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Pharmacology > 4.5 Heart Failure Drugs > Flashcards

4.5 Heart Failure Drugs Flashcards

1
Q

Reduced contractility along with decreased ejection fraction (pumping less blood)

A

Systolic failure

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2
Q
  • Reduced Filling + CO, due to:
    • Stiffness
    • Loss of adequate relaxation

Heart is not stretching enough to fill up

A

Diastolic Failure

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3
Q

What is the effect of CHF on contracility, HR, preload + afterload?

A
  • Decreased:
    • Contractility
  • Increased:
    • HR
    • Preload
    • Afterload
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4
Q

Why is HR increased in congestive heart failure?

A

Sympathetic activation of beta-adrenergic receptors

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5
Q

Why is preload increased in congestive heart failure?

A

Increased BV + venous tone

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6
Q

Why is afterload increased in congestive heart failure?

A

Increased systemic vascular resistance

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7
Q

What problem is associated with pts taking ACE Inhibitors?

A
  • ACE is also responsible for the breakdown of bradykinin
    • ACE converts Angiotensin I to Angiotensin II
  • Pts taking ACE Inhibitors get an acculumation of bradykinin resulting in persistent cough , etc.
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8
Q

Are beta-adrenergic blockers or agonists used for Chronic or Acute CHF?

A
  • Chronic CHF
    • beta-adrenergic blockers
      • ​metoprolol
  • Acute CHF
    • beta-adrenergic agonists
      • ​dobutamine, dopamine
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9
Q

What are the ACE Inhibitors used in the tx of Chronic CHF? (4)

A

- prili = ACE Inhibitors

  • Benazepril
  • Captopril
  • Enalapril
  • Lisinopril
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10
Q

What are the cardiac effects of ACE Inhibitors? (2)

A
  • Reduce:
    • Peripheral Resistance
    • Afterload
    • Aldosterone secretion
    • Sympatethic activity
      • via inhibition of angiotensin
  • Prevent Myocardial Remodeling
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11
Q

What are the Angiotensin II Type-1 Receptor Blockers? (3)

A

- sartan

  • Losartan
  • Velsartan
  • Olmesartan
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12
Q

What drugs are considered in pts intolerant to ACE Inhibitors due to incessant cough?

A

Angiotensin II Type-1 Receptor Blockers

Losartan, velsartan, olmesartan

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13
Q

What is a plant derived cardiac glycoside (only cardiac glycoside used in USA)?

A

Digitalis/Digoxin

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14
Q

In what form is digitalis/digoxin active, and what is the half life?

A
  • Orally active
  • Long 1/2 life = 36-40 hrs
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15
Q

How is digitalis/digoxin excreted?

A

excreted in kidneys

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16
Q

What is the mechanism of action of Digoxin?

A
  • Inhibits the Na+/K+ ATPase
  • Thus increases intracellular Na+, which in turn inhibits Na+/Ca2+ exchanger (NCX)
  • Which leads to the retention of intracellular calcium, causing increases myocardial contractility
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17
Q

What effect does Digitalis have on the CNS?

A
  • Disorientation
  • hallucinations
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18
Q

What effect does Digitalis have on the GI tract?

A
  • Anorexia
  • Nausea
  • Vomiting
  • Diarrhea
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19
Q

Gynecomastia may occur in men who take …

A

Digitalis

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20
Q

What effect does Digitalis have on potassium?

A

Hypokalemia

  • Potassium + digitalis compete for the binding to Na+/K+-ATPase
  • Postassium supresses the efficacy of digitalis
  • Reducing the toxicity of digitalis
21
Q

What effect does Digitalis have on Magnesium?

A

Hypomagnesemia

  • Increasing susceptibility to Digoxin toxicity
22
Q

What effect does Digitalis have on calcium?

A

Hypercalcemia

  • Increasing the risk of digitalis-induced arrhythmia
23
Q

What drug is a Calcium Sensitizer?

A

Levosimendan

24
Q

What is the clinical benefit from Levosimendan (calcium sensitizer)?

A

Vasodilation

  • Opens ATP-sensitive K-channel
25
Q

What drugs are beta-adrenoceptor agonists?

A
  • Dobutamine
  • Dopamine
26
Q

What drug is a selective beta1 agonist?

A

Dobutamine

27
Q

What receptors are effected with low dose Dopamine?

A

D-dopaminergic receptor

28
Q

What receptors are effected with high dose Dopamine?

A

beta1 receptor

29
Q

What drug(s) are arrhytmogenic in CHF pts?

A

Dobutamine + Dopamine

Beta-adrenoceptor agonists

30
Q

What drugs are Phosphodiesterase-III Inhibitors?

A

Inamrinone + Milrinone

31
Q

What is the effect of inhibiting PDE-III?

A

cAMP elevation

32
Q

What are PDE-III Inhibitors (Inamrinone + Milrinone) used to treat?

A

Acute Heart Failure

33
Q

Inamrinone + Milrinone (PDE-III Inhibitors) are only available …

A

parenterally

34
Q

Which PDE-III Inhibitor is less liver toxic?

A

Milrinone

35
Q

What drug is a Natriuretic Peptide?

A

Nesiritide

36
Q

What is Nesiritide a synthetic form of?

A

Endogenous BNP

37
Q

What are potential toxic effects of Nesiritide (Natriuretic Peptide)?

A
  • Excessive hypotension
  • Even death
38
Q

What diuretic is suitable for systolic heart failure?

A

Furosemide

39
Q

What diuretics are aldosterone antagonists?

A

Spironolactone + Eplerenone

40
Q

Spironolactone + eplerenone should be concomitantly used with …?

A

ACE Inhibitors

41
Q

What drugs are beta-adrenoceptor blockers?

A
  • Metoprolol
  • Nebivolol
  • Carvedilol
42
Q

What are the effects of beta-adrenoceptor blockers (metoprolol, nebivolol)? (3)

A
  • Reduce mortality in pts with severe chronic heart failure
  • Reduce adverse effects of high concentrations of catecholamines
  • Reduce remodeling effects of catecholamines
43
Q

What is the effect of carvedilol (beta-adrenoceptor blocker)?

A

Reduces pre- and after-load, and antioxidant action

44
Q

What drug is a direct vasodilator?

A

Hydralazine

45
Q

Hydralazine (direct vasodilator) is combined with …?

A

inotropic agents

46
Q

What is used to treat:

  • Advanced stage heart failure
  • Resistant cases
  • Pts that cannot tolerate other medications
A

Hydralazine + isosorbide dinitrate

47
Q

Use of muscarinic (agonists) drugs may have what side effect?

A

Increase HR

48
Q

What drug increases digoxin uptake in GI?

A

Antibiotics (macrolides, tetracyclines)

49
Q

What drugs may antagonize digoxin?

A

Antimuscarinic drugs

Pharmacology (18 decks)

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