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Master YLL Pharmacology > CVS - Diseases of the Myocardium, Heart Failure and Treatment > Flashcards

CVS - Diseases of the Myocardium, Heart Failure and Treatment Flashcards

1
Q

What is heart failure?

A

Heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs.

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2
Q

What are the types of heart failure?

A

Systolic and diastolic dysfunction.

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3
Q

How do beta-blockers work in heart failure?

A

They reduce heart rate and myocardial contractility, decreasing oxygen demand.

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4
Q

Name a non-selective beta-blocker.

A

Propranolol.

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5
Q

What is a cardioselective beta-blocker?

A

A beta-blocker that predominantly blocks beta-1 receptors, like metoprolol.

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6
Q

What is Sacubitril-Valsartan used for?

A

It’s used for reducing the risk of cardiovascular death and hospitalization in heart failure patients.

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7
Q

What is the action of loop diuretics in heart failure?

A

They reduce fluid overload by inhibiting sodium reabsorption in the kidneys.

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8
Q

Name a loop diuretic used in heart failure.

A

Furosemide.

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9
Q

What are potassium-sparing diuretics’ role in heart failure?

A

They help conserve potassium while eliminating sodium and water.

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10
Q

What is the mechanism of action of hydralazine in heart failure?

A

It’s a vasodilator that decreases afterload.

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11
Q

What is Isosorbide Mononitrate/Dinitrate’s role in heart failure?

A

They are vasodilators that reduce preload and afterload.

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12
Q

How do cardiac glycosides like Digoxin work in heart failure?

A

They increase the force of myocardial contraction.

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13
Q

What are the adverse effects of beta-blockers in heart failure?

A

Bradycardia, hypotension, and fatigue.

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14
Q

What is the key adverse effect of Sacubitril-Valsartan?

A

Angioedema.

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15
Q

What electrolyte imbalance can loop diuretics cause?

A

Hypokalemia.

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16
Q

What is an example of a potassium-sparing diuretic?

A

Spironolactone.

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17
Q

What is a major side effect of hydralazine?

A

Reflex tachycardia.

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18
Q

What is a contraindication for Isosorbide Mononitrate/Dinitrate?

A

Concurrent use with phosphodiesterase inhibitors.

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19
Q

What is a risk with cardiac glycosides like Digoxin?

A

Narrow therapeutic window and toxicity.

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20
Q

What is the pharmacokinetics of beta-blockers in heart failure?

A

Variable absorption and metabolism, some cross the blood-brain barrier.

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21
Q

How is Sacubitril-Valsartan administered?

A

Orally.

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22
Q

What is the primary site of action for loop diuretics?

A

The ascending limb of the loop of Henle in the kidneys.

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23
Q

How are potassium-sparing diuretics metabolized?

A

In the liver.

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24
Q

What is hydralazine’s pharmacokinetics in heart failure?

A

Rapidly absorbed orally and metabolized in the liver.

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25
Q

How does Isosorbide Mononitrate/Dinitrate improve heart failure symptoms?

A

By reducing myocardial oxygen demand.

26
Q

What is the therapeutic use of Digoxin in heart failure?

A

To improve symptoms and increase exercise capacity.

27
Q

What monitoring is necessary for beta-blocker therapy in heart failure?

A

Heart rate and blood pressure monitoring.

28
Q

What is a unique feature of Sacubitril in Sacubitril-Valsartan?

A

It’s a neprilysin inhibitor, enhancing natriuretic peptides.

29
Q

What precaution is needed when prescribing loop diuretics?

A

Monitoring electrolytes, especially potassium.

30
Q

In which patients are potassium-sparing diuretics especially beneficial?

A

Patients at risk of hypokalemia.

31
Q

What is a common indication for hydralazine in heart failure?

A

In combination therapy for symptomatic heart failure.

32
Q

What is the dose adjustment criterion for Isosorbide Mononitrate/Dinitrate in heart failure?

A

Based on patient response and tolerance.

33
Q

How is Digoxin toxicity managed?

A

With Digoxin immune Fab and supportive care.

