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Pharma > Cardiac Heart Failure > Flashcards

Cardiac Heart Failure Flashcards

1
Q

Dec in renal bf are sensed by

A

JGC of the afferent arterioles

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2
Q

Heart remodelling from RAAS activation by myocardial and vascular fibrosis and baroreceptor fxn

A

Aldosterone

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3
Q

Compensatory responses in HF (2)

A

1 sympathetic activation

2 RAAS

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4
Q

cardenolide structure

A

steroid nucleus + lactone ring + sugar

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5
Q

cardenolides come from

A

digitalis fox glove

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6
Q

Digitalis Bioavailability and Half life

Elimination

A

60-75% bio
36-40h

Elimination: 60% renal 40% hepatic metab

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7
Q

Digoxin MOA

A

Inhibition of Na pump (Na/K ATPase) -> inc Intracell Na -> alters Na-Ca exchange (dec Ca excretion) -> inc intracytoplasmic Ca (inc contraction) by SERCA

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8
Q 
Inc CO
Inc ventricular ejection
Inc renal perfusion
Dec EDS
Dec sympa tone
A

Digoxin

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9
Q

Digoxin during early response shows electrical changes (4)

A

1 inc PR interval
2 flat T wave
3 slowed ventricular rate
4 shortened QT interval, T wave inversion, ST depression late

Early brief prolongation of AP then shortening of plateau bec of K conductance!

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10
Q

Digoxin toxic response

A

1 inc automaticity (arrhythmia)

2 delayed afterdepolarization (Ca overload)

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11
Q

Digoxin indication

A

CHF with systolic dysfxn
Atrial fibrillation
Improves functional status only

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12
Q

Digitalis SE (4)

A

CNS , GI stimulation
Color perception aberration
Gynecomastia
Electrolyte (hypokalemia, hypomagnesemia, HYPERcalcemia)

Arrhythmia, arrest

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13
Q

Digitalis tox tx (3)

A 
1 correct K and magnesium deficiency 
2 antiarrhythmics (lidocaine, phenytoin, propanol) if not refractory to K
severe acute overdose (artificial pacemaker)
3 Digoxin antibodies
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14
Q

Digoxin Minimum Effective Concentration

A

1 ng/mL

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15
Q

bipyridine that inhibits PDE3 leading to inc cAMP, inc intracellular contractility

Also promotes vasodilation

Cannot be used in chronic Hf bec of inc mortality

A

Milrinone
Theophylline
Aminophylline

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16
Q

Bipyridine SE (3)

A

N &amp v, arrhythmia
Thrombocytopenia
Liver enzyme

17
Q

First line for both systolic and diastolic dysfxn

A

Diuretics

18
Q

Immediately reduces pulmo congestion and severe edema

A

Furosemide

19
Q

Diuretic For mild chronic HF

A

HCTZ

20
Q

Diuretic that dec mortality in CHF

A

Aldosterone antagonist
Spironolactone
Eplerenone

21
Q

First line drugs that dec morbidity and mortality in CHF

Dec aldosterone sec, salt water ret, vasoconstriction

A

ACEI

22
Q

Drugs for ACUTE HF with marked depression of systolic dysfunction

Also for cardiogenic or hypovolemic shock

A

Beta1 Adrenoreceptor agonist

Dobutamine
Dopamine

Do not give to chronic bec of tolerance, lack of oral efficacy, significant arrhythmogenic effects

23
Q

Selective B1 agonist that inc CO and dec ventricular filling pressure

Given intermittently

SE: tachy, angina and arrhythmia, inc O2 consumption

A

Dobutamine

If need to inc BP give Dopamine

24
Q

Dec preload by vasodilation
Dec afterload by arteriolar dilation
Reduces remodelling

A

Vasodilators

25
Q

For acute severe failure with congestion

Dec preload and afterload

A

Nitroprusside NTG

26
Q

Promotes vasodilation and natriuresis for acute failure (renal toxicity)

A

Nesiritide

27
Q

Dec mortality in African-American with CHF

A

Hydralazine and ISDN

28
Q

Nesiritide MOA

A

BNP inc CGMP -> dec venous tone, dec arteriolar tone

29
Q

Nesiritide SE

A

Hypotension

Renal toxicity

30
Q

Degrades BNP and ANP

A

Sucabitril LCZ696

ARB + Neprilysin inhibitor

31
Q 
ACE MOA
Dec afterload by
Dec preload by
Dec angiotenstin and sympathetic
Dec remodelling by
A

Dec peripheral resistance arteriolar dilation
Dec salt and water retention
Dec NE release
Dec aldosterone activation

32
Q

Steroid derivative inc contractility by inhibiting NaK ATPase pump

Facilitates sequestration of Ca by SR

Less arrhythmogenic

A

Istaroxime

33
Q

Sensitizes troponin to Ca

Inhibits phosphodiesterase

Vasodilator

A

Levosirerdan

34
Q

Activates myosin and prolongs systole without inc in O2

A

Omecamtir mecarbil

Pharma (26 decks)

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