Chapter 30: Heart Failure cardiac pharm exam 2

What is heart failure?

The heart cannot pump enough blood to meet the body's oxygen demands.

Common causes of heart failure?

• Hypertension

• Cardiomyopathy

• MI

• Dysrhythmias

• Valve disorders

• Volume overload

• Renal failure

What happens when contractility decreases?

RAAS is activated.

What does RAAS cause in heart failure?

• Increased preload

• Increased afterload

What is BNP?

B-type natriuretic peptide.

Why is BNP released?

Excess preload/fluid.

What does BNP indicate?

Severity of heart failure.

Left-sided heart failure symptoms?

Think "L = Lungs"

• Tachypnea

• Dyspnea

• Orthopnea

• Crackles

• Pink frothy sputum

Right-sided heart failure symptoms?

• Edema

• JVD

• Hepatomegaly

Nonpharmacologic management of heart failure?

• Low sodium diet

• Fluid restriction if hyponatremic

• Weight loss

• Oxygen therapy

• Reduced activity if symptomatic

• Heart transplant if indicated

How does Digoxin work?

Increases contractility and decreases heart rate.

Digoxin is what type of inotrope?

Positive inotrope.

Digoxin is what type of inotrope?

Positive inotrope.

Digoxin is what type of chronotrope?

Negative chronotrope.

Major adverse effects of Digoxin?

• Bradycardia

• Digoxin toxicity

What can cause Digoxin toxicity?

• Hypokalemia

• Fluid imbalance

• Hypoxia

• Hypothyroidism

Symptoms of Digoxin toxicity?

• Dysrhythmias

• Nausea

• Vomiting

• Loss of appetite

• Yellow-green halos

Antidote for Digoxin toxicity?

Digibind

Why is hypokalemia dangerous with Digoxin?

Potassium should be corrected before giving Digoxin.

What is special about Digoxin dosing?

Narrow therapeutic index and loading dose (digitalization).

How does Milrinone work?

Increases contractility and decreases afterload.

Major adverse effects of Milrinone?

• Ventricular dysrhythmias

• Hypotension

• Thrombocytopenia

Contraindications for Milrinone?

• Hypotension

• Pregnancy

• Severe valve disease

Major adverse effects of Sacubitril/Valsartan (Entresto)?

• GI effects

• Orthostatic hypotension

• Hyperkalemia

Which ACE inhibitor adverse effects occur less often with Entresto?

• Cough

• Angioedema

Black box warning for Entresto?

Pregnancy

Major adverse effects of Ivabradine (Corlanor)?

• Bradycardia

• Arrhythmias

• Hypotension

• Phosphene

What is a phosphene?

Visual brightness/light phenomenon.

ACE inhibitors used in heart failure end in?

-pril

Beta blockers used in heart failure end in?

-olol

Example thiazide diuretic?

Hydrochlorothiazide (HCTZ)

Example potassium-sparing diuretic?

Spironolactone

What electrolyte abnormality occurs with Spironolactone?

Hyperkalemia

Example loop diuretic?

Furosemide

What electrolyte abnormality occurs with Furosemide?

Hypokalemia