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Pharm Test 3 > CHF > Flashcards

CHF Flashcards

1
Q

Aldosterone ags

Rx

A
  • spironolactone ALDACTONE

* eplerenone INSPRA

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2
Q

ACEI

Rx

A
  • catopril

* enelapril

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3
Q

ARBs

Rx

A
  • Candesartan

* Valsartan

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4
Q

BBlocker

Rx

A

Carvedilol

Metoprolol

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5
Q

Funny channel blocker

Rx

A

Ivabradine CORLANOR

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6
Q

Combined vasodilators

Rx

A

*isosorbide dinitrate/ hydralazine BIDIL

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7
Q

Phosphodiesterase Inhibitor

Rx

A

Milrinone PRIMACOR

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8
Q

RAAS axis

Rx

A

ALDOSTERONE ANTAG
*spironolactone, eplerenone

ACEI
*Captopril, enalapril

ARB
*candesartan, valsartan

ARNI
*sacubitril/valsartan ENTRESTO

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9
Q

DOWN adverse remodeling

Rx

A

BBLOCKER

*carvedilol, metoprolol

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10
Q

DOWN HR

A

FUNNY CHANNEL BLOCKER

*ivabradine CORLANOR

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11
Q

UP CONTRACTILITY

A

PHOSPHODIESTERASE INHIBITORS
*milrinone PRIMACOR

CARDIAC GLYCOSIDE
Digoxin

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12
Q

Angiotensin receptor - neprolysin inhibitor (ARNI)

A

Sacubitril/valsartan ENTRESTO

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13
Q

Cardiac glycoside

A

digoxin

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14
Q

Heart failure with REDUCED EJ

A
  • systolic dysfunction

* Down systolic, up Diastolic

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15
Q

Heart failure with PRESERVED ejection fraction

A
  • Diastolic dysfunction

* Down systolic, Down diastolic

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16
Q

What compensation causes remodeling?

A

Chronic B1 receptor + Ang II receptor

17
Q

Goals

A

Decrease preload, decrease afterload, increase contractility

18
Q

Most common HF

A

Systolic = caused by HTN (volume overload)

19
Q

Diuretics

Mech

A
  • thiazide
  • loop

K depleting
*REDUCE PRELOAD = relieve pulmonary congestion

20
Q

RAAS system

Effect

A
  • UP Blood volume (Preload)
  • UP BP (Afterload)
  • Fibrosis (aldosterone)
21
Q

DOWN RAAS]

Rx

A
  • SYMPA = Bblocker
  • ACE = ACEI
  • ANG II = ARB (vasodilation)
  • DOWN FIBROSIS = Spironolactone (+pee Na, keep K)
22
Q

Spironolactone

ALDACTONE

A
  • DOWN morbidity+mortality
  • Aldosterone antag = UP Na excretion
  • Protect from fibrosi
  • high dose= diuretic
  • UP K (monitor)
  • W/ Digoxin = AV block
  • block progesterone/androgen receptors = gynecomastia
23
Q

Eplerenone

INSPRA

A
  • like spironolactone

* More selective for aldosterone receptor = less gynecomastia

24
Q

RAAS system Rx

Effects

A 
ACEI, ARB, ARNI
*DOWN afterload
*DOWN preload
*Protect against adverse remodeling
*K+ retention (monitor electrolytes)
*DOWN GFR (ang ii efferent arteriole) = mild/moderate renal failure good (ACEI)
*monitor: K, kidney function (Cr/BUN)
WARNING: DEAD BABY
25
Q

ARNI effects

A

*Same as angiotensin II
*Inhibition of both pathways (up neprylisin, up angiotensin II) has greatest effects
*ANRI = GREATER morbidity/mortality reduction than ACEI
*STOP degredation of ANP/BNP by neprilysin =
DOWN renin secretion, UP Na excretion, UP vasodilation

26
Q

ACEI mech

A

Block Ang 1 to Ang 2

27
Q

Neprolysin Rx + dose

A

Sacubitril (LBQ657) = ANP/BNP
+
Valsartan = takes care of ang 2
ENTRESTO

28
Q

ARNI vs ACEI

S.E.
WHICH MORE?
*Hypotension
*Mild angioedema
*Renal Impairment
*Hyperkalemia
*Cough
A

*Hypotension = ARNI
*Mild angioedema = ARNI
Renal Impairment = ACEI
(ARNI will constrict afferent/dilate efferent, ACEI will dilate efferent)CHECK THIS
*Hyperkalemia = ACEI
*Cough = ACEI

29
Q

BBlocker

Why give?

A
  • inhibit RAAS
  • INHIBIT REMODELING

Carvedilol/metoprolol (ONLY THESE) = DOWN morbidity/mortality w/ ACEI + diuretic +/- digoxin

30
Q

Ivabradine CORLANOR

A
  • blocks funny current (SA)
  • reduce HR
  • NO EFFECT ON CONTRACTILITY OR CONDUCTION
  • symptomatic CHF, LVEF <35%, HR >70
  • REDUCE TACH
  • Reduce s/s, NO MORTALITY REDUCTION
31
Q

Vasodilators

Preload vs afterload?

A

*Preload = Isosorbide dinitrate
NO => dephos Myosin light chain

*Afterload = Hydralazine
BIDIL

32
Q

Isosorbide dinitrate

A

*holiday = must have 8 hours free of patch in day, pill needs 14 hours free
*NO w/ PDE5 inhibitor (viagra)
HAWAIIAN SYNDROME

33
Q

Hydralazine

A
  • have version w/ isosorbide (BiDil) = refractory to ACEI/ARB (blacks)
  • arterial dilation
  • CAREFUL CAD = drop BP
34
Q

Diastolic Dysfunction Tx

A
  • ARNI = might be able to help
  • BBlocker ==Rate control = carvedilol/metoprolol (improve diastolic filling)
  • CCA can (not in systolic!)
35
Q

Contraindicated in Systolic failure

A

CCB!!

Block contractility

36
Q

Milrinone

PRIMACOR

A 
MYOCARDIUM = UP contractility
PDE inhibitor (more cAMP, Up Ca2+)

ARTERIOLES = DOWN afterload
Up cAMP = MLCK phosphorylated =>Relaxation

*Acute Decompensated HF (less than2 days use)

37
Q

Digoxin

A 
AFib RATE CONTROL
LESS S/S, SAME MORALITY
*UP Ca2+ in (stop NaKATPase)
*HyperK serum
*UP CONTRACTILITY/CO (inital effect)
*DOWN RAAS w/ UP CO (delayed effect)
*DOWN HR (up vagal, down SA/AV node) 
*Toxicity = other drugs (antibio, diuretics (K) )
MONITOR TI, K, HR

Pharm Test 3 (11 decks)

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