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Pharma Recall - Pharmacology > Ch 22 - Drugs Used to Treat Congestive Heart Failure - DONE > Flashcards

Ch 22 - Drugs Used to Treat Congestive Heart Failure - DONE Flashcards

1
Q

Define congestive heart failure (CHF):

A

CHF results when CO is inadequate for the metabolic demands of the body

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2
Q

What are some of the most common cause of CHF?

A
  • Myocardial infarction (MI)
  • Hypertention (HTN)
  • Arrythmia
  • Valvular disease
  • Arteriosclerotic heart disease
    • these conditions either impair the ability of cardiac muscle to contract (MI, arrythmia) or increase the workload imposed upon the heart (HTN).
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3
Q

Name some of the physical signs of CHF:

A
  • left-sided heart fialure results in pulmonary edema and dyspnea
  • right-sided heart failure results in liver congestion and peripheral edema
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4
Q

Describe the compensatory physiological mechanisms that occur in heart failure:

A
  • increased sympathetic tone, which results in tachycardia and greater peripheral vascular resistance
  • reduced renal blood flow, which stimulate aldosterone and increases salt and water retention
  • myocardial hypertrophy
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5
Q

Name three pharmacological approaches for the treatment of CHF:

A
  1. improve myocardial contractility
  2. reduce preload (which decreases myocardial oxygen demands)
  3. reduce afterload.
    • Remember that cardiac output = heart rate x stroke volume.
    • Stroke volume is dependent on preload, afterload, and contractility.
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6
Q

What are the pharmacological options of treating people who have CHF?

A
  • cardiac glycosides
  • bipyridine derivatives
  • β-adrenergic agonists
  • vasodilators
  • diuretics
  • Angiotensin-converting enzyme (ACE) inhibitors
  • β-adrenergic blockers
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7
Q

Name three Cardiac glycosides:

A
  • Digoxin
  • Digitoxin
  • Ouabain (no longer in use)
    • Digoxin is by far the most widely used form because of its favorable pharmacokinetics
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8
Q

Where do Cardiac glycosides originate?

A

they are extracts of the foxglove plant, Digitalis lanata

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9
Q

Describe how glycosides work? ALOT

A

READ ON PAGE 188+ difference between digoxin and digitoxin

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10
Q

What are the clinical indications for the administration of Digoxin?

A
  • Congestiv eheart failure
  • Atrial flutter and fibrillation- Digoxin slows the conduction velocity and increases the refractory period at the AV node
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11
Q

State the contraindications of using Digoxin and Digitoxin?

A

bradycardia and ventricular fibrillation

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12
Q

What major electrolyte imbalances can predispose to Digoxin toxicity?

A
  • Hypokalemia (most important)
  • Hypercalcemia
  • Hypomagnesemia
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13
Q

Describe the potential ECG findings that occur with Digoxin toxicity?

A
  • AV nodal block
  • Prolongation of PR interval, shortening of QT interval, and inversion of the t wave
  • Ventricular fibrillation
  • Complete heart block
  • Premature ventricular contraction
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14
Q

In addition to arrythmias, patients with Digoxin toxicitiy have what symptoms?

A
  • Nausea and vomiting
  • Diarrhea
  • Headache
  • Fatigue
  • Blurred vision
  • Hallucination
  • Altered color perception (yellow-green hue)
  • Rarely, gynecomastia
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15
Q

How do you treat Digoxin toxicity?

A
  • By discounting the use of the drug
  • By correcting any electrolyte imbalances
  • Antiarrythmics (Lidocaine)!!
  • If necessary. by using Digoxin antibodies that bind to and inactivate the drug
  • Cardiac pacer: last resort
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16
Q

Are there any drug interactions to be aware of when using Digoxin?

A
  • Quinidine, and amiodarone, and verapamil all reduce plasma clearance of Digoxin and can precipitate Digoxin toxicity.
  • Loop and Thiazide diuretics can deplete K+ and cause Digoxin toxicity.
17
Q

Has Digoxin been shown to reduce mortality?

A

No. Unlike ACE inhibitors or β-blockers Digoxin reduces only symptoms, not mortality

18
Q

Name two Bipyridine derivatives:

A
  • Amrinone

- Milrinone

19
Q

Bipyridine derivatives mechanism of action:

A
  • They inhibit phosphodiesterase, which leads to increased levels of cyclic adenosine monophosphate and intracellular calcium.
    • This subsequently results in increased contractility.
  • They also cause vasodilation
20
Q

What is the clinical role of Bipyridine derivatives?

A

Bipyridine are rarely used today because of their AE. In the past they were used to treat acute heart failure.

21
Q

Describe the route of administration of Amrinone and Milrinone (Bipyridine derivatives):

A

IV

22
Q

What are the major toxicities of Amrinone and Milrinone (Bipyridine derivatives)?

A
  • Arrythmias
  • GI distrurbances
  • Hepatotoxicity
  • Thrombocytopenia - Amrinone only
23
Q

Name two β-adrenergic agonists used in the treatment of CHF:

A
  • Dobutamine

- Dopamine

24
Q

What is the mechanism of action of β-adrenergic agonists?

A

By stimulating β-adrenergic receptors, they increase cardiac contractility

25
Q

How are the β-adrenergic agonists used clinically?

A

They are used to treat acute heart failure only; they are not indicated for chronic therapy

26
Q

Which Vasodilators are considered appropriate for the treatment of CHF?

A
  • Nitrates
  • Hydralazine
  • ACE inhibitors
27
Q

What is the reasoning for using Vasodilators for the treatment of CHF?

A

Vasodilators reduce both preload (through venodilation) and afterload (through arterial dilation)

28
Q

Give some examples of Diuretics used in CHF:

A
  • Furosemide
  • Hydrochlorothiazide
  • Spironolactone
29
Q

How do Diuretics work in the treatment of congestive heart failure?

A
  • They reduce the preload by minimizing salt and water retention .
  • They also reduce the afterload by decreasing plasma volume.
30
Q

What is Furosemide useful in?

A

Acute CHF

31
Q

What is Spironolactone useful in?

A

Chronic CHF

32
Q

Give examples of ACE inhibitors:

A
  • Quinapril
  • Enalapril
  • Captopril
  • Lisinopril
33
Q

Why are the ACE inhibitors used in the management of CHF?

A

ACE inhibitors provide several benefits to patients who have heart failure:

  • They reduce PVR by causing vasodilation
  • They minimize salt and water retention by reducing aldosterone levels
  • They reduce cardiac remodeling
  • They reduce mortality
34
Q

If ACE inhibitors are not well tolerated by the patient, what can be used as a potential substitute?

A

An angiotensin receptor blocker (ARB), such as Losartan

35
Q

Name two β-blockers approved for the treatment of chronic CHF:

A
  • Carvedilol

- Metoprolol

36
Q

What role do the β-adrenergic blockers plain in CHF?

A
  • mortality is reduced by their use

- help preventing AE of chronic sympathetic output and reducing remodeling of the heart

37
Q

When should the physician employ β-adrenergic blockers?

A

These agents should be used only when the patient is hemodynamically stable; they should never be used during acute heart failure

Pharma Recall - Pharmacology (14 decks)

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