Term
|
Definition
1. Relieve Pulm Edema and Peripheral congestion 2. Improve fxn capacity and QOL 3. Prolong life expectancy |
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Term
| Strategies to achieve goals of HF |
|
Definition
1. tx correctable causes (HTN, dysrrythmias, ect) 2. Lifestyle mods 3. Drug tx (if 1st 2 fail) |
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Term
|
Definition
1. Diuretic 2. ACE-I 3. BB 4.Vasodilators 5. Inotropic Agents |
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|
Term
| All types of drugs for HF work by |
|
Definition
1. Decr. myocardial load 2. Decr. fluid volume (edema) 3. Increase cardiac contractility 4. Slow rate of remodeling |
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Term
| At what stage should BB not be used in HF? |
|
Definition
Stage IV d/t negative inotropic effect (CO would suffer) ***All stages before benefit d/t block of symp input*** |
|
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Term
| Only BB approved specifically for tx in HF |
|
Definition
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Term
Thiazide Diuretics used to tx HF |
|
Definition
1. HCTZ 2. Chlorothalidone 3. Metolazone 4. Indapamide |
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Term
In patients w/ severe HF what type of diuretics should be used? |
|
Definition
LOOP (Furosemide, Torsemide, Bumetanide) ***Also in severe renal dz |
|
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Term
What drugs offer the most effective means of providing early sx relief in HF pts? |
|
Definition
|
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Term
A failing heart is more sensitive to _________ _________ |
|
Definition
Electrolyte abnormalities (watch K levels) |
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Term
| Diuretics work synergistically with ACEI to? |
|
Definition
provide a more thorough blockade of RAAS (stop remodeling) conserve K, and eliminate Na and H2O |
|
|
Term
Advantages of taking Epleronone for HF |
|
Definition
| No gynacomastia/impotence |
|
|
Term
What 2 types of drugs have been proven to prolong life for pts in HF? |
|
Definition
|
|
Term
Which BB is cardioselective? |
|
Definition
|
|
Term
| In pts who cannot tolerate ACEI, what combo of drugs decreases mortality |
|
Definition
Isosorbide and hydralazine |
|
|
Term
What 2 types of drugs are 2nd line to ACEI's And ARB's |
|
Definition
Hydralazine and Nitrates **decre afterload (mitral regurg) -> less backup in lungs!** |
|
|
Term
| What 2 drugs added to digitalis improve survival in pts w/ chronic severe HF? |
|
Definition
|
|
Term
| What are the 2 Cardiac Glycosides? |
|
Definition
1) Digoxin 2) Digitoxin **Pos. inotropic agents |
|
|
Term
| What is the role of a pos. inotropic agent |
|
Definition
| Increase force of contraction of the heart |
|
|
Term
What drugs are used parentally in an
EMERGENCY for HF when CO is low? |
|
Definition
1. Dobutamine 2. Milirinone |
|
|
Term
Is digoxin thought to decrease cardiac remodeling? |
|
Definition
| YES -> Also delay progression of dz!! |
|
|
Term
What is the chemical composition of cardiac glycosides? |
|
Definition
1. Sugar (incr. solubility) 2. Steroid Nucleus (pharm effect) 3. Lactone Ring (pharm effect) |
|
|
Term
|
Definition
-Inhibit Na/K ATP-ase -promotes Ca accumulation in cells (incr. force of contraction) ***Also incr SV and CO!! |
|
|
Term
How does digitaliz incr. contractility while decr. HR? |
|
Definition
crosses BBB and incr. vagal tone -> decr HR ***also good for SV dysrythmia |
|
|
Term
|
Definition
GI: Drooling CNS: fatige, vision dist. (halo) Cardiac: dysrhythmias |
|
|
Term
How do you tx digitalis toxicity? |
|
Definition
-withold drug -tx w/ digibind! (antidig. antibody) |
|
|
Term
| How does K interact w/ Digitoxin to produce inotropic action? |
|
Definition
-they compete for binding site on Na/K ATP-ase ***if K is low->incr. binding of dig.= TOXIC *** if K is high -> reduced response! |
|
|
Term
| Effects of Digitalis in CHF |
|
Definition
Decr. CO by: 1. decr. symp tone 2. incr. urine production 3. decr Renin ***IMPROVE quality of life! |
|
|
Term
| How to determine effectiveness of digoxin |
|
Definition
1. wt loss d/t decr fluid 2. incr. urine production 3. decr. edema 4. decreased JVD |
|
|
Term
| What inhibits absorption of digoxin?? |
|
Definition
|
|
Term
What drugs paired with digoxin precipitate toxicity? |
|
Definition
| Diuretics-> d/t hypokalemic response |
|
|
Term
| How do ACEI affect course of HF? |
|
Definition
decr. morbidity and mortality! decr. PVR and BP -> incr in CO |
|
|
Term
| BB role in progression of HF |
|
Definition
improves systolic fxn and reverses remodeling = DELAYED PROGRESSION! |
|
|
Term
Direct Vasodilators work well in this population? |
|
Definition
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