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Questions and Answers
What is the primary action of phosphodiesterase inhibitors like milrinone in heart failure treatment?
What is the primary action of phosphodiesterase inhibitors like milrinone in heart failure treatment?
Which of the following adverse effects is associated with the use of phosphodiesterase inhibitors?
Which of the following adverse effects is associated with the use of phosphodiesterase inhibitors?
Which statement about direct vasodilators is true?
Which statement about direct vasodilators is true?
What should patients monitor while receiving treatment for heart failure?
What should patients monitor while receiving treatment for heart failure?
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Which of the following patient teachings is important regarding the use of medications for heart failure?
Which of the following patient teachings is important regarding the use of medications for heart failure?
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What is the recommended monitoring for heart failure patients taking medications?
What is the recommended monitoring for heart failure patients taking medications?
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What critical symptom should patients report when on heart failure medications?
What critical symptom should patients report when on heart failure medications?
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Which of the following statements regarding the mechanisms of action of heart failure drugs is correct?
Which of the following statements regarding the mechanisms of action of heart failure drugs is correct?
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Which condition is characterized by the accumulation of blood in the left ventricle, leading to hypertrophy?
Which condition is characterized by the accumulation of blood in the left ventricle, leading to hypertrophy?
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What is the primary effect of decreasing afterload in patients with heart failure?
What is the primary effect of decreasing afterload in patients with heart failure?
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In heart failure, what is preload dependent on?
In heart failure, what is preload dependent on?
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Which of the following diseases is least likely to be directly associated with heart failure?
Which of the following diseases is least likely to be directly associated with heart failure?
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Which of the following mechanisms is NOT part of the pharmacologic management of heart failure?
Which of the following mechanisms is NOT part of the pharmacologic management of heart failure?
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What is a common symptom resulting from left-sided heart failure?
What is a common symptom resulting from left-sided heart failure?
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Which term describes the law stating that myocardial fibers contract more forcefully the more they are stretched?
Which term describes the law stating that myocardial fibers contract more forcefully the more they are stretched?
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Which statement is true regarding right-sided heart failure?
Which statement is true regarding right-sided heart failure?
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What is the primary focus of treatment for Stage A heart failure?
What is the primary focus of treatment for Stage A heart failure?
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Which medication is commonly used in Stage B heart failure for patients with prior heart failure symptoms?
Which medication is commonly used in Stage B heart failure for patients with prior heart failure symptoms?
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What characterizes Stage C heart failure?
What characterizes Stage C heart failure?
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In the treatment of Stage D heart failure, what is likely to be included?
In the treatment of Stage D heart failure, what is likely to be included?
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What is the main action of ACE inhibitors in the context of heart failure?
What is the main action of ACE inhibitors in the context of heart failure?
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What additional treatment may be added for Stage C heart failure to control symptoms?
What additional treatment may be added for Stage C heart failure to control symptoms?
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Which condition is NOT a focus for intervention in Stage A heart failure?
Which condition is NOT a focus for intervention in Stage A heart failure?
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Which of the following best describes the treatment approach for symptomatic patients in Stage C heart failure?
Which of the following best describes the treatment approach for symptomatic patients in Stage C heart failure?
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What is the primary mechanism of action of lisinopril?
What is the primary mechanism of action of lisinopril?
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Which of the following is NOT an adverse effect of ACE inhibitors?
Which of the following is NOT an adverse effect of ACE inhibitors?
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What is the main purpose of diuretics in cardiovascular treatment?
What is the main purpose of diuretics in cardiovascular treatment?
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Which of the following describes the primary action of cardiac glycosides?
Which of the following describes the primary action of cardiac glycosides?
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Which adverse effect is specifically associated with digoxin?
Which adverse effect is specifically associated with digoxin?
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What is the primary benefit of using beta-adrenergic blockers in heart failure?
What is the primary benefit of using beta-adrenergic blockers in heart failure?
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What is a common outcome of fluid retention caused by beta-adrenergic blockers?
