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Cardiovascular > 04.21 - CHF Pharm (Ostrom) > Flashcards

04.21 - CHF Pharm (Ostrom) Flashcards

1
Q

Tx for Stage A CHF

A

Preventive Measures, ACEi’s and ARB’s

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2
Q

___ is a vasodilator that acts directly on vascular SM

A

Hydralazine

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3
Q

2 “other” Considerations for Diuretic Tx in CHF

A

ACEi’s and ARB’s also have diuretic effects; Spirinolactone, Eplerenone have benefits beyond diuretic effect

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4
Q

3 BB’s approved for CHF

A

Metoprolol, Carvedilol, Bisoprolol (Carved Bison Meat)

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5
Q

3 most common AE’s of ACEi’s

A

First dose hypotension, Na depletion, Dry Cough

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6
Q

3 most common AE’s of Aliskerin

A

First dose hypotension, Hyperkalemia, Angioedema

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7
Q

3 most common AE’s of ARB’s

A

First dose hypotension, Hyperkalemia, Hepatic Dysfunction

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8
Q

4 Drugs that interact with Digoxin

A

Quinidine, Amiodarone, Verapamil, Diuretics

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9
Q

ACEi effect on Bradykinin

A

Increase levels due to inhibitor of metabolism

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10
Q

ACEi’s end in

A

pril

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11
Q

Advantage of ACEi’s

A

Little effect on lipids or sexual function

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12
Q

Advantage of Milrinone over Dobutamine

A

Milrinone doesn’t desensitize receptors

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13
Q

Aldosterone and AngII combine to stimulate

A

fibrosis in cardiac tissue

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14
Q

Angiotensin Receptor Antagonists end in

A

tan

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15
Q

Arterial Vasodilators alone may what change in Frank-Starling Curve

A

Left and Upward

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16
Q

Arterial Vasodilators work best when combined with

A

Inotrope and Diuretic

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17
Q

At what stage do you add beta blockers

A

B (NYHA I)

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18
Q

At what stage do you add Diuretic, Digoxin

A

C (NYHA II, III)

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19
Q

BB approved for CHF only in Europe

A

Nebivolol

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20
Q

BB least likely to induce increase TPR cause by reflex vasoconstriction

A

Carvedilol: alpha1 antagonist

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21
Q

BB that potentiates NO in vasculature; approved for HTN but not CHF

A

Nevivolol

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22
Q

Benefit of Nesiritide is comparable to

A

IV nitroglycerin but hypotension may persist longer

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23
Q

Can hemodynamic drugs slow progression of CHF?

A

No

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24
Q

Diuretics effects on Preload, CO

A

Reduce Preload, Do NOT increase CO

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25
Q

Do Diuretics improve survival or prognosis in CHF?

A

No (except for spironolactone/Eplerenone)

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26
Q

Dobutamine and Milrinone can cause

A

Arrhythmias

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27
Q

Does mortality change in CHF with Digoxin

A

Yes, reduced

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28
Q

Drug interactions of Aliskerin

A

Inhibits P-Glycoprotein (Erythromycin, Amiodarone)

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29
Q

Effect on K of Spirinolactone

A

K-Sparing

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30
Q

Hemodynamic effects of Natriuretic Peptides

A

(1) Reduce vent filling pressure; (2) Inhibit renin, aldosterone release; (3) Inhibit Na reabs; (4) Selective afferent arteriole vasodilation

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31
Q

How can Loop Diuretics cause arrhythmias

A

Hypokalemia

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32
Q

How do Arterial Vasodilators Increase CO

A

Reduce Afterload

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33
Q

How do beta blockers affect receptor numbers

A

Increase (reverse desensitization)

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34
Q

How do you favor gene regulation pathway over inotropic pathway

A

Slower, sustained catecholamine signaling (BAR internalization)

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35
Q

How does BP change with Atropine?

A

Doesn’t

36
Q

How does Digoxin affect Pressure-Volume Curve

A

Shifts upward: CO increases at each level of preload

37
Q

How is Digoxin excreted

A

Kidneys

38
Q

In which patients is benefit of Digoxin greatest

A

EF < 0.25, Cardiac Enlargement, NYHA III/IV

39
Q

Increased Aldosterone may worsen

A

LV function

40
Q

Interactions of Diuretics

A

NSAIDs reduce efficacy

41
Q

Leading cause of death in Class II, III CHF?

