Anti-heart failure

Question 1

Anti-heart failure drugs

Answer 1

Diuretics
Vasodilators
Positive Inotropic drugs
B receptor antagonists

Question 2

Diuretics

Answer 2

see anti-hypertensive drugs

Question 3

Do loop and thiazide diuretics increase survival?

Answer 3

Nope

Question 4

Does spironolactone alone and in combination with ACE inhibitors increase survival?

Answer 4

Yep

Question 5

ACE inhibitors

Answer 5

Captopril, enalapril, lisinopril

Question 6

ACE inhibitor - MoA

Answer 6

drug angiotensin II levels

drop peripheral resistance and preload/afterload and CO

drop aldosterone release

Question 7

ACE inhibitor - adverse effects

Answer 7

Cough (bradykinin)
Angioedema
Hyperkalemia
Hypotension

Question 8

Angiotensin II receptor antagonists

Answer 8

Losartan, candisartan

Question 9

ARB - MoA

Answer 9

Blocks AT1

Similar effects to ACE

Question 10

Sodium Nitroprusside (IV) - MoA

Answer 10

Converted to NO
Smooth muscle relaxation
Reduces preload/afterload

Question 11

Sodium Nitroprusside - adverse effects

Answer 11

hypotension, reflex tachycardia, ischemia

Thiocyanate toxicity

Question 12

Nitroglycerin (topical, sublingual) - MoA

Answer 12

Same as nitroprusside

Question 13

Nitroglycerin - adverse effects

Answer 13

Hypotension, reflex tachy, ischemia, tolerance

Question 14

Hydralazine (oral) - MoA

Answer 14

dilate arterioles

Reduces afterload

Question 15

Isosorbide dinitrite (oral) - MoA

Answer 15

converted to NO
preload drops
increases renal blood flow

Used in combination with hydralazine for people (af americans) who are resistant to ACE

Question 16

Cardiac Glycosides (oral)

Answer 16

Digoxin, Digitoxin

Question 17

Digoxin, Digitoxin - MoA

Answer 17

inhibits Na/K ATPas and leads to an increase in calcium in the cell

contractility increases

Question 18

Digoxin - specific effects

Answer 18

Incr. sensitivity of baroreflex
Incr. parasymp tone
Decr. automaticity, AV conduction

Question 19

Digoxin - spectrum

Answer 19

Pts in HF with atrial arrhythmia or if symptoms persist after ACE inhibitors and Beta blockers

Question 20

Positive Inotropic drugs cont’d

Answer 20

Dopamine
Dobutamine
Inamrinone and Milrinone (PDE blockers)

Question 21

Dopamine - MoA

Answer 21

D1, B1, alpha 1 agonist

Dilates renal arteries at low doses

Question 22

Dobutamine - MoA

Answer 22

Beta1 Beta2 agnoist

Question 23

Dopa/Dobuta - adverse effects

Answer 23

tachycardia, tolerance

Not intended for long term use

Question 24

Phosphodiesterase inhibitors (inamrinone/milrinone) - MoA

Answer 24

Incr. cAMP and incr. Ca. leading to incr contractility.

Incr. cGMP in smooth muscle leading to dilation

Question 25

PDE inhibitors - spectrum

Answer 25

short term severe heart failure

Question 26

Beta Receptor antagonists

Answer 26

Carvedilol (B1, B2 > a1) Metoprolol (B1) Bisprolol (B1- off label)

Question 27

B receptor - MoA

Answer 27

Drops demand on failing heart

Question 28

Sacubitril/Valsartan - Entresto

Answer 28

increases naturetic peptides, bradykinin, and adrenomedullin | drops vasoconstriction