Card Set Information
What is the New York classification of heart failure?
: sx upon excessive exertion
: sx upon normal activity of daily living
What is the New Approach classification of heart failure?
: high risk for developing HF
: refractory end-stage HF
What are the causes of systolic failure (dilated cardiopyopathy)?
What are the causes of diastolic failure (hypertrophic cardiomyopathy)?
What are the sx of poor perfusion?
high BUN/creatinine ratio
decreased urine output
pulmonary edema (L side failure)
peripheral edema and JVD (R side failure)
high ADH = low Na
lab value = poor perfusion is stimulating the ADH despite low Na
What are the sx of CHF?
What is BNP?
B Natriuretic Peptide - stimulated by stretch of the atria and ventricles and causes Na
and water excretion.
kind of a counter-regulatory hormone to aldosterone
What is the vicious cycle of aldosterone on CHF?
and water retention
increased preload and pulmonary edema
more RAAS stimulation
also stimulates the SNS which causes even
How does the body compensate for low CO in CHF?
poor perfusion stimulates RAAS
Angiotensin stimulates SNS (+) inotrope effect to increase CO
aldosterone causes Na
and water retention which increases preload, which increases CO
the vicious cycle means that eventually it will overstimulate and cause decreased CO
What is the best parameter to monitor for CHF?
1kg = 1L of water loss
goal is 1L/d net loss
700mL insensible loss (respiration, perspiration)
What is the best way to dose diuretics for CHF?
Nike rule......just do it!
20-40mg for 1-2h then
80mg for 1-2h then
be a wimp, keep it low if at all d/t possible decrease in CO
What is the relationship between loops and thiazides in CHF?
thiazides are better until kidney fx declines
loops are better as kidney fx declines
What are the SE of diuretics?
increased BUN/Cr ratio
decreasing hydration status
What are the SE of thiazides?
ric acid increase
What are the effects of ACE inhibitors on CHF?
decreased preload d/t venous dilation = decreased fluid overload
increased artery dilation
increased output but decreased pressure = kidney fx worse initially
increased exercise capacity
mental status improved
What are the SE of ACE inhibitors?
increased potassium (d/t increased Na
cough (dry, non-productive)
What is the diffence in ACEI dosing between CHF and HTN?
lower dose is better - don't want to make pressure too low
high dose is better because pressure is too high
How are ARBs useful in HF?
in place of ACEI - DO NOT add to an ACEI!
DO NOT add to a BBL - increased mortality
better outlook for angioedema and cough - no effect on bradykinin
How are Nitrates and Hydralazine used in CHF?
nitrates decrease preload (dilate arteries)
hydralazine decreases afterload (dilate veins)
less mortality benefit than ACEI
more sx benefit than ACEI
less renal impairment (no dilation of efferent arterioles)
What are the SE of nitrates and hydralazine?
Pill Overload Syndrome (POS)
What is digoxin's role in CHF?
flogging the heart (pos inotrope)
probably diuretic effect
LAST thing to add, no benefit for CHF, but some decreased SE
in diastolic dysfunction
What should be monitored for digoxin tx?
What are the SE of digoxin?
low potassium will increase dig toxicity
mental status change
What are the uses of BBL in CHF?
do not use unless fluid stable
What should you do if pt is on a BBL and becomes fluid unstable?
add a diuretic, if that doesn't work, decrease BBL dose 50% until stable
What is the use of spironolactone in CHF?
not sure if it has benefit when added to ACEI
great for hypokalemic CHF pts instead of K
What are the SE of spironolactone?
What is the use of BNP levels in CHF?
good for diffentiating cause of SOB
not good for progress check
What are the clinical sx of CHF fluid overload?
DOE (dyspnea on exertion)orthopnea/Peroxismal nocturnal dyspnea (SOB upon laying down)
What is the treatment for diastolic HF?
NO GOOD WAY
ACEI (just because it can't hurt)
What are some inappropriate drugs for CHF pts?
corticosteroids (Na+ retention)
non-DHP CCBs (in systolic HF)
What is the pharmacist's role in CHF?
weights daily (3-5lbs increase = call physician)
ensure labs (esp. K
teach to take their pulse
get rid of NSAIDs
cough syrup patrol
appropriate drugs (ACEI, BBL, diuretic)
What are the mandatory drugs for CHF?
BBL (once fluid stable)
diuretic (most likely)