Congestive Heart Failure Meds

Question 1

Diuretics

Answer 1

Indicated in pt w. Current or prior sxs of HF and reduced LVEF who have evidence of fluid retention

Predominantly work in loop of henle

Inc Na excretion and K excretion

Question 2

Loop Diuretics - MC used?

Answer 2

MC used are Bumetanide and Torsemide

Question 3

Torsemide

Answer 3

Loops diuretic
One of MC used
Half life is 5 hours (longer than the others)

Question 4

Diuretic Key points

Answer 4

Sdfgg

Question 5

Vasodilators

Answer 5

Nitroglycerine - dec preload
Nitroprusside - dec pre and after load
Nersirtide - dec pre and after load

Question 6

Inotropes

Answer 6

Dobutamine - B 1-agonist
Milrinone - PDE inhibitor (inc CO by dec preload and afterload)

Not to be used in outpatient setting. Hospital only

Question 7

ACE inhibitors

Answer 7

“Should be used in all pts with a reduced EF to prevent HF”

Question 8

ARBs

Answer 8

An alternative drug to ACE inhibitors as first line of therapy

Should never be used in combo with ACE inhibitors

Question 9

Aldosterone Antagonists

Answer 9

….

Monitor for potassium

Question 10

Beta Blockers

Answer 10

BB block the non-epinephrine receptors

Question 11

Hydralazine/ISDN

Answer 11

Given in combination
Bc need balance between NO and O2

Hydralazine - antioxidant that inhibits the destruction by NO
ISDN (isosorbide dinitrate): NO donor

Question 12

Digoxin

Answer 12

Listen to recording for key thing to remember…

Question 13

Hawthorn interactions

Answer 13

Interactions with BB, CCB, PDE-5 inhibitors
Causes vasodilation… s it may dec BP, cause dizziness and light headedness

Also interacts with antiplatelet/anticoagulants
Inhibits thomboxane A2
Increases bleeding risk

Question 14

End stage vs early stage HF and use of BB vs beta agonists

Answer 14

End stages of HF - you are decompensated
So you have to rely on adrenergic response
You have to inc contractility by giving beta agonists

Early stages - you give beta blockers
Must be careful bc it can cause the fluid retention
If there is fluid.. must get rid of fluid before putting beta blockers

Question 15

Polypharmacy

Answer 15

If you put a pt on [specific drug she said], and they are also on digoxin… you have to dec digoxin by 50%.. bc taking that drug will inc the concentration of digoxin…..

Cardio-renal failure — in this stage it might be necessary to use polypharmacy?

It is a very difficult to do.
It is the people with the multiple chronic illness that are on the poly path…

Question 16

Potassium homeostasis

Answer 16

Diuretics to spare K

Amptrine?