Term
What do patients with "congestive" heart failure receive what to reduce blood volume in order to reduce fluid retention and venous pressure? |
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Definition
Diuretics (primarily loop diuretics, such as furosemide) |
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Term
Along with diuretics, standard therapy for heart failure includes drugs that block the RAAS system. What class of drugs are these? |
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Definition
| ACEIs, ARBs, Aldosterone antagonists |
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Term
Those with heart failure also receive drugs to block the SNS. What class of drugs are this? |
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Definition
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Term
| What enzyme converts angiotensinogen to angiotensin I? |
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Definition
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Term
| What converts angiotensin I to angiotensin II? |
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Definition
| angiotensin converting enzyme |
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Term
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Definition
| ACEI block ACE and prevent the conversion of ATI to ATII |
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Term
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Definition
| Block ATII directly at a receptor site on the smooth muscle wall of the vessel |
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Term
| Blocking the RAAS system will do what phsiological systems? |
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Definition
Will relax and dilate blood vessels (vasodilation), making it easier on the heart to pump. This is called reducing afterload. These drugs also reduce blood volume and decrease preload.
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Term
| What is raised whilst on ACEIs and ARBs? |
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Definition
Increased potassium - which in many cases of heart failure is offset by the use of loop diuretics.
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Term
| How do beta blockers work? |
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Definition
Bind to beta receptors and block epinephrine and norepinephrine. Causes vasodilation, decreases HR and makes it easier for the heart to pump.
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Term
| Which beta blocker is commonly used for heart failure? |
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Definition
| Metoprolol (Toprol XL &c.), it's beta-1 selective at typical doses. |
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Term
| Name some aldosterone blockers? |
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Definition
spironolactone;
Eplerenone |
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Term
| Brand name for spironolactone |
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Definition
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Term
| Brand name for eplerenone |
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Definition
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Term
| When are aldosterone used in heart failure? |
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Definition
Advanced cases of heart failure (in addition to ACEIs, ARBs and beta blockers)
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Term
| Aldosterone blockers can decrease what and increase what? |
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Definition
Decrease: mortality
Increase: Potassium |
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Term
| What is another agent used in advanced cases, especially black patients? |
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Definition
| isosorbide dinitrate/hydralazine |
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Term
| Brand name for isosorbide dinitrate/hydralazine? |
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Definition
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Term
| Hydralazine and nitrates are what (phsiologically)? |
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Definition
arterial and venous dilators
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Term
| Bidil is contraindicated with what other drug? |
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Definition
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Term
| Digoxin is used for what? |
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Definition
| symptom control and occasionally for arrhythmias |
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Term
| What physiological effects does digoxin have on the heart? |
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Definition
Digoxin is a positive inotrope, which means it increases the force of the heart's contractions and is a negative chronotrope, which means it decreases heart rate
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Term
| What must patients on digoxin monitor? |
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Definition
Heart rate to make sure the rate does not get too low, which could indicate digoxin toxicity |
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Term
| How is digoxin primarily cleared? |
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Definition
~85% renally cleared
Digoxin can become toxic with poor renal clearance |
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Term
| Low levels of what can make digoxin toxic? |
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Definition
hypokalemia (low potassium)
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Term
| Digoxin toxicity can lead to what? |
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Definition
| CNS effects, GI effects and arrhythmias |
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Term
Name some drugs that can worsen heart failure, and describe signs and symptoms of heart failure |
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Definition
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Term
| What are the classifications of heart failure? |
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Definition
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