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Pharm-T2 -HF
Heart Failure Drugs
| Question | Answer |
|---|---|
| NYHA Class of Heart Failure: How many classifications are there? | IV |
| NYHA Class of Heart Failure: Oridinary physical activity causes fatigue, dypnea, palpitations or angina, what class is this? | Class II |
| NYHA Class of Heart Failure: Less than ordinary physical activity cause symptoms, Comfortable only at rest is what class? | Class III |
| Systolic dysfunction is equal to LVEF less than what %? | less than 40% |
| what describes a structural heart problem, w/ or w/o Sx of Congestion, w/ concurrent neurohormonal activation and/or remodeling taking place? | Chronic Heart Failure |
| What Diuretics work in the medulla and which work in the cortex of the kidney? | Medulla; Loops // Cortex; Thiazides and K-sparing |
| For a patient with Heart Failure monotherapy is sufficient? T or F | False |
| IF you use a Diuretic Rx on a patient and you would like to get rid of more Na would you use a loop or thiazide diuretic? | Loop Diuretic; 20-25% Na Excretion with loop Rx //// Thiazide Diuretics; Distal Tubule 5-10% Na excretion with Rx |
| When is there a clinical advantage in using IV vs PO with Diuretics? | Severe pulmonary edema or has GI absorption issues (intestinal edema). Otherwise only during the first 1-2 hrs does IV exceed PO, b/t 4-6hrs to |
| Systolic dysfunction is equal to LVEF less than what %? | less than 40% |
| what describes a structural heart problem, w/ or w/o Sx of Congestion, w/ concurrent neurohormonal activation and/or remodeling taking place? | Chronic Heart Failure |
| What Diuretics work in the medulla and which work in the cortex of the kidney? | Medulla; Loops // Cortex; Thiazides and K-sparing |
| For a patient with Heart Failure monotherapy is sufficient? T or F | False |
| IF you use a Diuretic Rx on a patient and you would like to get rid of more Na would you use a loop or thiazide diuretic? | Loop Diuretic; 20-25% Na Excretion with loop Rx //// Thiazide Diuretics; Distal Tubule 5-10% Na excretion with Rx |
| When is there a clinical advantage in using IV vs PO with Diuretics? | Severe pulmonary edema or has GI absorption issues (intestinal edema). Otherwise only during the first 1-2 hrs does IV exceed PO, b/t 4-6hrs total urinary output is equivalent. |
| What diuretic is Lasix? and of the three diuretic you know, list them in order from strongest to weakest? | Furosemide (laSIX)./// BFT is order; Fumetanide, Furosemide, and Torsemide (Notice all end in "IDE") |
| HypOtension, OtOtOxicity, Electrolyte abnormalities, and HYPERuricemia are all symptoms of what Meds? | Diuretics (put pt on low purine/gout diet) |
| When using diuretics what other meds (triple whammy) with diuretics will cause acute renal failure? | Diuretic w/ACEI + NSAID |
| Patient with Heart failure gets what meds, in order of importance? | Diuretic, ACEIs (ARBs if ACEI not tolerated well), Beta-Blockers, Aldosterone Antagonists (AA) |
| What subgroups are at high risk with use of ACEIs? | DM, Renal, Atherosclerosis/CAD, Post Stroke (w/thiazide) |
| Renal Artery stenosis bilateral can severly be affected by what Medication? | ACEIs |
| Would you every Rx ACEI by its self? | No |
| How can you tell by the name of the medication that it is an ACEI? name six of them. | ends in "PRIL" // CAptopril, Enalapril, Lisinopril, Perindopril, Ramipril, and Trandolapril |
| What Are ABSOLUTE CONTRAindications to the use of ACEIs? 4 of them | Angioedema, Anuric (decrease in urine or not passing urine), Bilateral RAS, Pregnancy |
| ACEIs are known for there cough, why does this happen? | Increase accumulation of BradyKinin |
| What are some DDIs (drug-drug interactions) with ACEIs? | Li+ (cause Li+ toxicity), Diuretic + NSAID (ARF), Azathioprine (myelosuppression) |
| How can you tell a drug is an ARBs by its name and what is the best ARB? | ends in "SARTAN or ARTAN", CAndesartan best. Losartan only Rx b/c it has a generic but not the best. |
| ARB's might be prescribed due to ACEI causing a cough or patient has had Angioedema in the past, But ARBs can still cause Angioedema. Why would you still Rx ARB if Pt has history of Angioedema? | As long as Angioedema was not life threatening, ARB would be a Relative Contra-indication |
| What medication inhibits the effects of sympathetic nervous system and is Rx for HF? | Beta-Blockers |
| What medication is important to help decrease remodeling with heart failure patients? | Beta-Blockers (decrease Morbidity/mortality too) |
| What medication is it important to discuss with your patients that HF symptoms may worse and/or take 2-3 months before improvement in symptoms so they don't stop taking with out telling you? | Beta-Blockers |
