Block 11 > Pharm: CHF > Flashcards

Pharm: CHF Flashcards

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1
Q

What is preload?

A

Volume of blood in ventricles at end of diastole

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2
Q

What is afterload?

A

Pressure or resistance the heart has to overcome to eject blood

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3
Q

What are the main pathways activated in HF?

A

RAAS, Sympathetic nervous system, Vasopressin, ANP and BNP

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4
Q

ANP and BNP are hormones produced by the cardiomyocytes in response to ____________

A

Stretching

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5
Q

ANP and BNP work to __________ blood vessels

A

Widen

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6
Q

Renin converts _______ to _________.

A

Angiotensinogen to angiotensin I

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7
Q

Angiotensin I is converted to angiotensin II by

A

Angiotensin converting enzyme (ACE)

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8
Q

ATII causes ____________ and stimulates release of __________

A

Vasoconstriction and stimulates release of aldosterone

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9
Q

Aldosterone causes _________ and __________ retention and increases ______________ excretion

A

Sodium and water retention, increases potassium excretion

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10
Q

Venous dilators reduce __________

A

Preload

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11
Q

Arterial dilators reduce __________

A

Afterload

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12
Q

What medications that are used to treat HF reduce cardiac remodeling and decrease mortality?

A

ACEIs, ARBs, Aldosterone antagonist (MRA), Beta Blockers, SGLT2 Inhibitors, Neprilysin Inhibitors

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13
Q

ACEI drugs

A

Prinivil, Enalapril, Lisinopril

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14
Q

ARB drugs

A

Losartan, Valsartan, Telmisartan

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15
Q

Aldosterone antagonist drugs

A

Spironolactone, Eplerenone

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16
Q

Beta blocker drugs

A

Metoprolol, Bisoprolol, Carvedilol

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17
Q

SGLT2 inhibitors

A

Dapagliflozin, Empagliflozin

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18
Q

Neprilysin inhibitor

A

Sacubitril

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19
Q

What other drugs did we discuss that can be used to treat HF, but have no impact on remodeling or survival?

A

Digoxin, Ivabradine, Loop and Thiazide diuretics, Verapamil and Diltiazem (CCB), Amlodipine (CCB), Prazosin (A1B)

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20
Q

Sacubitril is a ___________________

A

Neprilysin inhibitor

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21
Q

Sacubitril is only available in combination with ___________

A

Valsartan

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22
Q

Combination of Neprilysin inhibitor and angiotensin II receptor blocker is known as an _________ and does what?

A

ARNI, Used as an alternative to ACEIs

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23
Q

Neprilysin is an enzyme that does what?

A

Breaks down ANP and BNP

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24
Q

By inhibiting Neprilysin, what does sacubitril do?

A

Increases the half life and activity of ANP and BNP

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25
How does sacubitril impact bradykinin levels? And what does this contribute to?
Increases bradykinin levels, contributing to vasodilation and risk of cough/angioedema
26
Side effects of using an ARNI
Hypotension, Cough and angioedema, Increased risk of dementia
27
What is considered first-line therapy for HFrEF?
RAAS inhibitors (ACEIs and ARBs)
28
RAAS inhibitors block angiotensin II effects causing ____________ and ______ afterload
Vasodilation and decreased afterload
29
How do RAAS inhibitors impact aldosterone release?
Inhibit aldosterone release
30
How does inhibiting aldosterone release impact sodium and water retention? And preload?
Decreased sodium and water retention, Decreased preload
31
How do RAAS inhibitors impact preload, afterload and remodeling/survival?
Decreased preload, Decreased afterload, Decreased remodeling and increased survival
32
RAAS inhibitors are contraindicated in ____________
Pregnancy
33
Are beta blockers first-line therapy for HFrEF with RAAS/ARNI?
Yes
34
How do BB impact HR, contractility and sympathetic activation?
Decrease HR, contractility, sympathetic activation
35
Do beta blockers impact survivability with HF?
Yes, increase survival
36
For dosing with BB, start ______ and titrate __________
Low, Slowly
37
Ivabradine blocks what current?
Funny sodium channel (If) in the SA node
38
Outcome of ivabradine action
Decreased HR without decreased contractility or conduction
39
Ivabradine is used in what patients?
HFrEF patients with LVEF /= 70 bpm and are already on max tolerated beta-blocker
40
Does ivabradine reduce mortality?
No
41
Side effects of ivabradine
Bradycardia, Blurred vision - phosphenes
42
Three classes of diuretics
Loop diuretics, Thiazide diuretics, Potassium sparing diuretics (aldosterone receptor antagonists)
43
Loop diuretics are used in __________ CHF
Severe
44
Thiazide diuretics and loop diuretics are ____________ wasting
Potassium
45
Loop diuretics inhibit the _______/______/______ symporter
Na+/K+/2Cl-
46
Loop diuretics cause ________ preload
Rapid decreased
47
Thiazide diuretics inhibit the ______/_____ symporter
Na+/Cl-
48
MRAs
Spironolactone, Eplerenone
49
MRAs block __________ receptors
Aldosterone
50
How do loop and thiazide diuretics impact symptom relief and survival?
Relieve symptoms only
51
How do MRAs impact symptom relief and survival?
Improve both symptoms and survival
52
SGLT2 inhibitors
*-FLOZIN*, Dapagliflozin, Empagliflozin
53
How do SGLT2 inhibitors impact mortality rate?
Decrease
54
Empagliflozin
Jardiance
55
Side effects of SGLT2 inhibitors
Genitourinary infections, Hypotension, Rare ketoacidosis, Modest weight loss and BP reduction
56
Are SGLT2 inhibitors standard of care in CHF?
Yes
57
How does digoxin act?
Inhibits Na+/K+ ATPase
58
How does digoxin impact intracellular Na+ and Ca2+?
Increase intracellular Na+ and Ca2+
59
Digoxin is reserved for what type of HF patients?
HF patients with atrial fibrillation and persistent symptoms
60
Digitalis toxicity
Arrhythmias, Anorexia, nausea, vomiting, HA, fatigue, confusion, Blurred/Yellow vision (xanthopsia)
61
How does digitalis cause an increased risk of hypokalemia?
Binds to Na+/K+ ATPase
62
What 3 drugs can increase digoxin levels?
Quinidine, Verapamil, Amiodarone
63
Treatment of severe toxicity with digoxin?
Digoxin-specific antibody fragments (digibind)
64
Guideline-Directed Medical Therapy (GDMT) for HF
ARNI (or ACEi/ARB), Beta Blocker, SGLT2 Inhibitors, MRA
65
When should a beta blocker be given with heart failure?
Once patient is clinically stable
66
At what ejection fraction % should Guideline-Directed Medical Therapy be initiated?
EF
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