24. Drugs for Heart Failure

Question 1

Drug:

Important facts: competetive inhib of ACE, half life 1.7hrs, toxicities= cough and angioedema

Answer 1

Captopril

enalapril prodrug IV, benazepril long 1/2, lisinopril long 1/2life

Question 2

Drug:

Important facts: competitive non peptie AGTII receptor antagonist with 1000x greater selectivity for AT1 than AT2

Answer 2

Losartan

Question 3

Drug:

Important facts: t1/2 life is 6-10hrs, NOT a prodrug requiring activation, excreted in feces as unchanged drug

Answer 3

Valsartan

Question 4

Drug:

Important facts: 1/2 life 5-9hrs, it is relatively IRREVERSIBLE binding

Answer 4

Candesartan

Question 5

Drug: combo
Important facts: an ARB, with prodrug that inhibits neprilysin (neutral endopeptidase NEP), both drugs are co crystalized. blockade of neutral endopeptidase prolongs ANP half life leads to natriuretic peptides, for heart failure *expensive recently approved july 2015

Answer 5

valsartan/sacubitril

Question 6

No ACE = ARB but ace is first choice, if not tolerated give ARB for anyone with LV systolic failure/LV dysfunction except pregnant, hypotensice, serum creatinine above 3, and?

Answer 6

hyperkalemia

Question 7

Drug:
Important facts: a/b antagonist, if clinically stable- give when there is recent MI or ACE and reduced ejection fraction, rEF to prevent symptomatic HF

Answer 7

carvedilol (labetalol)

Question 8

Drug:
Important facts: Clinical: tx of resting HR greater than 70 bpm in patients with stable symptomatic CHF with LV ejection fraction less than 35%, who are in sinus rhythym with maximally tolerated doses of beta blockers.. *contraindication to beta blocker use

Answer 8

ivabradine

Question 9

Drug:
Important facts: compet antagonist of aldosterone receptors, K+ sparing diuretic, steroid effects are slow on and slow off so single dose lasts 2-3days…dec myocardial fibrosis, reduce early morning rise in HR< reduce mortality and morbidity ***fear of hyperkalemia

Answer 9

Spironolactone

more selective eplerenone

Question 10

Drug:
Important facts: block NaK2Cl cotransporter at TLH, manages edema, decrease preload, decrease EC vol, rapid dyspnea relief, works in patients with low GFR, **sulfonamide with many toxicities, metabolic alkalosis

Answer 10

Furosemide

(toresmide long1/2, better oral absorption works better in HF, bumetanide more predicatble oral absorption, ethacrynic acid = nonsulfa!)

Question 11

Drug:
Important facts: Block NaCl cotransporter at DCT, K+ losing, management of hypertensions, not effective in pt with low GFR, sulfonamide drug with many toxicities, metabolic alkalosis

Answer 11

Hydrochlorothiazide (HCTZ)

cholorthiazide similar but poor absorption

Question 12

use loop first, then add K sparing if needed and if need more diuresis add ?

Answer 12

thiazide

Question 13

isosorbide dinitrate plus hydralazine (BiDil) for african american is the first dru ever intended for one?

Answer 13

racial group

Question 14

Drug:

Important facts: forms NO, more prominent effect on the veins

Answer 14

nitroglycerin

Question 15

Drug:
Important facts: endothelium dependent, hyperpolarizes, requires activation of COX, mediated by prostacyclin PGI2 receptor, direct vasodilation of arterioles, for HTN, HF, hypertensive emergency, toxicities drug like lupus, flushing angina pectoris, edema tachycardia

Answer 15

hydralazine (dec. work on heart)

Question 16

Drug:
Important facts: inhibit Na/K ATPase, increased contractility, supress av node, positive inotropy, enhanced vagal tone, decreased ventricular rate to fast atrial arrhythmias, used in HF, kids to increase myocardial contractility, administered orally, 1/2 life 36-48hrs requires loading dose, crosses placenta

Answer 16

Digoxin