Acute Decompensated HF drugs

Question 1

Enumerate types of drugs used in ADHF

Answer 1

• Loop Diuretics (furosemide, torsemide, bumetanide)
• Vasodilators (Nitrates, Sodium Nitroprusside, Nesiritide)
• Inotropic Agents:
  1.Beta-1 Agonists: dopamine & Dobutamine, epinephrine, isoproterenol
  2.Phoshopdiesterase inhibitors: Amirinone, Milirinone
  3.Calcium sensitizers: Levosimendan

Question 2

Action of Nitrates in ADHF

Answer 2

Nitroglycerin, Dinitrate, mononitrate:
* more venodilation –> reduce ventricular preload

Question 3

Action of Sodium Nitroprusside

Answer 3

Balanced Arterial & Venous dilation

Question 4

Action of Nesiritide in ADHF

Answer 4

Synthetic form of BNP –> Balanced Arterial & Venous dilatation

Question 5

Inotropic agents of ADHF are divided into

Answer 5

• Beta 1 agonists
• Phospodiesterase (3) inhibitors
• Calcium Sensitizers

Question 6

Beta 1 agonists used in ADHF

Answer 6

• Dopamine & Dobutamine
• Epinephrine (also for cardiac arrest & anaphylactic shock)
• Isoproterenol (also for cardiogenic shock secondary to Bradycardia)

Question 7

Phosphodesterase inhibitors used in ADHF

Answer 7

• Amironone
• Milirinone

Question 8

Action of Amrinone in ADHF

Answer 8

INO-DILATOR:
* they are inotropic agents that increase Ca2+ by increasing cAMP by inhibiting Phosphodiestrase 3 —> Accumulation of cAMP in heart
* Mixed Arterial & Venous Dilatation as well

with minimal changes in Heart rate & Blood pressure

Question 9

Adverse effects of Amrinone

Answer 9

Allergy:
* Fatal thrombocytopenia
* Hepatotoxicity

Worsens Angina pectoris

Question 10

Phosphodiesterase 4 Inhibitor

Answer 10

Theophylline

Question 11

Phosphodiesterase 5 inhibitor

Answer 11

sildenafil

Question 12

Mechanism of action of Levosimendan

Answer 12

Calcium Sensitizer
* Inreases Sensitivity of troponin C to Ca2+

Question 13

adverse effects of Levosimendan

Answer 13

its effect can last up to at least a week after infusion