Pharm: HF

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Author:
itzlinds
ID:
270113
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Pharm: HF
Updated:
2014-04-13 12:40:08
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Heart failure
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Description:
HF
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  1. ventricular fxn that is insufficient to meet the body's demands is called:
    heart failure
  2. how is heart failure produced:
    • decrease in the hearts ability to fill during diastole
    • a decrease in the hearts contraction during systole
  3. list (5) causes of HR:
    • coronary artery disease
    • MI
    • valve disorders
    • DM
    • untreated HTN
  4. name the 3 major factors affecting cardiac output:
    • preload
    • contractility
    • afterload
  5. the amount of blood that delivered to a ventricle is called:

    what is the result of this delivered blood:
    preload

    result: stretch of the myocardial fibers during diastole

    the more the fibers are stretched the more forcefully they'll contract, up to a limit

    if that limit is exceeded, heart failure will result
  6. the strength of every contraction is called:
    contractility

    once a pt. has had an MI, myocardial tissue is lost so the the contractility is decreased.
  7. what makes heart cells less able to contract as forcefully, as needed (2):
    • decreased coronary artery diameter
    • decreased blood flow to the heart
    • ...
    • these decrease O2 delivery to the heart cells
  8. what is the fxn of negative inotropic drugs:

    list 3 negative inotropic drugs:
    fxn: decrease contractility

    • negative inotropic drugs
    • beta blockers
    • CCBs
    • quinidine
  9. the systemic arterial pressure and/or peripheral resistance of the arteries is called:
    afterload   ... is what lies beyond the heart

    this pressure must be overcome by the Left ventricle for blood to be pumped out
  10. if the afterload (systemic arterial pressure/peripheral resistance) is excessive, how does the heart respond:
    enlarging, producing ventricular hypertrophy
  11. if the cardiac output from the enlarged ventricle also becomes insufficient to overcome the pressure in the arteries, what will result:
    cardiac output will drop and be insufficient and heart failure will occur
  12. heart failure causes: (3)
    increased preload

    and/or

    decreased contractility

    and/or

    increased afterload
  13. when such compensation (preload, contractility, afterload) is no longer adequate, the insufficient cardiac output becomes apparent, with blood backing up from the inability to pump enough forward.


    what are the symptoms of Left sided heart failure:
    • lung congestion
    • shortness of breath
  14. what are the symptoms of right sided heart failure:
    edema from vein engorgement caused by the resulting increased venous hydrostatic pressure
  15. which class of drugs are used to tx preload:
    diuretics
  16. what is the fxn of positive inotripic drugs:

    name (4) naturally occuring positive inotripic drugs:
    fxn: increase the strength of contractions

    • naturally occuring:
    • epinephrine
    • NE
    • thyroid hormone
    • dopamine
  17. which positive iontropic drug, has been the long mainstay of heart failure:
    digoxin
  18. list (3) ways in which ACEIs and ARBs are  useful for heart failure:
    • decrease cardiac remodeling
    • decrease angiotensin II (or its ability to interact with receptors)
    • indirectly decreasing aldosterone secretion

    considering angiotensin II is the most important vasoconstrictor in the body, decreaseing it lowers BP and thus afterload

    decreasing aldosterone decreases Na+ and blood volume, thus decreasing preload
  19. which class has become the standard heart failure prevention and tx drug:
    ACEIs
  20. pt. care of ACEI or ARB tx should include no background history of which (3) things:
    • angioedema
    • not pregnant
    • not breast feeding
    • .... before starting an ACEI or ARB
  21. watch pts. on ACEIs or ARBs for s/sx of infection, considering they cause:
    neutropenia (low WBC count)
  22. pt. care for ACEIs and ARBs should include watching K+ before and during their tx because:
    ACEI and ARBs cause hyperkalemia
  23. a persistant cough can develop as an adverse effect of:
    ACEI and ARBs
  24. though the BP may respond quickly to ACEIs and ARBs, how long may it take to see improvments in heart failure:
    several weeks
  25. which (2)  stages of cardiac output do the diuretics improve:
    preload and eventually decreasing afterload

    This decrease in heart workload increase the cardiac output as it makes it easier for the heart to pump out the blood
  26. diuretics are rarely given alone for heart failure.

    when are diuretics usually given for the tx of heart failure:
    if there is significant volume excess or edema
  27. in the case of acute heart failure or chronic renal failure, which diuretic is usually preferred:
    loop diuretics are preferred for rapid diuresis

    after an IV dose increased diuresis starts in about 5 minutes
  28. list the (3) contraindications of diuretics for heart failure:
    • anuria
    • hepatic failure
    • dehydration
  29. for pts. on diuretics for HF, report a weight increase or decrease of:
    greater than 2#/day
  30. get enough foods high in potassium of the pt. is on which (2) types of diuretics:

    avoid foods high in potassium if the pt. is on which diuretic:
    • intake high K+ foods:
    • thiazide
    • loop diuretics

