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Pharm CHF

Pharmacology 9/16/08

QuestionAnswer
CHF Risk Factors in Men Cigarette smoking in younger but not older than 65 years HTN and DM (4 fold increase < 65) ECG evidence of LVH (15 fold increase <65)
CHF Risk Factors in Women (under age 65) HTN (3 fold increase) DM (5 fold increase) LVH (15 fold increase)
General Risk Factors for Both Genders Obesity Increased total cholesterol ProteinuriaECG evidence of intraventricular conduction disturbances or non specific repolarization abnormalities
Pre-existing conditions that can cause an increase in pressure or volume overload of the mycardium lead to heart failure HTN Valvular Heart Disease CAD (myocardial infarction) Cardiomyopathies Pericardial Disease Infectious etiologies (viral myocarditis)
Severity of Heart Failure Classification Class I Asymptomatic Left ventricular dysfunction. No limitation of physical activity. No fatigue, dyspnea, or palpitations with ordinary activity
Severity of Heart Failure Classification Class II Slight limitation of physical activity. Although comfortable at rest, fatigue, dyspnea, or palpitations occur with ordinary physical activity (mod. To max exertion)
Severity of Heart Failure Classification Class III Marked limitation of physical activity. Although comfortable at rest, fatigue, dyspnea, or palpitations occur with less than ordinary activity (minimal exertion)
Severity of Heart Failure Classification Class IV Unable to carry on physical activity without discomfort or worsening symptoms. Fatigue, dyspnea, or palpitations occur at rest
Symptoms of Left sided Heart Failure Dyspnea Orthopnea Fatigue Paroxysmal nocturnal dyspnea
Symptoms of Right sided Heart Failure Peripheral edema Right upper quadrant discomfort (hepatic enlargement)
Clinical physical findings Diaphoresis Tachycardia Tachypnea Pulmonary rales, wheezes Jugular venous distention Hepatomegaly Peripheral edema
What is the primary goal of tx? Remove the underlying cause
Three factors that help control CHF Improving cardiac performance Reducing cardiac workload Controlling Na and water retention
Treatment components Dietary considerations (Na restriction) Physical conditioning (exercise rehab.) Drug therapy
Precipitating and Underlying Disease or conditions Infection, Fever, Fluid overload, Increased dietary salt intake, Uncontrolled HTN, Cardiac Arrhythmias, Thiamine deficiency, Myocardial Ischemia, Renal failure, Thyrotoxicosis, Pulomonary Embolism, Anemia, High environmental temperature, Respiratory insuf
5 Drug Classes used in treatment Diuretics Digoxin ACE inhibitors Beta blockers Vasodilators
Nitroprusside (Nitropress) Vasodilator Ind: Overt Heart Failure with severe HTN, valvular heart disease, or cardiac surgery MOA: Inc CO, reduce peripheral resistance ADR: HA, GI distress, may get build up of metabolites during or in pts with renal dysfunction
Nitroglycerin (nitrostat, minitran, nitro-dur) Vasodilator Ind: Left ventricular dysfunction resulting from unstable coronary insufficiency MOA: decreases left ventricular pressure and systemic vascular resistance; dilates coronary arteries ADR: HA, hypotension, nitrate tolerance requiring upward f
Minoxidil Vasodilator Ind: Severe HTN (Not used in CHF) MOA: direct vasodilation of the arterioles with decreased systemic vascular resistance ADR: EKG changes, CHF, tachycardia
Hydralazine (Apresoline) Vasodilator Ind: CHF and moderate to severe HTN MOA: direct vasodilation of the arterioles with decreased systemic vascular resistance ADR: HA, nausea, dizziness, tachycardia, lupus like syndrome
Minoxidil Vasodilator Ind: Severe HTN (Not used in CHF) MOA: direct vasodilation of the arterioles with decreased systemic vascular resistance ADR: EKG changes, CHF, tachycardia
Isosorbide Dinitrate (Dilatrate) Vasodilators Ind: CHF; proven effective in combination with hydralazine MOA: decreases left ventricular pressure and systemic vascular resistance; dilates coronary arteries ADR: HA, hypotension, flushing
Created by: Marywood
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