34
Q

What are the drug interactions of beta-blockers in heart failure?

A

Interaction with anti-arrhythmic drugs and insulin.

35
Q

What is an important drug interaction for Sacubitril-Valsartan?

A

With ACE inhibitors and ARBs.

36
Q

Name a side effect specific to potassium-sparing diuretics.

A

Hyperkalemia.

37
Q

What is a unique adverse effect of hydralazine?

A

Lupus-like syndrome.

38
Q

How does Isosorbide Mononitrate/Dinitrate affect blood pressure?

A

They can cause hypotension.

39
Q

What is the effect of Digoxin on heart rate?

A

It can decrease the heart rate.

40
Q

How do beta-blockers affect exercise capacity in heart failure?

A

They may initially decrease exercise capacity.

41
Q

What is the effect of Sacubitril-Valsartan on renal function?

A

It can worsen or improve renal function.

42
Q

How do loop diuretics affect renal function?

A

They can cause renal impairment with excessive use.

43
Q

What is a rare but serious side effect of potassium-sparing diuretics?

A

Gynecomastia with spironolactone.

44
Q

What is the interaction of hydralazine with other heart failure medications?

A

It can potentiate the effect of other antihypertensives.

45
Q

What dietary advice is necessary for patients on Isosorbide Mononitrate/Dinitrate?

A

Avoid alcohol as it can enhance the hypotensive effect.

46
Q

What are the treatment goals for heart failure with preserved ejection fraction (HFpEF)?

A

Treatment aims to manage symptoms and comorbidities like hypertension and renal dysfunction.

47
Q

How do ARNIs benefit patients with HFpEF?

A

ARNIs may reduce hospitalizations for heart failure in HFpEF patients.

48
Q

What is the role of SGLT2 inhibitors in HFpEF treatment?

A

SGLT2 inhibitors like empagliflozin can reduce mortality and hospitalizations in HFpEF.

49
Q

What is the role of beta-blockers in HFpEF?

A

Beta-blockers are used only when there is an existing indication like atrial fibrillation, angina, or post-myocardial infarction.

50
Q

Why are aldosterone antagonists used in heart failure?

A

They reduce mortality and are particularly useful in patients with left ventricular ejection fraction (LVEF) < 30% and chronic heart failure.

51
Q

What monitoring is required when using aldosterone antagonists?

A

Regular monitoring of serum potassium and creatinine levels is necessary.

52
Q

What is the preferred combination therapy in patients with HFrEF?

A

An aldosterone antagonist plus either an ACE inhibitor or an ARB.

53
Q

How do ACE inhibitors benefit heart failure patients?

A

They improve hemodynamics by causing arterial and venous vasodilation and have favorable effects on ventricular remodeling.

54
Q

Why might digoxin be harmful in patients with certain types of cardiomyopathy?

A

In infiltrative, restrictive, or hypertrophic cardiomyopathy, digoxin is not effective and may be harmful.

55
Q

What is the benefit of ARNIs in heart failure with mildly reduced ejection fraction (HFmrEF)?

A

ARNIs may specifically benefit patients with HFmrEF, although this requires further confirmation.

56
Q

What is the role of SGLT2 inhibitors in HFmrEF?

A

SGLT2 inhibitors like empagliflozin benefit patients with HFmrEF as part of standard care.

57
Q

What should be avoided when using aldosterone antagonists?

A

Concurrent use with both an ACE inhibitor and an ARB due to the high risk of hyperkalemia and renal dysfunction.

58
Q

What is the therapeutic action of ARNIs in heart failure?

A

ARNIs combine a neprilysin inhibitor with an ARB to enhance natriuretic peptides and improve artery opening and blood flow.

59
Q

What are the considerations for using beta-blockers in heart failure?

A

Beta-blockers should be used carefully as they may exacerbate symptoms in severe HFpEF by lowering cardiac output.

60
Q

When are aldosterone antagonists particularly indicated in HFpEF?

A

In patients with HFpEF who are volume overloaded and/or have a history of HF hospitalization.

Master YLL Pharmacology (36 decks)

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