26 - Pharm of CHF Flashcards
plasma levels of what hormone predict mortality in CHF patients?
NE
amrinone and milrinone mech
PDE3 inhibs - prevent breakdown of cAMP in heart and vessels
type of diuretic preferred for CHF
loop diuretic (ex furosemide)
main drugs used in acute CHF
digoxin/digitalis
PDE2 inhibs
dobutamine
diuretics
main drugs used in chronic CHF
digoxin/digitalis (although not as much anymore)
beta blockers
diuretics
ACEi, ARB
digitalis ___ CO and ____ ventricular EDP
inc
dec
why is digoxin preferred over digitoxin
more bioavailable
faster onset
better control / shorter half life
SEs of digoxin
arrhythmias
PVCs
muscle weakness
fatigue
why is digoxin toxicity so common?
narrow therapeutic window
lots of drugs commonly used for heart problems change digitalis conc (amiodarone, verapamil)
diuretics (also used for CHF) dec K conc, increase toxicity
tx for digoxin toxicity
give K
antiglycoside antibodies
effects of PDE inhibs on heart fn
inc HR, contractility, CO
relax vascular smooth muscle
AEs of PDE3 inhibs
hepatic and GI tox
thrombocytopenia
arrhythmogenic
overall inc mortality - only used acutely now
how does dobutamine dec afterload?
dec sympathetic tone as CO improves
direct arterial dilation via weak beta2 activity
hydralazine
arterial vasodilator, but not used much b/c can cause drug induced SLE
why are CCBs not very useful in CHF?
negative inotropes - relatively c/i in CHF
