOA?
Definition
Negative ionotropic effect = decreased HR
Term
Your HFrEF pt calls, and reports feeling bad over the last two weeks since the started the BB you prescribed - what next?
Definition

Do nothing!  They will begin to feel better than ever over the next week

 

Term
Your new HFrEF pt has depression.  Should they receive a BB script?
Definition
YES!
Term
T/F A HFrEF pt will immediately feel better when starting a loop diuretic?
Definition
True - effect is immediate unlike ACEi/BB
Term

Accessing a HFrEF pt they have

  • dry mucus membrane
  • skin tinting
  • dizziness

What next?

Definition
Toom much diuretic - not enough volume
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

Definition

1. furosemide (common)

2. Beumetanide

3. Turosemide

4. Metolazone (add on)

5. Archraothinic (sp) Acid (allergy)

Term
T/F Furosemide should be given as a drip
Definition
NO Bollus!
Term
Which HFrEF pts should not receive an aldosterone agent
Definition
Those with compliance issues!
Term
Major concern when using an aldosterone antagonist?
Definition
Hyperkalemia
Term

What two aldosterone agents are approved for HFrEF pts?

When is each one used

Definition

Spironolactone 25mg/qDAY (preferred b/c cost)

eplerenone 50mg/qDAY (expensive, for men who grow breasts on spironolactone)

 

Term
Aldosterone monitoring schedule
Definition
3 days, 1 week, every month thereafter
Term
When is hydralazine used as an add on therapy in HFrEF?
Definition
African american males (NYHA III/IV) who can not reach therapeutic goals on ACEi and BB alone
Term
When is hydralizine used as a primary therapeutic agent in HFrEF?
Definition
In pts with AKI and/or ACEi intolerance
Term
How is hydralazine dosed for HFrEF?
Definition

75mg hydralazine/40mg Nitrate TID

 

Daily total: 225/120

Term
T/F Pts can use PDE-5s while on hydralazine?
Definition
False
Term
T/F - Hydralazine effects BP and BNP hormone levels?
Definition
False - BP only
Term
Digoxin is best suited for a pt with HFrEF and what other heart disorder?
Definition
A fib
Term

Digoxin dosing goals for

1. Normal HFrEF pt

2. Reduced renal function pt

3. ESRD pt

Definition

Normal HF pt - 125mcg qDAY

 

PT with CrCl <50 - 125mcg q48h

 

Pt with ESRD - 125mcg on Dialysis days

 

Term
What is amioderone's effect on digoxin?
Definition
Decreases elimination rate by half.  Therefore you should reduce the dose by half
Term

Which classification is ideal?

 

[image]

Definition
I
Term

Which classification requires the use of both a diuretic, and an ionotrope?

 

[image]

Definition
IV
Term

Which classification requires the use of only a diuretic?

 

[image]

Definition
II
Term

What are CI and PCWP goals in HFrEF?

 

Definition

CI above 2.2

PCWP less than 18

Term
How is CI calculated?
Definition
Cardiac index = Cardiac Output ÷ BSA
Term
How is PCWP measured?
Definition
Invasively
Term
What two categories of HFrEF pts are best suited for long-term ionotrope use?
Definition

1. Hospice

2. Transplant waiting list

Term
What should be monitored during ionotrope therapy?
Definition

1. HR

2. BP

3. PCWP - if possible

4. CO

5. Volume

Term
What is the problem with long-term ionotrope use?
Definition

1. Ventricular arrhythmias

 

Term
What are the 4 ionotropes of HFrEF?
Definition

Milrinone

Dobutamine

Nitroprusside

Nitroglyceride

Term
Should milrinone be given as a bolus dose?
Definition
No - it has a quick onset (30 min)
Term
Dobutamine, and milrinone what type of drugs?
Definition
Beta agonists
Term
What is the half life of dobutamine?
Definition
Extremely short - Only minutes
Term
What is the most efficent way to test for cyanide activity in realation to Nitroprusside?
Definition
Look for symptoms of meatbolic acidosis - lab test take 2-3 Days
Term
Under what cicumstance is nitroglycerine best used in a HFrEF pt
Definition
Pt with an acute MI + HF - It reduces preload
Term
What two antiarrhythmic drugs are okay for HFrEF pts, and which is most common?
Definition

Amiodorone (common)

Dofetilide

Term
What two CCB drugs are okay for HFrEF pts?
Definition

amlodipine

felodipine

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