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Pharmacology II > CVS Drugs Part 2 HTN and HF > Flashcards

CVS Drugs Part 2 HTN and HF Flashcards

Treatment of HTN and HF

1
Q

Thiazides MOA

A

inhibit sodium, potassium, and chloride reabsorption in the distal tubule resulting in mild diuresis (sodium and water excretion)

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2
Q

Thiazides most commonly used for primary HTN

A

hydrochlorothiazide (HCTZ) and chlorthalidone

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3
Q

HCTZ clinical indications

A

ideal starting agent for HTN, chronic edema or idiopathic hypercalciuria and can also be used to treat kidney stones and Meniere’s Disease

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4
Q

HCTZ adverse effects

A

hypokalemia, hyperuricemia (gout), hyperglycemia, hypotension, hyponatremia, and hypercalcemia

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5
Q

Thiazide contraindications

A

patients with a history of gout or hypercalcemia, pregnant women, anuria

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6
Q

HCTZ pharmacokinetics

A

administered orally and absorbed rapidly, eliminated primarily unchanged

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7
Q

HCTZ drug interactions

A

can increase the toxicity of digitalis and lithium and can cause significant hypokalemia if given with corticosteroids or ACTH

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8
Q

Chlorthalidone pharmacokinetics

A

only thiazide that is available in IV form, is structurally different from most thiazides, and has a long half life

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9
Q

Metolazone pharmacokinetics

A

structurally different from other thiazides and 10 times more potent than HCTZ, excreted unchanged in urine

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10
Q

Metolazone clinical indications

A

often used together with loop diuretics for the treatment of excess fluid (edema) in heart failure, safe to use in patients with renal insufficiency

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11
Q

Indapamide pharmacokinetics

A

undergoes hepatic metabolism and is excreted in both urine and bile

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12
Q

Indapamide clinical indications

A

uncommonly used but can treat hypertension and decompensated heart failure

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13
Q

Loop diuretics MOA

A

inhibits reabsorption of Cl-, Na+, K+, Ca2+, Mg2+, and HCO3- in the ascending loop on Henle resulting in loss of sodium, water, and high potassium in urine (more powerful diuretics than thiazides) leading to decreased preload and afterload

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14
Q

Loop diuretics

A

Furosemide, Bumetanide, and Torsemide

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15
Q

Loop diuretics adverse effects

A

hypokalemia, DEHYDRATION, DOSE-DEPENDENT OTOTOXICITY, hyponatremia, hypomagnesemia, hypotension, hyperuricemia (gout), and hyperglycemia

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16
Q

Furosemide clinical indications

A

preferred for treating hypertension in patients with low GFR (renal failure) and in hypertensive emergencies, also can treat peripheral edema in heart failure, decompensated cirrhosis, and acute pulmonary edema (limited mortality benefit)

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17
Q

Furosemide drug interactions

A

increases toxicity of ototoxic and nephrotoxic drugs and lithium, inhibited efficacy with probenecid and indomethacin, use caution in patients with sulfa antibiotic allergy as this is a sulfonamide-based med

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18
Q

Bumetanide clinical indications

A

most potent loop diuretic with the same clinical indications as Furosemide

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19
Q

Bumetanide adverse effects

A

large doses may cause severe myalgias, no ototoxicity, use caution in patients with sulfa antibiotic allergy as this is a sulfonamide-based med

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20
Q

Torsemide adverse effects

A

headache and dizziness

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21
Q

Potassium-sparing diuretics MOA

A

inhibit potassium secretion and sodium reabsorption in the distal tubule resulting in reduced potassium loss in the urine

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22
Q

Potassium-sparing diuretics

A

Amiloride, Spironolactone, Triamterene, and Eplerenone

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23
Q

Spironolactone MOA

A

aldosterone receptor antagonist that prevents sodium reabsorption and potassium excretion and androgen receptor blocker that inhibits androgen biosynthesis (conversion of androstenedione to testosterone)

