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66 Cards in this Set
- Front
- Back
what is hear failure?
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heart failure is a condition with multiple causes that result in cardiac output that is inadquate to provide oxygen needed by the body
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what are the primary signs of CHF?
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tachycardia
decreased exercise tolerance SOB peripheral and pulmonary edema |
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what is a positive inotropic effect?
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increase contractility (the force of the heart contraction)
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where does a positively inotropic drug act?
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on the heart to increase contractility
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what are the classes of drugs that are positive inotropic drugs?
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Digitalis glycosides: digoxin
Phosphodiesterase inhibitors: inamrinone, milrinone B-adrenoceptor agonist: dobutamine/dopamine |
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what is the effect of Digoxin on cardiac contractility, heart rate, preload reduction, afterload reduction, and risk of arrhthymia in treatment of CHF?
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increases contractility
decreases heart rate Reduces afterload reduces preload other effects: increase parasympathetic tone and decreases sympathetic tone |
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________ inhibits Na+/K+ ATPase pump in treatment of CHF
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Digoxin
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_________ increases the force of contraction and length of time of the interaction between actin and myosin filaments in the cardiac sarcomere.
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Digoxin
via increased free calcium concentration in the vicinity of contractile proteins during systole |
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how long is the onset of action for Digoxin in treatment of CHF?
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1 hour
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how long is the duration of action in the treatment of CHF with Digoxin?
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24 hours
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what are the clinical effects of Digoxin in treatment of CHF?
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improves symptoms & exercise tolerance
reduces hospitalization withdrawal of patients receiving digoxin leads to worsening heart failure |
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does Digoxin decrease mortality?
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NO
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what is the hockey stick configuration of an ECG caused by?
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Digoxin causes ST segment depression in the ECG giving the hockey stick configuration
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If digoxin reduces the AV velocity what does it appear as in the ECG?
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increase the PR interval
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Digoxin shortens action potentials in the ventricular tissue, what does this appear as on an ECG?
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decreases the QT interval
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what are some common side effects of Digoxin?
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anorexia, nausea, vomitting, arrhythmias, blurred vision, chomatopsia, gynecomastia, seizures, hypokalemia induced arrhythmias
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what are common drug interactions in administration of Digoxin in CHF?
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digoxin absorption inhibited by antacids and cholestyramine
digoxin clearance reduced by dilitiazem (CCB), quinidine, verapamil (CCB) |
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If your patient is on digoxin and has a diuretic induced hypokalemia what is this going to do to digoxin in the treatment of CHF?
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precipitates digoxin toxicity
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what are b1-selective agonist used for in the treatment of CHF?
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increase cardiac contractility
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what type of drug is Dobutamine? what is it used for?
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Dobutamine is a b1-selective agonist used to treat acute heart failure or heart failure that does not respond to other agents
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if heart failure does not respond to positive digoxin or other agents what is another positive inotropic drug that can be administered?
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Dobutamine and Dopamine
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why is Dopamine used in the treatment of CHF?
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it is a b-receptor agonist and is used in treatment of acute CHF or heart failure if it does not respond to treatment by other agents or Dobutamine
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What are you going to administer for treatment to a patient that has arrived in the ER with acute heart failure?
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Dobutamine administered by continuous infusion
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what is the effect of dobutamine on cardiac contractility, heart rate, preload, afterload, and risk of arrhythmia?
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increases contractility
increases heart rate decrease preload decrease afterload increase risk of arrhythmia |
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what is the onset of action for Dobutamine?
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1 minute
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what is the duration of action of dobutamine?
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less than 10 minutes
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what is the elimination half life of dobutamine?
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2 minutes
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what are some common adverse side effects in treatment of CHF with dobutamine?
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excessive vasoconstriciton
tachyarrhythmias hyper/hypotension |
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describe the mechanism of action for Phosphodiesterase inhibitors in treatment of CHF?
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these drugs inhibit the enzymes that inactivate cAMP and cGMP
selective for PDE type III which is only found in smooth and cardiac muscle inhibition of type III PDE results in increased cAMP concentration in the cell, causing increased cardiac muscle contracitlity and vasodilation |
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Name two Phosphodiesterase inhibitors
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Inamrinone
Milrinone |
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how are phosphodiesterase inhibitors used in the treatment of CHF?
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inamrinone and milrinone are used only for short term management of acute heart failure
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what are the cardiovascular effects associated with phosphodiesterase inhibitors in treating CHF?
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Milrinone and Inamrinone
increase cardiac contractility increase heart rate decrease preload decrease afterload slight risk of arrhythmia |
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onset of action of inamrinone and milrinone?
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phosphodiesterase inhibitor
onset of action 3 minutes |
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common adverse effects of Milrinone (phosphodiesterase inhibitor)
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arrhythmias
hypotension nausea vomitting thrombocytopenia do not mix milrinone with furosemide (loop diuretic) in an IV line because a precipitate will form |
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what types of drugs without positive inotropic effects are used to treat CHF?
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Vasodilators: Angiotensin II inhibitors, Hydralizine, nitrates
Some b-adrenergic antagonist diuretics |
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how do ACE inhibitors assist in treatment of CHF?
