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Pharmacology > CVS - Congestive Heart Failure > Flashcards

CVS - Congestive Heart Failure Flashcards

1
Q

Heart failure can be divided into

A

High output HF - increased tissue demand
Low output HF - Heart not adequately pumping

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2
Q

Which conditions can cause High output HF

A

Thyrotoxicosis
Severe anaemia

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3
Q

Left ventricular failure can be characterized by

A

Pulmonary edema - Dyspnea

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4
Q

Right ventricular failure can be characterized by

A

Elevated JVP
Congestive Hepatomegaly

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5
Q

Aim of treatment in Acute CHF

A

Congestion - remove the fluid
Heart not pumping - Inotropics (increases contractility)

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5
Q

Preferred group of diuretics in case of Acute CHF

A

Loop diuretics - Furosemide

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5
Q

Common side effects of Loop diuretics and Thiazides

A

Hypokalemia
Hypomagnesemia
Hyponatremia
Metabolic alkalosis

Hyperglycemia
Hyperlipidemia
Hyperuricemia

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5
Q

Difference in sire effects of Loop diuretics and Thiazides

A

Loop diuretics - Hypocalcemia
Thiazides - Hypercalcemia

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5
Q

Inotropics used in Acute CHF

A

Beta 1 agonist
PDE-3 Inhibitors

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6
Q

Beta 1 agonist used in Acute CHF

A

Dopamine
Dobutamine
Isoprenaline
Nor adrenaline

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7
Q

PDE-3 inhibitors used in Acute CHF

A

InAmrinone
Milrinone

Increases cAMP in both heart(Inotropic) and BV(Vasodilation)

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7
Q

Which drugs are termed as Inodilators and DOC in patient with right sided Heart failure

A

PDE-3 Inhibitors - InAmrinone, Milrinone

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8
Q

Aim of treatment in Chronic CHF

A

Decrease work of heart
Remove the fluid
To reverse LVH or cardiac remodeling

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9
Q

Drugs used to decrease work of heart in Chronic CHF

A

Vasodilators

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10
Q

Vasodilator which only acts on veins

A

Nitrates

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11
Q

Vasodilator which only acts on arteries

A

Hydralazine

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12
Q

Vasodilators which acts on both Veins and arteries

A

Sodium Nitroprusside
ACE inhibitors
ARBs

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12
Q

Drugs used to remove fluid in case of Chronic CHF

A

Loop diuretics

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13
Q

Drugs used to reverse Cardiac modeling or to decrease Mortality

A

Beta blockers
ACE inhibitors
ARBs
Aldosterone Antagonists

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13
Q

Beta blockers which are commonly used in Chronic CHF

A

Start with low dose
Carvedilol - MC
Metoprolol
Bisoprolol

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14
Q

ACE inhibitors

A

‘PRIL’
Captopril
Lisinopril
Enalapril
Ramipril
Perindopril
Moexipril
Trandolapril

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15
Q

ACE Inhibitors can increase Bradykinin levels and can cause side effects like

A

Dry cough
Angioedema

15
Q

Characteristics of ACE inhibitors

A

C - Cough
A - Angioedema
P - Prodrugs
T - Taste alternation (Dysgeusia )
O - Orthostatic hypotension
P - Pregnancy avoid
R - Renal artery stenosis avoid
I - increased K(Hyperkalemia) avoid
L - lowers risk of diabetic nephropathy - preferred in diabetics

16
Q

Which ACE inhibitors are not Prodrugs

A

Captopril
Lisinopril

17
Q

Angiotensin receptor Blockers

A

‘Sartan”
Valsartan
Losartan
Telmisartan
Irbesartan
Eprosartan
Candesartan

18
Q

Difference between ACE inhibitors and ARBs

A

In ARBs - No cough or Angioedema as side effect
Are not Prodrugs

18
Q

Which ARBs decreases uric acid levels

A

Losartan

19
Q

Which ARB can decrease insulin resistance by stimulating PPAR-alpha

A

Telmisartan

20
Q

Aldosterone Antagonist used in Acute CHF

A

Spironolactone - Potassium sparing diuretics
Decreases Na+ and H20
Increase K+ and H+

20
Q

Common side effect of Spironolactone

A

Gynecomastia

20
Q

Oral Inotropics that can be used in Chronic CHF

A

Cardiac glycosides - Digoxin

21
Q

Cardiac glycosides directly works on

A

Ventricular muscles

21
Q

Digoxin works by blocking

A

Na+-KA ATPase pump - increasing Ca2+ levels - leads to increased contractility

22
Q

Digoxin have which 2 actions

A

Increases contractility by acting on ventricular muscles
Vagomimetic action - decreases HR and conduction

23
Q

Due to Vagomimetic action, Digoxin can be given in which condition

A

Atrial fibrillation

24
Q

Digoxin is contraindicated in

A

Renal failure

25
Q

Side effects of Digoxin

A

1) Nausea and Vomiting - MC
2)Arrythmia - MC - ventricular bigeminy
Most specific - Non paroxysmal Atrial tachycardia with AV block
3) Xanthopsia (Yellow vision)
4) Gynaecomastia

26
Q

Which drugs can cause Gynecomastia as a side effect

A

D - Digoxin
I
S - Spironolactone
C - Cimetidine
K - Ketoconazole
O - oestrogens

27
Q

Which factors increases chances of Digoxin toxicity

A

Electrolyte imbalance
Drugs
Diseases

28
Q

Which electrolytes imbalances can cause Digoxin toxicity

A

Hypokalemia
Hypomagnesemia
Hypercalcemia

29
Q

Which drugs increases the risk of Digoxin toxicity

A

Quinidine
Verapamil
Amiodarone
Thiazides

29
Q

Which disease increases the risk of Digoxin toxicity

A

Renal failure
Liver failure in case of Digitoxin

29
Q

Treatment of Digoxin toxicity

A

Correct interactions if any
Antiarrhythmic - Lignocaine
Digibind

30
Q

DOC in Digoxin induced ventricular arrythmias

A

Lignocaine

30
Q

Bradycardiac agent that can be used in Chronic CHF

A

Ivabradine

30
Q

Actions of BNP(Brain natriuretic peptide)

A

Decreases Sodium (Sodium loss in urine)
Powerful vasodilators

30
Q

BNPs are metabolized by

A

Neprilysin

31
Q

Exogenous BNP that can be used in CHF

A

Nesiritide - not orally effective and Very short acting

31
Q

Neprilysin inhibitors used in CHF

A

Sacubitril
Ecadotril

31
Q

Vasopeptidase inhibitors used in CHF

A

ACE inhibitors + Neprilysin

Omapatrilat
Sampatrilat

32
Q

Most commonly used Angiotensin receptor Neprilysin inhibitors (ARNI)

A

Valsartan+ Sacubitril

32
Q

Vasopressin receptors antagonist acts on

A

V1 receptor - Vasoconstriction
V2 receptor - decrease urine

33
Q

Vasopressin receptors antagonist drugs

A

Conivaptan - iv
Tolvaptan - oral - Approved in autosomal dominant adult polycystic kidney disease

Pharmacology (14 decks)

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