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Pharmacology > Congestive Heart Failure > Flashcards

Congestive Heart Failure Flashcards

1
Q

What is Congestive heart failure

A

Inability of the heart to pump sufficient blood

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2
Q

What causes cardiac remodelling

A

Ischemia
Excessive workload
Angiotensin 2
Aldosterone

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3
Q

What drugs decreases cardiac remodelling

A 
RAAS inhibitors 
ACE inhibitors 
Angiotensin 2 receptor blocker 
Aldosterone receptor antagonist 
B blockers
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4
Q

ACE inhibitors mechanism of action

A
  • prils
  • Block angiotensin converting enzyme, decrease plasma angiotensin 2
  • decrease vasoconstriction, decrease NA+ and H2O retention
  • increase bradykinin
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5
Q

ACE inhibitors indications

A

Chronic HF

Hypertension (primary and secondary causes by DM)

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6
Q

What happens due to Increase in Bradykinin

A

It causes dry cough and angioedema

-vasodilation and increase in NO

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7
Q

ACE inhibitors adverse effects

A

Teratogenic, dry cough, angioedema and hyperkalemia

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8
Q

Which ace inhibitors are not metabolised by the liver

A

Captopril and lisinopril

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9
Q

ACE inhibitors contraindications

A 
Pregnancy
Allergy
Dry cough 
Renal insufficiency 
Bilateral renal artery stenosis
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10
Q

What causes angiotensin escape

A

Chumash TPA cathepsin

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11
Q

How should ACE inhibitors be dowsed

A

ACE I should be started at low doses and titrated to target dose

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12
Q

How often is AT blockers administered

A

Once daily except for valsartan twice daily

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13
Q

Which of the ARBs/ AT blockers is transferred in to active metabolites

A

Losartan

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14
Q

When and why are ARBs used

A

When ACE side effects can’t be tolerated because there is no blockade of bradykinin degradation there won’t be dry cough m

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15
Q

Why shouldn’t arbs and ace be used together

A

Increased risk of hypotension, hyperkalemia and renal dysfunction

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16
Q

List the aldosterone antagonists used for CHF

A

Spirinolactone and eplerenone

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17
Q

Why are aldosterone antagonists used in CHF

A

Aldosterone receptors on the heart can lead to cardiac hypertrophy and fibrosis (remodelling)

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18
Q

List B blockers used in CHF

A

Bisoprolol
Carvedilol
Metoprolol succinate

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19
Q

How is B blocker doses

A

Start at low dose and titrated up

The starting dose is 10% of target dose

20
Q

What are the benefits of giving B blockers to people with CHF

A

Increase survival of myocytes and left ventricular structure and function
Also decrease renin

21
Q

What should be monitored giving B blockers

A

BP
HR
EKG

22
Q

What is recommended for patients with stable symptomatic HFrEF (heart failure with increased ejection fraction)

A

ACE I and B blocker

23
Q

Why are diuretics given in CHF

A

Decrease in plasma volume leads to decrease in preload and after load

24
Q

Which diuretics are preferred in CHF

A

Loop diuretics

25
Q

When to discontinue diuretics in CHF patients

A

Hypovolemic patient

26
Q

Ionotropic drugs mechanism of action

A

Increase Ca2+ in cardiac muscle cells which leads to increase in contractility and increase in cardiac output in

27
Q

Digoxin mechanism of action

A

Block Na+/K+ ATPase -> increase of intracellular Na+ ->increase in Ca2+ leading to ionotropic effect

28
Q

Digoxin half life

A

36 hours

29
Q

What should be monitored when digoxin is given

A

K+

30
Q

What effects does digoxin have other than on the heart

A

It overstimulates of sympathetic system causes stimulation of the vagus nerve which increases the renal blood flow that leads to diuresis

31
Q

Digoxin indications

A

CHF, atrial flutter and fibrillation

32
Q

Digoxin adverse effects

A

Blurred vision m, CNS symptoms, cardiac toxicity (heart block)

33
Q

Treatment of digoxin toxicity

A

Lidocaine and propanol

34
Q

What are PDE I

A

Mil iron one is a PDE inhibitor it causes increase in CAMP that lead to increase in intracellular Ca2+

35
Q

Which drugs of CHF can be given in our patient settings

A

Milieu one and dobutamine

36
Q

Which cardio vascular drug causes xanthopsia, blurred vision, yellowish vision

A

Digoxin

37
Q

Which cardiovascular drug that causes visual disturbances like luminous phenomena

A

Ivabradine

38
Q

Which cardiovascular drug causes impairment of blue green colour discrimination

A

Sildenafil

39
Q

What should ivabradine be taken with

A

With meals

40
Q

Ivabradine mechanism of action

A
  • Selectively binds to funny channels HCN channel (mixed Na+ -K+ current)
  • inhibiting pacemaker current in SA node leading to decrease in heart rate
41
Q

What is ivabradine used for

A

Used for sinus rhythm

42
Q

List Vasodilators of CHF

A

Hydralazine- direct dilatory action on smooth muscle cells

43
Q

Hydralazine effect

A

Decrease systolic and diastolic blood pressure

Increase renin activity

44
Q

List venodilators

A

Isosorbide dinitrate that is used for angina pectoris

45
Q

What is H-ISDN

A

Hydralazine + Isosorbide dinitrate

46
Q

When is H-ISDN given

A

It is given to African American patients who continue to have HF symptoms even with optimal doses of ACE-I and B- Blocker

47
Q

What is the other option other than H-ISDN given to patients who continue to have heart failure symptoms

A

Replace ACE I with Sacubitril/valsartan

Pharmacology (33 decks)

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