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HLST220: Pharmacology > Chapter 51: Drugs for Heart Failure > Flashcards

Chapter 51: Drugs for Heart Failure Flashcards

1
Q

what are the 2 main types of heart failure

A
  • left ventricular diastolic dysfunction
  • preserved LV ejection fraction (diastolic failure)
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2
Q

what is heart failure

A
  • heart is unable to pump sufficent blood to meet the metabolic needs of tissues
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3
Q

heart failure is characterized by

A

left ventricular dysfunction, reduced cardiac output, insufficent tissue perfusion, signs of fluid retention

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4
Q

causes of heart failure

A
  • chronic hypertension
  • myocardial infraciton
  • valvular heart disease
  • coronary artery disease
  • congenital heart disease
  • dysrhythmias
  • aging of the myocardium
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5
Q

signs and symptoms of heart failure

A
  • decreased exercise tolerance
  • fatigue
  • SOB
  • pulmonary edema
  • tachycardia
  • cardiogegaly
  • peripheral edema
  • hepatomegaly
  • weight gain
  • distention of jugular veins
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6
Q

what are the drugs for heart failure

A
  • Diuretics
  • RAAS inhibitors
  • beta blockers
  • digoxin
  • dopamine
  • hydralazine
  • SGT2 inhibitors
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7
Q

Diuretics MOA

A

reduce blood volume
- decreases venous and arterial pressure, decrease pulmonary and peripheral edema, cardiac dialtion

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8
Q

what are the types of diuretics

A
  • Thiazide diuretics (hydrochlorothiazide)
  • loop Diuretics (furosemide)
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9
Q

ACE inhibitors examples

A

Enalapril [Vasotec]

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10
Q

Enalapril [Vasotec] effects

A

Hemodynamic benefits
- arteriolar dilation (increases stroke volume and cardiac output)
- venous dilation (reduces edema)
- suppression of aldosterone release (enhances sodium and water excretion)
Favorable impact on cardiac remodelling

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11
Q

ACE inhibitors adverse effects

A
  • hypotension
  • hyperkalemia
  • intractable cough (mainly captopril)
  • angioedema
  • renal failure
  • teratogenic
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12
Q

example of ARB

A

Losartan [Cozaaar]

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13
Q

Losartan [Cozaaar] effects

A

improve LV ejection fraction, reduce HF symptoms, increase exercise tolerance, decrease hospitalization, enhance quality of life, and reduce mortality

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14
Q

Sacubitril / valsartan [Entresto] is indicated for

A

HF (NYHA class II or III) to reduce death and hospitalization

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15
Q

Sacubitril / valsartan [Entresto] contradiction

A

** must wait 36 hours after stopping ACE treatment before starting Entresto
- diabetes and moderate to severe renal impairment, pregnancy/nursing, history of angioedema

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16
Q

Spironolactone [Aldactone] is used for

A

standard HF therapy
- can decrease symptoms, hospitalizations, and prolonged life

17
Q

patients taking Spironolactone [Aldactone] should be monitored for

A

hyperkalemia

18
Q

Beta blocker adverse effects

A
  • fluid retention or worsening of HF
  • fatigue
  • hypotension
  • bradycardia or heart block
19
Q

example of beta blockers

A
  • Carvedilol
  • Bisoprolol
  • Metoprolol
20
Q

SGLT2 Inhibitors

A
  • lower BP, reducing cardiac afterload which increases cardiac efficiency
21
Q

SGLT2 inhibitors examples

A
  • Dapagliflozin
  • Empagliflozin
  • Canagliflozin
22
Q

Vasodilators examples

A
  • Nitroglycerin
  • Sodium nitroprusside [Nitropress]
  • Nesiritide [Natrecor}
23
Q

Nitroglycerin principle adverse effects

A
  • hypotension
  • resultant reflex tachycardia
24
Q

Sodium nitroprusside [Nitropress] principle adverse effect

A
  • profound hypotension
25
Q

Nesiritide [Natrecor] principle adverse effect

A

symptomatic hypotension

26
Q

Digoxin use

A
  • second line
  • doesn’t prolong life (actually shortens it)
27
Q

Digoxin relationship to potassium

A

low K = high digoxin

28
Q

digoxin [Lanoxin] effects

A
  • postive inotropic action (increases forces of contraction)
  • increased cardiac output ( decreases sympathetic tone, increased urine production, decreased renin release)
  • suppresses renin release in the kidney
  • increases responiceness/ electrical properties of the heart
  • anorexia, nausea, vomiting, fatigue, visual disturbances
29
Q

Digoxin [Lanoxin] adverse effects

A
  • cardiac dysrhythmias
30
Q

predisposting factors for cardiac dysrhythmias from digoxin

A
  • hypokalemia
  • elevated digoxin level (narrow therapeutic range)
  • heart disease
31
Q

how to manage digoxin- induced dysrhythmias

A
  • stop drug, stop K depleting diuretics, monitor K, treat symptoms
  • Digoxin Immune FAB (Digibind)
  • activated charcoal
32
Q

Stage A of managing heart failure

A
  • management is directed at reducing the risk
33
Q

management of stage B heart failure

A
  • prevent development of symptomatic HF
  • treatment is the same as stage A but with the addition of ACE inhibitors or ARBs
34
Q

management of stage C heart failure

A
  • releive pulmonary and congestive symptoms
  • improve functional capacity and quality of life
  • slow cardiac remodeling and progression of LV dysfunction
  • prolong life
35
Q

stage C heart failure drug therapy

A
  • Diuretics
  • ACE inhibitors and ARBs
  • aldosterone antagonists
  • beta blockers
  • Digoxin
  • Isosorbite dinitrate/hydralazine
36
Q

drugs to avoid during stahe C heart failure

A
  • antidysrhythmic agents
  • calcium channel blockers
  • NSAIDS (asprin)
37
Q

stage D heart Failure

A
  • marked symptoms of HF
  • best solution is heart transplant
  • advanced structural heart disease
38
Q

management of stage D heart failure

A

Control of fluid retention
- loop diuretic, thiazide diuretic
- dopamine, dobutamine

HLST220: Pharmacology (46 decks)

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