NURS 488 - Lec 2 Test
With Solution
Primary goal of acute HF management - ANSWER - improve ventricular
function
- decrease intravascular volume
- decrease preload
- decrease afterload
- improve gas exchange and oxygenation
- increase CO
pharmacological management of acute HF - ANSWER 1. furosemide (loop
diuretic)
- improve ventricular function
- decrease intravascular volume
- decrease preload
2. oxygen therapy
3. nitro patch
4. ACE inhibitor
5. digoxin
6. beta blockers
,- decrease afterload
- improve gas exchange and oxygenation
- increase CO
7. dobutamine and nitro infusions (for critical care)
investigations of acute HF - ANSWER 1. chest x-ray
2. ECG
3. echocardiogram to assess ejection fraction
pertinent labs for acute HF - ANSWER 1. CBC
2. clotting factors
3. electrolytes
4. brain natriuretic peptide (BNP)
GLP-1 receptor agonists MOA - ANSWER *end in -tide (ex. liraglutide,
exenatide ER)*
incretin hormones are released by the GI tract in response to food and do the
following
- stimulate insulin secretion
- reduce postprandial glucagon production
- slow gastric emptying
- increase satiety
benefits of GLP-1 receptor agonists in HF - ANSWER - in combination therapy
with SGLT2 inhibitors after diagnosis of T2D
, SGLT2 inhibitors MOA - ANSWER *end in -liflozin (ex. canagliflozin,
dapagliflozin, empagliflozin)*
- blocks the tubular reabsorption of glucose in the kidneys via the
sodium-glucose cotransporter
benefits of SGLT2 inhibitors in HF - ANSWER - reduces BP
- promotes natriuresis and diuresis
- improves cardiac energy metabolism
- reduces systemic inflammation
- weight loss
- improves glucose control
- inhibits SNS
- prevents cardiac remodelling
GLP-1 receptor agonist and SGLT2 inhibitor recommendations - ANSWER -
SGLT2i is a foundational therapy for patients with HF with ACE or ARB
therapy, beta blocker, and mineralocorticoid receptor antagonist (MRA ->
spironolactone)
- must monitor: eGFR, urine albumin to creatinine ratio (UACR), and A1c, and
to document left venticular ejection fraction (LVEF) when evaluating
symptoms of HF
- in adults with HF and LVEF ≤ 40%, recommend use of SGLT2i to reduce
all-cause and CV mortality, hospitalization for HF, and the composite end
point of significant decline in eGFR, progression to end-stage kidney disease,
or death due to kidney disease
With Solution
Primary goal of acute HF management - ANSWER - improve ventricular
function
- decrease intravascular volume
- decrease preload
- decrease afterload
- improve gas exchange and oxygenation
- increase CO
pharmacological management of acute HF - ANSWER 1. furosemide (loop
diuretic)
- improve ventricular function
- decrease intravascular volume
- decrease preload
2. oxygen therapy
3. nitro patch
4. ACE inhibitor
5. digoxin
6. beta blockers
,- decrease afterload
- improve gas exchange and oxygenation
- increase CO
7. dobutamine and nitro infusions (for critical care)
investigations of acute HF - ANSWER 1. chest x-ray
2. ECG
3. echocardiogram to assess ejection fraction
pertinent labs for acute HF - ANSWER 1. CBC
2. clotting factors
3. electrolytes
4. brain natriuretic peptide (BNP)
GLP-1 receptor agonists MOA - ANSWER *end in -tide (ex. liraglutide,
exenatide ER)*
incretin hormones are released by the GI tract in response to food and do the
following
- stimulate insulin secretion
- reduce postprandial glucagon production
- slow gastric emptying
- increase satiety
benefits of GLP-1 receptor agonists in HF - ANSWER - in combination therapy
with SGLT2 inhibitors after diagnosis of T2D
, SGLT2 inhibitors MOA - ANSWER *end in -liflozin (ex. canagliflozin,
dapagliflozin, empagliflozin)*
- blocks the tubular reabsorption of glucose in the kidneys via the
sodium-glucose cotransporter
benefits of SGLT2 inhibitors in HF - ANSWER - reduces BP
- promotes natriuresis and diuresis
- improves cardiac energy metabolism
- reduces systemic inflammation
- weight loss
- improves glucose control
- inhibits SNS
- prevents cardiac remodelling
GLP-1 receptor agonist and SGLT2 inhibitor recommendations - ANSWER -
SGLT2i is a foundational therapy for patients with HF with ACE or ARB
therapy, beta blocker, and mineralocorticoid receptor antagonist (MRA ->
spironolactone)
- must monitor: eGFR, urine albumin to creatinine ratio (UACR), and A1c, and
to document left venticular ejection fraction (LVEF) when evaluating
symptoms of HF
- in adults with HF and LVEF ≤ 40%, recommend use of SGLT2i to reduce
all-cause and CV mortality, hospitalization for HF, and the composite end
point of significant decline in eGFR, progression to end-stage kidney disease,
or death due to kidney disease
