Cardiac 2 drugs Flashcards
Drugs to manage heart failure
Diuretics
Inhibitors of RAAS
Beta-Adrenergic Blockers
Cardiac Glycosides
SGLT-2 Inhibitors
Drugs to manage dysrhythmias
Beta-Adrenergic Blockers
Calcium Channel Blockers
Potassium Channel Blockers
Definition of heart failure
Syndrome in which the heart is unable to pump sufficient blood to meet metabolic needs of tissue
What is heart failure characterized by?
Inadequate tissue perfusion (fatigue, SOB, exercise intolerance)
Volume overload (venous distension, peripheral/ pulmonary edema)
General objectives when treating heart failure
- Identification of underlying cause
- Correct Na and water retention & volume overload
- Reduce cardiac workload
- Improve myocardial contractility
What is the most effective diuretic?
Furosemide (Lasix)
MOA of furosemide (Lasix)
Acts on loop of Henle to block reabsorption of Na and Cl, preventing passive reabsorption of water
Indications for furosemide (Lasix)
Situations that require rapid or massive removal of fluid ex. pulmonary edema, edema of hepatic, cardiac, or renal cause, HTN
Adverse effects of furosemide (Lasix)
Hyponatremia, hypochloremia, dehydration, dry mouth, thirst, oliguria, excessive weight loss, hypotension, hypokalemia, otoxotoxicity
Hydrochlorothiazide MOA
Blocks reabsorption of Na and Cl in distal convoluted tubule, causing water to be retained. Maximum diuresis considerably lower than loop diuretics
Indications for hydrochlorothiazide
Hypertension, edema (mild to moderate HF)
Hydrochlorothiazide adverse effects
dehydration*, dry mouth, thirst, oliguria, excessive weight loss,
Spironolactone MOA
Blocks actions of aldosterone in distal nephron. Maximum diuresis considerably lower than loop and thiazide diuretics. Delayed effect up to 48 hours
Spironolactone indication
Hypertension, edema, HF (decreased mortality)
Spironolactone adverse effects
Hyperkalemia (never use if K > 5, caution with ACE inhibitors, ARBS), can have endocrine effects (gynecomastia, impotence, menstrual irregularities)
Results of using diuretics
Lowers blood volume
Results in:
Lowered preload (venous pressure)
Lowered pulmonary edema
Lowered peripheral edema
Big idea of ACE inhibitor Captopril
Work on RAAS
Decreases BP (monitor)
Can cause K retention (monitor)
Side effects: cough/ angioedema
Results from Captopril
Vasodilation, lowered blood volume, lowered cardiac remodeling
Big idea of using Angiotensin II receptor blockers Losartan (Cozaar)
Works on RAAS (different than ACE)
Lowers BP (monitor)
S/E: angioedema
Doesn’t cause cough as frequently as ACE
2nd line of drug for HF
Angiotensin receptor neprilysin inhibitor drug example
Sacubitril/ Valsartan (Entresto)
Sacubitril/ Valsartan (Entresto) MOA
Sacubitril - inhibits neprilysin leading to increased natriuretic peptides; induces vasodilation and natriuresis. Valsartan - ARB
Sacubitril/ Valsartan (Entresto) big idea
Combo drug
Lowers blood pressure
Watch for dehydration and electrolyte imbalance, renal failure
Metoprolol (Lopressor) SR (Sustained release) big idea
Slows heart rate, decreases BP, decreases contractility (less work for the heart) *If you slow the heart too much can tip into heart failure when CO drops below metabolic demands
Adverse effects of metoprolol (Lopressor)
Hypotension, dizziness, signs of HF (dyspnea, crackles, weight gain, peripheral edema)
Drug example of cardiac glycosides
Digoxin
Digoxin big idea
Increased force of contraction, decreased heart rate
SE: dysrhythmias (esp with decreased K, bradycardia, hypotension, GI disturbances)
Metoprolol (Lopressor) & Diltiazem MOA
Decreases movement of Ca into cells
Metoprolol (Lopressor) & Diltiazem results
Decreased contractility, decreased AV conduction, decreased automaticity in SA node
Indication for metoprolol (Lopressor) & Diltiazem
Afib
Potassium channel blocker drug example
Amiodarone
Amiodarone MOA
Prolongs the effective refractory period (ERP is time during which cell is unable to respond to excitation and to initiate a new action potential)
Amiodarone additional cardiac effects
Decreased SA automaticity, decreased contractility, decreased AV conduction
Amiodarone adverse effects
Increased arrhythmias, pulmonary toxicity, thyroid toxicity, liver toxicity
Antidysrhythmic summary
These 2 drug BB, CCB, Amio all slow the movement of ions through gated channels in cardiac cells. This has the overall effect of slowing conduction which is helpful in controlling or converting arrhythmias. Risk for blood clots (Warfarin & Apixaban are used). Amio has unique side effects