5 HF drugs

Question 1

what are the 2 forms of congestive heart failure?

Answer 1

systolic dysfunction: impaired ventricular contraction

diastolic dysfunction: impaired ventricular relaxation

Question 2

classes of drugs for HF

Answer 2

vasodilators
- nitrates (ISDN, ISMN)
- loop diuretics (furosemide, bumetaminde)
- ACE-I / AT1R

others
- sacubitril-valsartan
- beta blockers (carvediolol, bisoprolol, metoprolol, nebivolol)
- K+ sparing diuretics (spironolactone, eplerenone)
- hydralazine
- ivabradine

Question 3

MoA of nitrates

ISDN, ISMN

Answer 3

supplies NO (endogenous vasodilator)
→ activate guanylyl cyclase
→ increase conversion of GTP to cGMP
→ inactivate myosin-Light chain
→ leads to relaxation of vascular smooth muscle

increase vasodilation helps with preload & afterload

Question 4

2 therapeutic effects of nitrates

Answer 4

vasorelaxation
- venodilation → preload ↓
- arteriolar dilation → afterload ↓

∴ cardiac load and BP ↓

Question 5

Which beta blockers are also approved to treat heart failure?

lower BP + treat heart failure wow

Answer 5

• Carvedilol (non-selective)
• Bisoprolol (β1)
• Metoprolol (β1)
• Nebivolol (mixed)

Question 6

MoA of beta blockers

Carvedilol, Bisoprolol, Metoprolol, Nebivolol

Answer 6

Carvedilol (non-selective)
also blocks α1 receptors → reduce peripheral vascular resistance

Bisoprolol, Metoprolol (β1)
blocks β1-AR of heart
→ ↓ contractility
→ reduce workload

Nebivolol (mixed)
also has vasodilatory effects through increase NO release

can use for HTN and angina pectoris (IHD)

Question 7

Name 2 loop diuretics

Answer 7

Furosemide
Bumetaminde

Question 8

MoA of loop diuretics

Answer 8

1. LD selectively inhibit the luminal Na+/K+/2Cl- cotransporter in the thick ascending limb of loop of Henle
2. LD cause increase in Mg2+ and Ca2+ excretion
3. LD induce renal PG synthesis (∴ NSAIDs interfere with action of LD by reducing PG synthesis)

Furosemide increases renal blood flow

see pg 18

Question 9

PK of loop diuretics

Answer 9

radpidly absorbed, diuretic response is extremely rapid following IV injection
duration of action: 2-3 hours
eliminated by tubular secretion & glomerular filtration

Question 10

Name 4 clinical uses for loop diuretics

Answer 10

1. acute pulmonary edema / other edema
2. acute hyperkalemia
3. acute renal failure
4. anion overdose: toxic ingestions of bromide, fluoride, iodide

Question 11

4 adverse effects of loop diuretics

Answer 11

1. hypokalemic metabolic alkalosis
2. ototoxicity - DONT USE WITH AMINOGLYCOSIDE
3. hyperuricemia
4. hypomagnesemia