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decrease activation of cardiac angiotensin receptors > decreases cardiac remolding & wall thinning > increases ventricular performance > decreases morbidity & mortality
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what are the adverse affects of ACE inhibitors in treatment of CHF?
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chronic cough
severe hypotension hyperkalemia rash acute renal failure in patients with bilateral renal stenosis |
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what are the cardiovascular effects of all of the ACEI in treating CHF?
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decrease preload
decrease afterload |
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what ACEI are used in treating CHF?
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Captopril
Enalapril Lisinopril |
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what are the cardiovascular effects of ARBs in treating CHF?
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decrease preload
decrease afterload |
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Candesartan, Losartan, and Valsartan are examples of what type of drug to treat CHF?
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Angiotensin II receptor blockers
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what is the CV effect of Hydralazine in treating CHF?
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Hydralazine is a vasodilator
increases heart rate reflex decreases afterload reduces blood pressure risk of arrhythmia |
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what type of drug is Isosorbide dinitrate?
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Nitrate drug that is broken down into NO which causes vasodilation
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what are the CV effects of Isosorbide dinitrate in treating CHF?
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reduces pulmonary congestion
increases heart rate reflex decreases preload decreases afterload |
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what is the role of diuretics in the treatment of CHF?
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thiazide and loop diuretics increase excretion of NaCl and water
reduction in plasma volume and ventricular preload reduction of pulmonary and peripheral edema reduction of cardiac size and improved pumping efficiency |
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what is significant about Spironolactone in the treatment of CHF?
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Spironolactone is a potassium sparing diuretic
has been shown to reduce morbidity and mortality in patients with severe CHF administered with other therapies increases the excretion of sodium and increases potassium retention |
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what is the main effect of diuretics in the treatment of CHF?
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decreases preload
reduces edema and congestion |
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name some loop diuretics that would be used in the treatment of CHF?
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Bumetanide
furosemide torsemide |
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what two potassium sparing diuretics are used with other therapies to treat CHF?
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Spironolactone
Eplerenone |
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when do you administer spironolactone in the treatment of CHF?
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Severe heart failure
it is an aldosterone receptor antagonist |
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what class of CHF patient have b-adrenergic antagonist been shown to be beneficial in?
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patients with class II and III heart failure
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how do b-adrenergic antagonist benefit patients with CHF?
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increase cardiac output and left ventricular ejection fraction
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Can a patient expect immediate improvement of symptoms with administration of b-adrenergic antagonist in the treatment of CHF?
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NO
it takes 2-3 months for improvement start with low dose and gradually titrate upward |
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why do you start treatment of CHF with a small dose of b-blockers?
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because to much b-blocker can kill the patient with CHF because of their negative inotropic effects
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What b-adrenoceptor antagonist are used in the treatment of CHF?
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Carvedilol
Metoprolol bisoprolol atenolol |
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what type drug is Carvedilol?
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a- and b-adrenoceptor antagonist
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what type of drug is Metoprolol and Bisoprolol?
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B1-antagonist
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what type of drug is atenolol?
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B1-antagonist
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what is a benefit of prescribing Carvedilol to a patient with CHF?
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slows cardiac remolding
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what drugs are used in the treatment of CHF that increase cardiac output?
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Digoxin
B-receptor agonist: dobutamine/dopamine Phosphdiesterase inhibitors: Inamrinone, milrinone |
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what drugs are used in the treatment of CHF that reduce preload and congestion?
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Diuretics: spironoloactone, furosimide
Angiotensin II inhibitors: ACEI: Captopril, Enalapril, Lisinopril ARBs: Candesartan, Losartan, Valsartan Hydralzaine, Isosorbide dinitrite digoxin |
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what drugs are used in treatment of CHF that reduce afterload?
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Inotropic drugs:
Inamirine, Milrinone (PDEI) ANGII Inhibitors: ACEI: Captopril, Enalapril, Lisinopril ARBs: Candesartan, Losartan, Valsartan Hydralazine b-blockers: Carvediliol, Metprolol, Bisoprolol, Atenolol |
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Drugs that reduce cardiac remolding and improve ventricular performance in the treatment of CHF?
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ANGII inhibitors:
ACEI: Captopril, Enalapril, Lisinopril ARBs: Candesartan, Losartan, Valsartan B-blockers: Caredilol, metoprolol, bisoprolol, atenolol Spironolactone |
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Drugs that can reduce mortality or morbidity in treatment of CHF.
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Angiotensin II inhibitors:
ACEI: Captopril, Enalapril, Lisinopril ARBs: Candesartan, Losartan, Valsartan B-receptor antagonist (blockers): Carvediliol, metoprolol, bisoprolol, atenolol Spironolactone in severe HF |
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why is spironolactone only administered to patients who are in severe heart failure?
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because spironolactone has been shown to increase mortality and morbidity in patients with mild and moderate CHF
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why is early stage CHF often treated with an ACEI and b-blocker?
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decrease/stop cardiac remodeling
will not have pulmonary edema SOB is due to decreased blood flow to the lungs, not from not receiving enough oxygen |