Heart failure medications

Loop diuretics exert their action at the ____.

The diuretics are not filtered through the ___, but instead undergo active transport into the tubular lumen via the organic acid pathway.

In the diuretics oral diuretic efficacy may vary based on the different bioavailability, which is almost complete for ___ and ____, but averages only 50% for ___.

Diuretics should be initiated at a latus, and titrated to achieve a weight loss up to _____ pounds per day.

Metolazone is a thiazide that can be dose _____ or _____ in use with a loop diuretic

Metolazone must be with caution because

Absolute contraindications to using an ace inhibitor include history of ____, bilateral ____, and _____.

Relative contraindications for using its inhibitor includes_________,_________,_________, _________, and _________.

Ace inhibitors should be used in patients with serum creatinine less than _________ to_________.

A small increase of _________ is possible with the addition of any ace inhibitor, it usually becomes transient or becomes patients new serum creatinine baseline level

Ace inhibitor should be held if the serum potassium increases above _________.

Cough is coming soon with its inhibitors and may be related to chelation of tissue_________

In patients truly intolerant or contraindicated to ace inhibitors or ARB's the combination of _________and _________should be considered.

Nitrates reduce presented by causing primarily venous vasodilation to reactivation of _________and _________in vascular smooth muscle

The beneficial effect of external nitric oxide source may be more appropriate and_________ population.

Combination therapy with hydralazine and isosorbide dinitrate is an appropriate substitute for a key to antagonists and those who are unable to tolerate an ace inhibitor or ARB or as add-on therapy and African-Americans. True or false.
True False

Isosorbide dinitrate is given_________ times per day.

Hydralazine was given _________ times per day

Hydralazine is also associated with a dose-dependent risk for_________.

Instead of giving isosorbide dinitrate 2 to 4 times daily to increase patient adherence _________ could be given once daily.

A nitrate free interval is still required when using nitrates for heart failure. true or false
True False

Beta adrenergic antagonists are also called_________.

Beta blockers competitively blocks the influence of the SNS at the _________site.

As recently as 15 years ago, beta blockers were thought to be detrimental in heart failure due to their negative inotropic actions. True or false
True False

Chronic beta blockade reduces _________mass, improves _________shape, and reduces _________volumes.

Beta blockers improve ejection fraction, reduce all causes and heart failure related hospitalizations, and decrease all cause mortality in patients with diastolic heart failure. True or false
True False

Beta blockers also exhibit antiarrhythmic effects, slow or reverse catecholamine induced ventricular remodeling, decrease myocyte death from catecholamine induced necrosis or apoptosis, and prevent myocardial fetal gene expression. True or false

The three beta blockers that have been shown to reduce mortality and systolic heart failure include bisoprolol (selective or nonselective), metoprolol succininate (selective or nonselective), and carvedilol (selective or nonselective).

The key to utilizing beta blockers and systolic heart failure is initiation with high doses and fast hydration to target over days. True or false
True False

Beta blockade should begin with the lowest possible dose, after which the dose may be double every 2 to 4 weeks, depending on the left ventricular ejection fraction and short-term worsening of heart failure symptoms upon each dose titration. True or false
True False

If the left ventricle ejection fraction is less than 20% metoprolol succinate or carvedilol would be a better choice?

In patients with higher blood pressure and heart failure would be better to start metoprolol succinate or carvedilol?

Beta blockers should be used with patients who display active respiratory system symptoms. True or false
True False

Metoprolol and carvedilol are metabolized by the liver through the cytochrome P450. Beta blockers should not be used in patients with severe hepatic failure. True or false
True False

Aldosterone antagonists available are _________and _________.

Aldosterone antagonists inhibit aldosterone, thus producing week diuretic effects while sparing potassium concentrations. True or false
True False

_________aldosterone antagonists is selective for mineralocorticoid receptor and hence does not exhibit the endocrine adverse effect profile, seen with_________.

_________Should be given to patients with a New York heart Association III to IV,_________ given directly to post MI patients with evidence of LV dysfunction.

The major risk related to aldosterone antagonists is _________.

Two parameters that must be assessed before and within one week of initiating aldosterone antagonist therapy include _________and _________

Dosing spironolactone starts at 12.5 225 mg daily, or occasionally _________days for patients with baseline renal insufficiency.

Dosing of aldosterone antagonist should be cut in half or alternate day dosing. If cretin clearance falls below _________ milliliters per minute.

