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Pharmacology II > CV & Renal: HF Drugs > Flashcards

CV & Renal: HF Drugs Flashcards

1
Q

Which two drug classes used to treat HF have positive inotropic effects?

A

sympathomimetics

Digitalis

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2
Q

Venodilators can be used to decrease _____

A

preload

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3
Q

Arteriodilators can be used to decrease ______

A

afterload

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4
Q

What effect do beta-blockers have on contractility?

A

decrease

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5
Q

Which drug class should be used?

Cause: increased preload due to increased volume and venous tone.

Goal: Reduce preload

A

Diuretic or venodilator

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6
Q

Which drug class should be used?

Cause: Increased afterload due to increased aortic impedance and arterial constriction.

Goal: Decrease afterload

A

Arteriodilator

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7
Q

Which drug class should be used?

Cause: Decreased contractility due to ventricular dilation, causing reduced pumping force

Goal: Increase contractility

A

Inotropic drug

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8
Q

Which drug class should be used?

Cause: Increased HR due to reflex tachy via sympathetic hyperactivity.

Goal: Reduce energy expenditure of heart

A

Beta Blocker

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9
Q

Positive inotropic drugs should be considered only when?

A

last resort

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10
Q

This drug class has the following characteristics:

decrease salt and water retention

Decrease venous pressure

decrease edema and cardiac size

A

Diuretics

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11
Q

Which diuretics have been shown to reduce mortality rate?

A

Aldosterone Antagonists: spironolactone and eplerenone

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12
Q

What are the three major pathophysiologic functions of AT II?

A

altered peripheral resistance, renal function, cardiovascular structure

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13
Q

What are the three results from AT II stimulation?

A

Increased afterload (rapid pressure response)

Increased preload (slow pressor response)

Increased cardiac remodeling

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14
Q

Which drugs are considered RAAS inhibitors?

A

ACEs and ARBs

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15
Q

This enzyme catalyzes the conversion of AT I to AT II

A

ACE

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16
Q

These drugs block AT II binding to the AT1 receptor thereby inhibiting RAAS

A

ARBs

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17
Q

ACE-Is have the suffix _____

ARBs have the suffix ____

A

ACE: pril

ARB: sartan

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18
Q

This drug class has the following therapeutic effects:

Tx of HF

Decrease HF mortality 28-40%

Diminish cardiac workload

A

ACE/ARBs (RAAS inhibitors)

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19
Q

This drug has the following adverse effects:

Dry cough due to reduced bradykinin metabolism

A

ACE-I

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20
Q

What is responsible for the decreased preload with RAAS inhibitors?

A

decreased aldosterone release

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21
Q

What is responsible for the decreased afterload with RAAS inhibitors?

A

decreased AT-II induced vasoconstriction

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22
Q

What drug class is a combination ARB and Neprilysin Inhibitor?

A

ARNI (entresto)

23
Q

Which drug class has the following mechanism?

Blocks binding of ATII to ATI

decreased degradation of natriuretic peptides, bradykinin

A

ARNI (entresto)

24
Q

What three effects does neprilysin inhibition of ARNIs have?

A

↓ vasoconstriction
↓ Na+ Retention
↓ Cardiac Remodeling

25
Q

Which RAAS antagonist is the best at reducing mortality?

A

ARNI (entresto)

26
Q

Three adverse effects of ARNIs…

A

hypotension
hyperkalemia
cough/angioedema

27
Q

Can you use an ARNI with an ACE or ARB?

A

no

28
Q

When can beta blockers be considered in heart failure?

A

early… dangerous in severe HF

29
Q

The below effects of beta blockers have what positive impact on HF?

↓ Renin

Modulate effects of catecholamines

Up-Regulate Beta Receptors

A

↓ Mortality

30
Q

Which three vasodilators can be used in HF?

A

sodium nitroprusside
isosorbide dinitrate
hydralazine

31
Q

The below effects of vasodilators have what overall benefit in HF tx?

↓ Preload via venodilation

↓ afterload via arteriolar dilation

A

↓ cardiac remodeling

32
Q

This HF drug is a selective B1 agonist with positive inotropic effects.

A

Dobutamine

33
Q

When should dobutamine be considered with HF?

A

short term tx of severe refractory HF

34
Q

Low dose dopamine has what effect?

A

D1 receptors in kidney → vasodilation

35
Q

Moderate dose dopamine has what effect?

A

B1 receptors in heart → positive inotropic effect

36
Q

High dose dopamine has what effect?

A

Alpha receptors in vessels → vasoconstriction

37
Q

Dopamine is indicated for…

A

severe, refractory HF w/ Hypotension

38
Q

The below mechanism describes which HF drug?

Inhibition of membrane Na+/K+ ATPase, resulting in ↑ intracellular Ca2+

A

Digoxin

39
Q

Both SNS stimulation and Digoxin can cause ↑ contractility.

In HF, there is increased SNS tone. What effect does adding digoxin have?

A

decreases SNS tone in failing heart

40
Q

When should digoxin be considered?

A

arrhythmia

last resort in HF

41
Q

What is an early sign of digoxin toxicity?

A

GI sxs

42
Q

Describe the margin of safety of digoxin…

A

toxic even at therapeutic doses

43
Q

What type of toxicity is experienced in 5-25% of patients using digoxin?

A

glycoside toxicity

44
Q

What tests and serum values must be measured regularly to avoid arrhythmia?

A

EKG + Potassium and Digoxin levels

45
Q

What is the most common and most dangerous SFx of digoxin?

A

arrythmia

46
Q

Cardioversion is only indicated in which digoxin induced arrhythmia?

A

VFib

47
Q

How is mild, moderate, and severe digoxin toxicity treated?

A

Mild (GI): Discontinue

Moderate (Arrhythmia): Above + PO/IV Potassium

Severe (life threatening arrhythmia): Above + Digitalis Immune Fab

48
Q

The below will have what effect on digoxin?

Hypokalemia

↓ SA/AV node activity

Myocardial sensitization to digoxin

A

Increased toxicity

49
Q

Hypokalemia has what effect on digoxin? What can cause this?

A

↑ Digitalis Action

Use w/ thiazide/loop diuretics, diarrhea

50
Q

↓ SA/AV node activity is exacerbated when digoxin is administered with…

A

beta blockers

51
Q

Myocardial sensitization to digoxin is worsened with administration of…

A

NE releasing agents

52
Q

What drug class decreases the effectiveness of digoxin?

A

CCBs

53
Q

Are CCBs indicated or contraindicated for HF?

A

contraindicated

Pharmacology II (23 decks)

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