What is a common outcome of fluid retention caused by beta-adrenergic blockers?
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Which statement is true regarding angiotensin II receptor blockers (ARBs)?
Which statement is true regarding angiotensin II receptor blockers (ARBs)?
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Flashcards
Heart Failure Stage A
Heart Failure Stage A
High risk of heart failure, no structural heart disease or symptoms.
Heart Failure Stage A Treatment
Heart Failure Stage A Treatment
Lifestyle changes and treat conditions like high blood pressure, high cholesterol, and diabetes.
Heart Failure Stage B
Heart Failure Stage B
Heart disease, no symptoms. Examples include previous heart attack or valve disease.
Heart Failure (HF)
Heart Failure (HF)
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Left-sided Heart Failure
Left-sided Heart Failure
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Heart Failure Stage B Treatment
Heart Failure Stage B Treatment
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Heart Failure Stage C
Heart Failure Stage C
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Right-sided Heart Failure
Right-sided Heart Failure
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Heart Failure Stage C Treatment
Heart Failure Stage C Treatment
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Preload
Preload
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Heart Failure Stage D
Heart Failure Stage D
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Afterload
Afterload
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Cardiac output
Cardiac output
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Heart Failure Stage D Treatment
Heart Failure Stage D Treatment
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Positive inotropic agents
Positive inotropic agents
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Pharmacologic management of Heart Failure
Pharmacologic management of Heart Failure
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ACE Inhibitors
ACE Inhibitors
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ARBs
ARBs
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Diuretics
Diuretics
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Cardiac Glycosides
Cardiac Glycosides
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Beta-Blockers
Beta-Blockers
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Digoxin
Digoxin
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Lisinopril
Lisinopril
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Metoprolol
Metoprolol
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Direct Vasodilators in Heart Failure
Direct Vasodilators in Heart Failure
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Phosphodiesterase Inhibitors
Phosphodiesterase Inhibitors
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Milrinone (Primacor)
Milrinone (Primacor)
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Positive Inotropic Response
Positive Inotropic Response
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Vasodilation
Vasodilation
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Heart Failure Treatment Timeframe
Heart Failure Treatment Timeframe
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Sodium & Potassium Restrictions
Sodium & Potassium Restrictions
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Adverse Effects of Phosphodiesterase Inhibitors
Adverse Effects of Phosphodiesterase Inhibitors
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Study Notes
Heart Failure (HF)
- Inability of ventricles to pump sufficient blood for body's needs
- Heart muscle weakens due to aging or diseases
Diseases Associated with Heart Failure
- Coronary artery disease (CAD)
- Mitral stenosis
- Myocardial infarction (MI)
- Chronic High Blood Pressure (HTN)
- Diabetes mellitus
- No cure, only prevention and slowing of progression is possible
Left-Sided Heart Failure
- Blood accumulates in left ventricle
- Left ventricle thickens and enlarges (hypertrophy)
- Cardiac remodeling occurs
- Blood backs up into lungs
- Cough and shortness of breath result
Right-Sided Heart Failure
- Blood backs up into veins
- Causes peripheral edema and organ engorgement
- Less common than left-sided HF
Pathophysiology of Heart Failure
- Failing heart leads to decreased cardiac output
- Diminished renal blood flow
- Increased sympathetic activity leads to increased heart rate & force of contraction
- Vasoconstriction increases blood pressure
- Retention of sodium and water leads to increased plasma volume
- Increased afterload
- Increased cardiac workload
- Myocardial dysfunction worsens heart failure
- Pulmonary and peripheral edema occurs
Preload
- Affects cardiac output
- Degree myocardial fibers stretched before contraction
- Frank-Starling law: more stretched, more forceful contraction
- Positive inotropic agents increase preload to increase contractility
Afterload
- Affects cardiac output
- Pressure in aorta, must be overcome to eject blood from left ventricle
- Lowering blood pressure decreases afterload, decreasing workload of the heart
Pharmacologic Management of Heart Failure
- Slowing heart rate
- Increasing contractility
- Reducing myocardial workload
Drugs for Heart Failure
- Treat symptoms: slow heart rate, increase contractility, reduce workload
Stages for Treating Heart Failure
- Stage A: High risk for developing HF, no structural heart disease or symptoms, lifestyle modifications, treat comorbid conditions.