    • avoid high K+ foods:
    • K+ sparing
    • aldosterone blockers
  31. a non-selective beta blocker with alpha 1 blockade used for the tx of heart failure is:
    carvedilol (coreg)
  32. a selective beta 1 blocker (non-selective at higher doses) is:
    metoprolol XR
  33. name the only (2) beta blockers approved for the tx of heart failure:
    • carvedilol (coreg)
    • metoprolol XR
  34. why are beta blockers effective for heart failure:
    because they counteract the excess sympathetic nervous system - a response that would, long term, damage the heart
  35. the beta blockers counteracting of the SNS has a:_____________ inotropic effect

    why:
    the beta blockers counteracting of the SNS has a negative inotropic effect

    why: because it decreases the HR
  36. list the (6) contraindications of beta blockers for heart failure:
    • decompensated Heart failure
    • cardiogenic shock
    • COPD
    • asthma
    • heart block
    • bradycardia
  37. for the tx. of beta blockers for heart failure, which (2) groups of pts. need to be monitored more closely:
    • pts. with diabetes mellitsis
    • elderly
  38. pts. should the tx of beta blockers and call their provider if their HR is:
    <60

    and/or

    BP is significantly decreased

    monitor frequently for worsening heart failure
  39. relaxing veins causing them to dilate and contain more blood in the venous system is the MOA of:
    Nitrates

    also dilates the coronary arteries increasing heart oxygenation
  40. nitrates work on which stages of cardiac output:
    preload
  41. if nitrates are given sublinguial, the pt. should avoid:

    how long will it take for nitrates to work if given SL:
    • avoid:
    • eating
    • drinking
    • smoking
    • talking

    ... until its dissolved

    nitrates starts to work: 2-5 minutes after the SL dose
  42. list the (3) side effects of nitrates:
    • a bad headache
    • reflex tachycardia
    • orthostatic hypotension
  43. list the (2) contraindications of nitrates:
    • incrased intra cranial pressure
    • severe anemia
  44. list (4) rx-rx for nitrates:
    • phenothiazines
    • anti-hypertensives
    • alcohol
    • sildenafil (viagra)
    • other drugs for ED
  45. cardiac glyosides are positive inotropics so the effect is:
    increasing the cardiac output
  46. via the cardiac glycosides effect of the SA node they:

    the cardiacy glyocsides also decreases the conduction thru the AV node giving it:
    via the cardiac glycosides effect of the SA node they: decrease the heart rate

    the cardiacy glyocsides also decreases the conduction thru the AV node giving it: anit-arrhythmic properties
  47. why are frequent lab levels needed for pts. on cardiac glycosides:
    cardiac glycosides have a narrow therapeutic range
  48. the improved contractility increases renal perfusion  and thus increaes urine output, thus in indirectly decreases which stage of cardiac output:
    preload
  49. vision changes such as yellow tinge, halos especially around lights, and blurred vision are all common with the overdose of:
    cardiac glycosides
  50. diuretics, beta blockers, antacids, anti-diarrheals, some lipid lowering drugs, Ca++ IV, quinidine, verapamil, amiodarone are the rx-rx interactions for:
    cardiac glycosides
  51. which drug should be given at the same time every day?
    cardiac glycosides
  52. check their apical pulse for 1 minute before giving cardiac glycosides, and hold it and call the provider if it doesnt meet the perscribed criteria, usallaly:
    bradycardia
  53. Hypokalemia, renal disease, diuretic use, plus digoxin use can be deadly with concurrent use of cardiac glycosides due to:
    potentail for arrhythmias
  54. what is the MOA for phosphodiesterase inhibitors:
    block phosphodiesterase, an enzyme found in the heart and smooth muscle cells, thereby increasing cardiac muscle Ca++ levels and heart contractility
  55. which stage of cardiac output do the phosphodiesterase inhibitors work on:
    afterload, because it causes vasodilation
  56. how long is phosphodiesterase inhibitors used for:
    usually only used for a few days at a time
  57. which type of heart failure are phosphoddiesterase inhibitiors used for:
    only for advanced decompensated heart failure
  58. because phosphodiesterase inhibitors can cause dysrhythmias,  the levels of what must be checked before and during the use of this drug:
    check K+ levels
  59. what are the rx-rx interactions for phosphodiesterase inhibitors:
    other positive inotriopic drugs
  60. advanced heart failure can be tx with beta adrenergic agonist, list (5):
    • isoproterenol (isuprel)
    • epienephrine
    • NE
    • ddopamine
    • dobutamine

    beta agonists increase the HR and can promote dysrythmieas
  61. in cases of advanced heart failure, why is dobutamine usually the preferred med:
    because it works quickly without significantly increasing the HR and BP (and thus not increasing heart oxygen demand)
  62. cardiac glycoside

    also classified as a positive inotropic, anti-arrhythmic:

    digoxin
    lanoxin
  63. vasodilators:

    hydralazine
    apresoline
  64. why are beta blockers avoided with those with type 1 diabetes?
    they can mask the effects of hypoglycemia
  65. what pulse reading should lead you to hold digoxin or a beta blocker:
    heart rate less than 60

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