| Generally you would start a patient on ACEI and Diuretic 1st before beta-blockers unless what? | Pt requires HR control for Afib or TAchycardia |
| How can you tell a drug is a beta-Blocker from its name? | ends in "LOL" |
| Uncontrolled bronchospastic disease, symptomatic HYPOtension/bradycardia, advanced heart block (w/o pacemaker) and severe decompensated HF are all ABSOLUTE CONTAindications of what Rx? | Beta-Blockers |
| What is not a contraindication for Beta-Blockers but needs to be monitored? | Diabetes |
| To minimize the risk of HYPOtension with ACEI and Beta-Blockers what should you have the patient do? | Administer at different times of the day. |
| What are some DDIs (drug-drug interactions) with Beta-Blockers? | NonDHP CCB, NSAIDS (inc BP), Amiodarone or Dronedarone (decr HR,BP, cardiac arrest), Beta-Agonists, Clonidine (if you miss one dose BP through the roof) |
| because Angiotension and aldosterone are produced through alternate pathways and ACEIs inadequately suppress AT and Aldosterone what other med would you include for a patient with HF? | Aldosterone Antagonists (AA) |
| When using spironolactone/eplerenone (AA) you want to monitor K+ and SCr with in 3days, @ 1 week, @ least monthly for 1st 3 months and every 3 months after that. What are your Goal limits for K+ mmol/L and SCr mg/dL? | K+< 5.0 mmol/L and SCr < 2.5 mg/dL |
| What are two reasons you would stop use of AA? | Diarrhea episode or while Loop Diuretic Tx is interrupted |
| What are AA absolute Contraindications? | Anuria (not producing urine), Acute Renal Insufficiency, HyperKalemia |
| AA DDIs with what b/c it may increase this drug by blocking tubular secretion of this drug? | Digoxin |
| What drug neurohormonal control dec. plasma Noradrenaline, peripheral Nervous system activity, RAAS activity (suppress kidney renin secretion) and INCREASES vagal Tone? | Digitalis |
| What Drugs Cause Li+ Toxicity? | AA, ARB, ACEI, Diuretics, |
| Digitalis improves symptoms and mortality? T or F | False, only improves symptoms, not mortality (will not live longer b/c of Digitalis) |
| If your patient has systolic dysfunction and is inadequately responding to diuretic + ACEI + Beta-Blocker what would you prescribe? | Digitalis |
| Digitalis would be contraindicated with what conditions? | AV block w/o Pacemaker, Bradycardia, PVC and V-Tach, WPW syndrome with AFib |
| How do you base your dosing with Digoxin? | Weight, age, renal function |
| What are Digoxin Toxicity symptoms? | Cardiac arrhythmias, GI Sx, Neurological complaints (visual disturbance, disorientation, & confusion) |
| What drug added with these drugs (Diuretics and beta-blockers or AMINODARONE) will cause toxicity? of added drug | Digoxin |
| IF patient is unable to take ACEI and ARB b/c renal dysfunction, HyperK, or angioedema what would you Rx? | Hydralazine S: 37.5mg (Tar: 75) TID Plus Isosorbide S: 20mg (Tar: 40mg) TID |
| What is a CONTRAindication for Hydralazine? | Dissecting Aortic Aneurysm // may cause SLE mainly in white Pts |
| Isosorbide (is like Nitroglycerine relaxes blood vessels) arContraindications | Concurrent use of PDE-5 inhibitors (Viagra, Cialis, Levitra) |
| What Inotropes are used for Decompensated HF? | Low dose Dopamine (1-3mcg/kg/min) renal dilation // Mid dose (3-10mcg/kg/min) renal dilation & cardiac stimulation |
| What are CONTRAindications for Dopamine? | Pheochromocytoma, TAchyarrhythmias/ventricular Fibrillation |
| What Inotropes is used for Decompensated HF and is more potent than dopamine? | Dobutamine 2.5-20mcg/kg/min (Beta-1 adrenergic) |
| Idiopathic Hypertrophic Subaortic Stenosis is a Contraindication for what Rx? | Dobutamine |
| Milrinone is used for what? | Decompensated HF // Dopamine, Dobutamine, Milrinone |
| In an ischemic setting Dobutamine incr myocardial O2 demand, therefore what may be preferred? | Milrinone |
| Nitroprusside dec preload and afterload and is like Nitroglycerine but what are disadvantages? | cyanide and thiocyanate intoxication// Unstable if exposed to heat or light |
| What are CONTRAindication for use of Nitroglycerine (NTG)? 3 of them to name. | Constrictive Pericarditis, Pericardial Tamponade, Restrictive Cardiomyopathy |
| Drugs to Avoid in Pts with HF Dx are what? | Class 1A and 1C Antiarrhythmics, Antacids, Aspirin, Ephedrine Deriva (nasal decongesants), Tricyclin Antidepress, NSAIDS, Antibiotics (Ampicillin, nafcillin, ticarcillin or Unasyn), Corticosteroids, Lithium (Li+), *Thiazoladinediones (put in HF), Pletal |
Created by:
cmuox2000
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