A

Arrhythmias

42
Q

Long term hemodynamic effects of BB’s in CHF

A

Inc CO, Decreased LVEDP

43
Q

Main ACEi adverse effect

A

Dry Cough

44
Q

Mitogenic effects of Ang II

A

Hypertrophy of myocytes and vascular SM; Cardiac and vascular fibrosis, remodeling; Atherosclerosis

45
Q

MOA of Aliskerin

A

Renin inhibitor

46
Q

MOA of Dobutamine

A

Beta-1-selective agonist: Intropic effects thru cAMP, PKA

47
Q

MOA of Hydrochlorothiazide

A

Diuretic

48
Q

MOA of Milrinone

A

PDE inhibitor: Increase cAMP level

49
Q

MOA of Neseritide (3)

A

(1) Vaso, Venodilation; (2) Increase GFR, Decrease Na reab; (3) Suppress Renin-Ag and SNS

50
Q

Most commonly used Diuretics

A

Furosemide (Loop); Spirinolactone (Aldosterone ant)

51
Q

Most powerful diuretic class

A

Loop

52
Q

Need to combine arterial vasodilator with __ to reduce both preload and afterload

A

Venodilator (nitrate)

53
Q

Preganancy status of ACEi’s

A

Fetotoxic

54
Q

Primary Vasodilators:

A

Hydralazine, Nitrates

55
Q

Renin inhibitor

A

Aliskiren

56
Q

Role of Bradykinin

A

Vasodilator and antifibrotic mediator (downregulated by ACEi’s)

57
Q

Role of Phosphobalmin

A

Regulates SR pump that removes Ca2

58
Q

Short term hemodynamic effects of BB’s in CHF

A

Dec CO, BP

59
Q

T/F: BB’s always decrease function in CHF?

A

False, actually improve

60
Q

T/F: BB’s can’t slow progression of CHF

A

FALSE

61
Q

Tachyphylaxis

A

Depletion of presynaptic vesicles within matter of minutes

62
Q

Toxicities of Digoxin

A

AV Block, Atrial/Vent Arrhythmias, Visual Changes (Halos)

63
Q

Toxicities of Diuretics

A

Electrolyte disturbances, Ototoxicity (Loop)

64
Q

Toxicity of Hydralazine

A

Nausea, Anorexia, +FANA

65
Q

Tx for Stage B CHF

A

Preventive, ACEi’s, ARB’s, Beta Blockers

66
Q

Tx for Stage C CHF

A

Preventive, ACEi’s, ARB’s, BB’s, Digoxin/ Spironolactone

67
Q

Tx for Stage D CHF

A

Preventive, ACEi’s, ARB’s, BB’s, Digoxin/ Spironolactone, IV inotropes, Transplant

68
Q

Use of Hydralazine is limited to what patients

A

Can’t tolerate ACEi’s

69
Q

Use of Nesiritide should be limited to those who

A

do not respond to nitroglycerin

70
Q

What attenuates deleterious effects of high levels of NE and Epi?

A

Beta blockers

71
Q

What does reduced afterload do to pressure-volume curve

A

Left and Upward

72
Q

What is counterintuitive about BB’s in CHF tx?

A

Slow progression

73
Q

What is Lusitropy

A

Activation of beta receptors also activates SR pump that removes Ca2+

74
Q

What is needed for rapid onset of Digoxin action

A

Loading dose

75
Q

What is Nesiritide

A

Recombinant b-type natriuretic peptide (BNP)

76
Q

What is primary goal of tx in patients with early (A and B) CHF?

A

Reign in overactivation of neurohormonal mediators, such as catecholamines and Ang 2

77
Q

What limits long-term dobutamine use

A

Desensitization of receptors; Arrhythmias

78
Q

What prevents vasodilator effect of Dobutamine?

A

BB therapy (creates unoppose a1 agonist)

79
Q

When is Nesiritide indicated?

A

IV tx of decompensated class IV (decompensated) CHF

80
Q

Which anti-HTN drugs should never be given to pregnant or nursing women?

A

ACEi’s or ARB’s

81
Q

Which does not increase vasodilator Bradykinin

A

ARB’s

82
Q

Which is more effective at reducing CHF endopoints: ARB’s or ACEi’s?

A

Equal

83
Q

Which is preferred: ACEi’s or ARB’s?

A

ACEi’s, unless patient can’t tolerate side effects

84
Q

Which shows aldosterone “escape”?: ACEi or ARB

A

ACEi

85
Q

Who responds less favorably to ACEi’s

A

Aas or Low-renin HTN patients

Cardiovascular (18 decks)

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