- Stage B: Structural evidence of heart disease (eg. previous MI), no symptoms, continue lifestyle changes, treat with ACE inhibitor or ARB; beta blockers can be added if prior or current symptoms
- Stage C: Structural heart disease with symptoms, continue lifestyle/meds from stage B, consider beta blockers, other measures like digoxin, isosorbide dinitrate with hydralazine, or aldosterone antagonist to control symptoms
- Stage D: Symptoms at rest or with minimal exertion, despite optimal medical therapy, lifestyle modifications/treatment as in stage C, or consider intravenous (IV) vasodilators or other medications like ivabradine, diuretics, dopamine, dobutamine and more intensive measures
ACE Inhibitors
- Reduce afterload
- Drugs of choice for heart failure
- Enhance excretion of sodium and water
- Lower peripheral resistance, reduce blood volume
- Increase cardiac output
- Prototype drug: lisinopril (Prinivil, Zestril)
- Mechanism: inhibit ACE enzyme and decrease aldosterone secretion
- Primary use: to decrease blood pressure, reduce blood volume; dilate veins
- Adverse effects: first-dose hypotension, cough, hyperkalemia, renal failure
Angiotensin II Receptor Blockers (ARBs)
- Actions very similar to ACE inhibitors
- Often used for patients intolerant of ACE inhibitors
Diuretics
- Increase urine flow
- Reduce blood volume and cardiac workload
- Reduce edema and pulmonary congestion
- Prescribed in combination with other drugs
Cardiac Glycosides
- Increase force of heartbeat, slow heart rate
- Improve cardiac output
- Second-line treatment for HF
- Narrow therapeutic range
- Prototype drug: digoxin (Lanoxin)
- Mechanism: to cause more forceful heartbeat, slower heart rate
- Primary use: to increase contractility or strength of myocardial contraction
- Adverse effects: neutropenia, dysrhythmias, digitalis toxicity
Beta-Adrenergic Blockers
- Slow heart rate and reduce blood pressure
- Inotropic effects
- Reduce workload of heart
- Prototype drug: metoprolol (Lopressor, Toprol XL)
- Mechanism: Block cardiac action of the sympathetic nervous system to slow heart rate, blood pressure, reducing workload of heart
- Primary use: reduce symptoms of heart failure, slow progression of disease
- Adverse effects: fluid retention, worsening of heart failure, fatigue, hypotension, bradycardia, heart block
Direct Vasodilators
- Minor role in HF treatment
- Lower blood pressure
- Relax blood vessels
Phosphodiesterase Inhibitors
- Block enzyme phosphodiesterase
- Increase calcium for myocardial contraction
- Cause positive inotropic response and vasodilation
- Increase contractility and decrease afterload
- Short-term therapy only
- Prototype drug: milrinone (Primacor)
- Mechanism: to block enzyme phosphodiesterase in cardiac and smooth muscle, increasing myocardial contraction force and cardiac output
- Primary use: as short-term therapy for heart failure
- Adverse effects: hypokalemia, hypotension, ventricular dysrhythmias
Patient Teaching
- Therapeutic response (weeks/months)
- Sodium and potassium restrictions
- Avoid use with other medications/herbals/vitamins
- Monitor sodium intake
- Report weight loss, fatigue, muscle cramps
- Change positions slowly
- Monitor blood pressure/pulse, report pulse below 50
- Report signs of worsening heart failure
- Do not stop medication abruptly
- Monitor therapeutic levels with laboratory tests
- Know signs/symptoms of toxicity
- Monitor pulse rate, report weight gain
- Eat foods high in potassium
- Report irregular/rapid heart rate
- Report fever of 101°F or higher, chest pain
- Report pain/swelling at IV infusion site
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