CV Heart Failure

Question 1

Loop Diuretics

Answer 1

treat CHF + ADHF. reversibly inhibit NaKCl co-transporter. increase renal E Na H2O K Ca Mg Cl H and relax systemic venous to decrease preload. K loss unintended, most efficacious. treat chronic with oral and acute decompensation with IV. Adverse V depletion, hypokalemia - prone to arrhythmias. resistance occurs, overcome with thiazide diuretic or higher dose. potentiated by renin-angiotensin inhibitors

Question 2

Thiazide Diuretics

Answer 2

treat CHF only. reversibly inhibit NaCl co-transporter. increase renal E of Na H2O K Mg Cl H, decrease E Ca. decrease preload, lower efficacy, oral admin. use with loop. Adverse V depletion, hypokalemia. potentiated by renin-angiotensin inhibitors

Question 3

K+ sparing Diuretics

Answer 3

treat CHF. block Na channels. increase renal E Na H20 Cl. low efficacy alone. Adverse hyperkalemia

Question 4

Aldosterone Antagonists

Answer 4

treat CHF. block expression Na channels. competitive antagonist. increase renal E Na H2O Cl. inhibit ventricular remodeling - slow progression HF. low efficacy alone but proven to prolong survival when added to treatment in severe CHF. Adverse hyperkalemia + gynecomastia

Question 5

Renin-Angiotensin Inhibitors

Answer 5

treat CHF. decrease venous/arterial contraction and sympathetic activity, increase renal E Na H2O, reduce ventricular remodeling. proven to improve survival. Adverse hypotension, hyperkalemia, cough. No benefit to combining with each other only aldosterone antagonists

Question 6

β Blockers

Answer 6

treat CHF. decrease ventricular remodeling, arrhythmias, cardiac work. oral very low dose, initially worsen then improve, not given to very severe. proven to prolong survival. Adverse bronchoconstriction. abrupt withdrawal precipitate angina

Question 7

Direct Arterial Vasodilators

Answer 7

treat CHF. decrease arteriolar contraction, decrease afterload, decrease O2 consumption. proven to prolong survival with nitrate. need multiple daily doses. Adverse headache, dizziness. combo with nitrate preferable to renin-angio inhibitors in blacks

Question 8

Nitrates

Answer 8

treat ADHF. decrease preload and afterload, decrease filling pressure, edema, cardiac work. IV or sublingual. no effect on survival alone. only used in combo. Adverse flushing hypotension. tolerance major problem, combine with ED drug

Question 9

Digoxin

Answer 9

treat CHF. binds to NaK ATPase, inhibits Na out, increases intracellular Ca, increase contractility. primary benefit decrease sympathetic/increase parasympathetic. only severe HF or those with A-fib, no effect on survival. many adverse effects and drug interactions

Question 10

β Agonists

Answer 10

treat ADHF. increase contractility and cardiac output, decrease filling pressure. decreases symptoms but no effect on survival. Adverse tachycardia, arrhythmia. tolerance possible

Question 11

Phosphodiesterase Inhibitors

Answer 11

treat ADHF. increase cAMP in SR, increase intracellular Ca. increase rate of relaxation, contractility and cardiac output, decrease filling pressure. maintains circulatory stability, less likely to cause arrhythmia. Adverse hypotension. drug of choice with β blockers, chronically decreased survival

Question 12

Vasopressin Antagonists

Answer 12

treat ADHF. blocks vasopressin R. increase plasma Na, reduce body weight, cardiac filling pressure, dyspnea. used to correct hyponatremia, no long term effects. Adverse constipation, dry mouth

Question 13

Nesiritide

Answer 13

treat ADHF. decrease venous/arterial contraction, increase cardiac output. decreases dyspnea, but no effect on survival long term. Adverse hypotension. not really used

Question 14

Diuretics for diastolic dysfunction

Answer 14

decrease preload, filling pressure and cardiac work allows good symptomatic relief. excessive decrease in filling pressure decreases cardiac output - big problem for already stiffened ventricles