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24
Q

Spironolactone clinical indications

A

can be co-prescribed with thiazides to treat edema in heart failure, ascites/cirrhosis, and nephrotic syndrome; resistant hypertension and primary hyperaldosteronism (secondary cause of HTN); acne and hirsutism

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25
Q

Spironolactone adverse effects

A

gynecomastia and increased risk for digitalis toxicity when co-administered, hyperkalemia, anuria, hypovolemia, hypertriglyceridemia, renal dysfunction/failure

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26
Q

Eplerenone MOA

A

aldosterone receptor antagonist that prevents sodium reabsorption and potassium excretion

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27
Q

Eplerenone clinical indications

A

used to treat edema in heart failure, resistant hypertension, and primary hyperaldosteronism

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28
Q

Eplerenone adverse effects

A

hyperkalemia, anuria, hypovolemia, hypertriglyceridemia, renal dysfunction/failure, less risk for gynecomastia than spironolactone

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29
Q

Amiloride MOA

A

distal tubule sodium channel inhibitor that directly increases sodium excretion and decreases potassium excretion in the urine

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30
Q

Amiloride clinical indications

A

3rd or 4th line agent to treat hypertension or heart failure specifically to compensate for potassium loss by other diuretics and can also be used to treat ascites and polyuria/polydipsia due to lithium-induced nephrogenic diabetes insipidus

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31
Q

Amiloride pharmacokinetics

A

more rapid onset than spironolactone

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32
Q

Triamterene MOA

A

distal tubule sodium channel inhibitor that directly increases sodium excretion and decreases potassium excretion in the urine

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33
Q

Triamterene clinical indications

A

typically paired with a thiazide to treat hypertension and also can be used to treat edema from various causes

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34
Q

Triamterene adverse effects

A

may turn urine blue, cause crystalluria and cast formation, and decrease renal blood flow (use caution in patients with renal disease)

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35
Q

Acetazolamide MOA

A

inhibits carbonic anhydrase in the proximal renal tubule promoting renal excretion of sodium, potassium, bicarbonate, and water

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36
Q

Acetazolamide adverse effects

A

metabolic acidosis, kidney stones, hyperammonemia in cirrhotic patients,

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37
Q

Acetazolamide clinical indications

A

used in prophylaxis for altitude sickness and in the treatment of open-angle glaucoma, less effective than thiazide or loop diuretics and used more commonly for its pharmacologic actions other than its diuretic effect

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38
Q

Acetazolamide pharmacokinetics

A

administered orally or IV, 90% protein-bound and eliminated renally, use caution in patients with sulfa antibiotic allergy as this is a sulfonamide-based med

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39
Q

Mannitol MOA

A

osmotic diuretic that promotes diuresis in the kidney by increasing the concentration of filtrates in the kidney and inhibiting the reabsorption of water in the proximal renal tubule and the glomerulus

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40
Q

Mannitol adverse effects

A

headache, nausea, dizziness, polydipsia, confusion, and chest pain, and may initially increase central venous pressure (BP) and induce heart failure in susceptible patients

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41
Q

Mannitol clinical indications

A

administered IV only and used to decrease intraocular pressure in glaucoma and decrease intracranial pressure, can also be used to increase lithium excretion in states of lithium toxicity

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42
Q

Mannitol contraindications

A

heart failure and pulmonary edema

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43
Q

Treatment of acute hypercalcemic crisis

A

immediate treatment with Furosemide (Lasix) and saline rehydration to achieve urine output of 200 mL/hr

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44
Q

Calcium levels indicative of acute hypercalcemic crisis

A

calcium levels greater than 14 mg/dL or calcium levels greater than 12 mg/dL in symptomatic patient

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45
Q

Symptoms of acute hypercalcemic crisis

A

hypertension, vascular calcification, shortened QT interval on ECG, impaired concentration, confusion, fatigue, muscle weakness, nausea, abdominal pain, anorexia, constipation, pancreatitis, polydipsia/polyuria resulting from nephrogenic diabetes insipidus, and nephrolithiasis resulting from hypercalciuria

