robbypowell's version from 2016-10-25 02:46

Heart Failure

Question Answer
reduction in pumping activity has what effect on Cardiac Outputdecreases Cardiac output
Decreased CO (cardiac output) causes (increase/decrease) end systolic volume in the heartIncreased end systolic volume (blood remains in the heart that should have been pumped out)
reduction in cardiac pumping --> decrease CO --> increase end systolic volume (leftover volume in heart) Heart tries to accommodate for greater residual blood volume by ____Dilating***
Less CO --> ____ (more/less) renal blood flowLess
Normally, the kidneys receive _____% of Cardiac Output25%
Ischemia in the kidney activates _____ apparatus which releases ______Juxtaglomerular apparatus; Renin
Renin converts _____ to ______Angiotensinogen to Angiotensin 1
ACE converts ____ to ______Angiotensin 1 --> Angiotensin 2
Angiotensin ____ is a powerful vasoconstrictor, __________ retains Na and fluid in the body = results in increase of blood pressure and edemaAngiotensin 2; Aldosterone
Angiotensin 2 stimulates release of ______ from adrenal cortexAldosterone
Severity of Heart Failure is determined by the ____ ____ test done on the lower limbPitting Edema
Pitting Edema indicates the body is in ____-____ overload and ______ can be used to decrease these levelsFluid-Sodim; Diuretics
Decreased CO ---> affects blood pressure how?Dec BP
Changes in blood pressure that result from decreased CO elicit a reflex activation of which part of the autonomic nervous system (para/sym)... how does this attempt to correct?Sympathetic reflex; Increase HR and force of Contraction (to increase BP)
term for Dyspnea that is experienced when patient is in recumbent positionOrthopnea (need to use pillows to elevate upper body to prevent pulmonary edema that makes it hard to breathe)
term for dyspnea that awakens patient from sleepParoxysmal nocturnal dyspnea
______-______ respiration: Hyperventilation followed by apnea during sleepCheynes'-stokes
Treatment for SYSTOLIC heart failureDigitalis Glycosides
_______ arrhythmia is a side effect of Digitalis GlycosidesVentricular
Digitalis Glycosides is used for ______ heart failure while the other drugs (o Diuretics, ACE inhibitors, angio-recep blockers, adrenergic alpha blockers, adrenergic beta blockers, vasodilators) are used to treat ______ heart failureSystolic; Diastolic
T/F: A person with CHF (congestive heart failure) will experience dyspnea during normal Cardiac OutputTrue
T/F: A normal person (no CHF) will experience dyspnea during normal Cardiac OutputFalse
2 Special membrane bound enzyme for Cardiomyocites Na-K ATPase Enzyme (pumps Na out, K in) and Na-Ca Exchanger (pumps Na in, Ca out)
Na-K ATPase enzyme (cardiomyocite) pumps ____ out and ____ in to the myociteNa out; K in
Na-Ca Exchanger enzyme (cardiomyocite) pumps ____ out and ____ in to the myocite under "normal" conditions... but can do the opposite when in the upstroke of the cardiac APCa out; Na in (but vice-versa when Na levels super high in cell)
2 major cardiac effects of Digitalis Glycosides are a Positive ______ effect and a negative _____ effect+ Inotropic; - Cornotropic
The negative ________ effect of Digitalis Glycosides alters electrical activity throughout the heart/HR (thus they can be used for arrhythmias too)Negative CORNOTROPIC effect (one of two major effects of DG's) (Increases CARDIAC EFFICIENCY)
The positive ________ effect of Digitalis Glycosides increases myocardial contractility (but really only effective at doing this for someone in CHF)Positive INOTROPIC effect (shorter systolic phase with greater effectiveness) (not much effect on CO of normal person, but pronounced effect in CHF patient)
Digitalis Glycosides overall have the effect of increasing cardiac ______Efficiency (yeah, so output too... but efficiency is key here because slows HR but increases power of contractions)
T/F: Digitalis Glycosides act like Cholinomimetic drugsTrue
T/F: Digitalis Glycosides act like Sympathomimetic drugsFalse (cholinomimetic)
What are the 2 different glycoside drugs?Digoxin and Digitoxin
Of the 2 glycosides, which is is eliminated by the liver (and therefore still good if the patient has renal failure)Digitoxin
Which of the 2 glycosides is absorbed BETTER and has a longer T1/2?Digitoxin
Which of the 2 glycosides is excreted in its unaltered form by the kidney and has a shorter half-life?Digoxin (lanoxin)
Cardiac glycosides have a _______ margin of safetyNARROW
T/F: Digitoxin and Digoxin have a narrow margin of safetyTrue
T/F: Digitoxin and Digoxin have a wide margin of safetyFalse (narrow)
Glycosides (DIgoxin and Digitoxin) are indicated in ________ or _______ output heart failureSystolicc; Low output
T/F: Low output (systolic) heart failure is an indication for use of glycosidesTrue
T/F: Low output (systolic) heart failure is a Contraindication for use of glycosidesFalse
T/F: High output (diastolic) heart failure is a Contraindication for use of glycosidestrue
T/F: High output (diastolic) heart failure is an indication for use of glycosidesFalse
T/F: Glycosides side effects include excess salivation, nausea, and diarrheaTrue
______ can be used to control sinus bradycardia and AV block, which are brought about from GlycosidesAtropine
What is the "anti-digoxin" drug?Digoxin immuno-antibodies (or cholestryaminase)
__________ = binds to cardiac glycosides to inc eliminationCholestryramine
Drug side effects that we should look out for from Heart failure patients are ... (list 4)orthostatic hypotension (due to diuretics, vasodilators), ARR (from digoxin overdose), nausea/vomiting (digoxin, vasodilators), palpitations (vasodilators)
How does Hypokalemia affect Digitalis Glycoside effects?Potentiates (increases) (toxicity risk)
How does hypercalcemia affect Digitalis Glycosides effects?Potentiates (increases) (toxicity risk)
T/F: Antibiotics can increase serum Digoxin concentrationTrue (only some?)
What is the max epi dose (for heart failure patients)0.04 mg
How do anti-sialogogues affect digoxin?Decrease effectiveness of digoxin

Indication or contraindication for Cardiac Glycosides?

Question Answer
low output heart failureIndication
SYSTOLIC heart failureIndication
atrial fibrillationIndication
atrial flutterIndication
paroxysmal atrial tachycardiaIndication
high output heart failureContraindication
DIASTOLIC heart failureContraindication
cardiac tamponadeContraindication
constrictive pericarditisContraindication
idiopathic hypertropic subaortic stenosisContraindication

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