CHF

Question 1

Milronone

Answer 1

PDE inhibitor =»Increased cAMP

Increases cardiac contractility and causes vasodilation

-Used for tx of acute, severe CHF

ADRs: Proarrhythmic, hypotension

Question 2

BBs in CHF

Answer 2

Mild- can slow the progression of CHF and prevent hospitalization

Moderate- severe (Metoprolol, bisoprolol)

Post-MI- Carvedilol

Overall benefits: Inhibit detrimental cardiac remodeling
Decrease myocardial O2 demand
Antiarrhythmic

Question 3

Digoxin

Answer 3

Decreases the fnxn of Na+/K+-ATPase =» Increased intracellular Ca2+ =» Increased myocardial contractility

-Also has vagomimetic effects (decreased AV nodal conduction and rhythmic fnxn) and causes an increase in the PR interval;

**will decrease Ventricular rate in A-fib and A-flutter **

ADRs: Arrhythmias, GI (N/V), Visual (blurring, photophobia), CNS (anxiety, lethargy, hallucinations)

***CANNOT GIVE TO PTS W/ RENAL FAILURE OR HYPOKALEMIA
(do not use w/ sympathomimetics and K+-sparing diuretics)

KNOW CHART FROM SLIDES

Question 4

Tx of Digoxin Toxicity

Answer 4

Administer K+, give atropine, and digoxin antibodies

Question 5

Nesiritide

Answer 5

Recombinant BNP; activates GC to increase cGMP causing vasodilation and will decrease the preload and afterload

• Used for acute decompensated CHF w/ dyspnea
• Not widely used; probs just know mechanism