When taking aldosterone antagonist potassium supplementation is often decreased or stopped and patient should be counseled to avoid high potassium foods. True or false
True False

Spironolactone has adverse effects, including _________for men and _________ for one and

eplereonne is a CYP3A4 substrate and should not be used with other strong inhibitors of 3A4. True or false
True False

Digoxin was shown to slow down heart failure progression and increase survival, but not to decrease heart failure related hospitalizations. True or false
True False

Digoxin is initiated at a dose of 0.125 to 0.25 mg daily depending on age, renal function, weight, and risk for toxicity. True or false
True False

Digoxin should be given at the lower dose. If the patient satisfies any of the following criteria; over 65 years of age, creating clearance less than 60 mL per minute, ideal body weight less than 70 kg. Dosing can also be every other day in patients with moderate to severe renal failure. True or false
True False

The desired concentration range for digoxin is _________to _________. Preferably with concentrations at or less than _________.

Digoxin toxicity may manifest as nonspecific findings such as fatigue, or weakness, and other CNS effects such as confusion, delirium, and psychosis. True or false
True False

In patients with life-threatening toxicity due to cardiac or other findings while on digoxin administration of _________therapy usually reverses adverse effects within an hour. In most cases.

Amlodipine and felodipine is the most extensively studied dihydropyridine.  Calcium channel blockers for systolic heart failure.  They have been shown to have a positive effect on patient survival. True or false
True False

Fish oils or omega-3 fatty acids have been recently studied for heart failure and found to mildly decreased cardiovascular permissions and mortality without significant adverse effects. True or false
True False

Hawthorn has been studied in heart failure and is shown to increase exercise capacity and reduce heart failure symptoms. True or false
True False

Treatment of heart failure with preserved left ventricular ejection fraction lacks trials and studies to show optimal treatment. True or false
True False

The current treatment approach for diastolic dysfunction or heart failure with preserved with intricate ejection fraction is correction control of underlying ideologies such as hypertension, CAD and maintenance of normal sinus rhythm, reduction of cardiac filling pressures at rest and enduring in section and increased diastolic filling time. True or false
True False

peripartum cardiomyopathy is defined as clinical and echocardiographic evidence for new onset heart failure occurring during pregnancy and up to six months after delivery.  True or false
True False

The leading hypothesis for peripartum cardiomyopathy is that it is caused by myocarditis via viral infection or abnormal immune response to pregnancy. True or false
True False

Treatment of peripartum cardiomyopathy is similar to that of regular heart failure patients except for _________.

Patients with peripartum cardiomyopathy at high risk of thromboembolism. Treatment options during pregnancy are limited to _________ and _________.

After pregnancy with patients with peripartum cardiomyopathy anticoagulation is recommended in patients with LVEF of less than _________ percent.

Types of drugs that may precipitate or exacerbate heart failure

Agents causing negative inotropic effects that may exacerbate HF

What are some cardiotoxic agents that can exacerbate HF

Agents causing sodium retention of water that exacerbate HF

Name the 18 symptoms of heart failure

What are the 13 signs of heart failure

Acute HF Subset 1 (warm and dry)
-CI ____ and pulmonary capillary wedge pressure less than ______
-Pt considered well compensated and perfused without evidence of congestion
no immediate interventions necessary except to maximize oral meds

Acute HF Subset 2 (warm and wet)
-CI greater than _____ and PCWP less than _____
-patients adequately perfused and display signs and symptoms of _____
-mail goal is to reduce _____ with ______

Acute HF Subset 3 (cool and dry)
-CI ____ 2.2 L/min/m² PCPW ____ 18 mmHg
-Pt are inadequately perfused and not congested
-Tx focuses on increasing ____ with ____ agents and replacing fluids
-fluid replacement must be done conservatively

Subset IV (cool and wet)
-CI ____ 2.2 L/min/m² PCWP _____ 18 mmHg
-Pts are inadequately ____ and ____
-worst prognosis
-____ are used to maintain blood pressure

Treatment of AHF targets relief of congestion and optimization of cardiac output, utilizing oral and IV_________, IV_________, and when appropriate allotropes based on presenting hemodynamics.

AHF
Diuretics reduce_________, but do not increase cardiac index, as do positive inotropes and arterial vasodilators

AHF
Furosemide 
onset of action (min)
duration of action (hours)
intermittent bolus dosing (mg)
cont infusion dosing (bolus/infusion)

AHF
Torsemide
onset of action (min)
duration of action (hours)
intermittent bolus dosing (mg)
cont infusion dosing (bolus/infusion)

AHF
Bumetanide
onset of action (min)
duration of action (hours)
intermittent bolus dosing (mg)
cont infusion dosing (bolus/infusion)