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46
Q

Nephrogenic diabetes insipidus

A

disease process where the kidneys have partial or complete resistance to the effects of antidiuretic hormone (vasopressin) resulting in the excretion of large amounts of diluted urine, it is often hereditary but also can be caused by drugs (lithium, amphotericin B, ofloxacin, orlistat) or other disorders

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47
Q

Treatment of nephrogenic diabetes insipidus

A

Hydrochlorothiazide alone or in combination with other drugs such as Amiloride ( helps maintain potassium level), for some patients a low sodium and low protein diet is suggested

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48
Q

ACE inhibitors MOA

A

suppress the synthesis of angiotensin II and release of aldosterone from adrenals resulting in natriuresis (decreased preload) and decreased peripheral vascular resistance - vasoconstriction (decreased afterload)

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49
Q

ACE inhibitors

A

enalapril, captopril, and lisinopril

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50
Q

ACE inhibitors clinical indications/advantages

A

first-line treatment of HTN in patients with high coronary artery disease (CAD) risk, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease - preferred in patients with diabetic nephropathy because they are renoprotective (stabilize renal function) and blood glucose levels are not impacted significantly

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51
Q

ACE inhibitors adverse effects

A

first dose hypotension, dizziness, proteinuria, rash, tachycardia, hyperkalemia, headache, cough, and angioedema

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52
Q

Enalapril pharmackinetics

A

administered oral or IV where the oral form is a prodrug that is converted to active form intestinally - enalaprilat

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53
Q

Captopril adverse effects

A

agranulocytosis or neutropenia - not common first line agent

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54
Q

Enalapril clinical indications

A

used to treat heart failure, hypertension, and diabetic kidney disease

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55
Q

Lisinopril clinical indications

A

used to treat hypertension and heart failure and also helps slow down the progression of diabetic kidney disease

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56
Q

Lisinopril pharmacokinetics

A

not a prodrug

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57
Q

Lisinopril adverse effects

A

side effects of all ACE inhibitors and can also cause some lowering of blood glucose

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58
Q

ARB MOA

A

antagonist at angiotensin II receptors in vascular smooth muscle that produce arteriolar and venous dilation and block aldosterone secretion

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59
Q

ARB advantages

A

have been shown to help slow the effects of diabetic neuropathy

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60
Q

ARB adverse effects

A

dry cough, hyperkalemia, skin rash, hypotension, and altered taste

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61
Q

ARBs

A

Losartan, Valsartan, Candesartan, Olmesartan

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62
Q

Losartan pharmacokinetics

A

administered once daily and undergoes extensive first-pass metabolism converting it to an active metabolite

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63
Q

Losartan clinical indications

A

treatment of HTN (especially in patients with LVH) and diabetic neuropathy, lowers serum uric acid levels, reduces chance of stroke

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64
Q

Valsartan pharmacokinetics

A

administered twice daily and metabolized to inactive metabolites

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65
Q

Valsartan clinical indications

A

treatment of HTN, the first ARB approved for the treatment of heart failure

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66
Q

Candesartan pharmacokinetics

A

administered once daily and metabolized to inactive metabolites

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67
Q

Olmesartan pharmacokinetics

A

administered once daily and metabolized to inactive metabolites

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68
Q

Olmesartan clinical indication

A

used to significantly reduce mean blood pressure

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69
Q

Aliskiren MOA

A

inhibits renin which prevents the conversion of angiotensinogen to angiotensin I, acting early in the RAAS

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70
Q

Aliskiren clinical indication

A

treatment of HTN

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71
Q

Aliskiren adverse effects

A

diarrhea, cough, angioedema

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72
Q

Aliskiren pharmacokinetics

A

metabolized by CYP3A4 so there is potential for many drug interactions

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73
Q

Aliskiren contraindications

A

pregnancy

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74
Q

Ambrisentan MOA

A

selective type A endothelin receptor antagonist

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75
Q

Bosentan MOA

A

nonselective endothelin receptor antagonist

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76
Q

Ambrisentan clinical indications

A

used alone or in combination with tadalafil in the treatment of pulmonary arterial hypertension (PAH) to improve exercise ability and delay clinical worsening of PAH

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77
Q

Ambrisentan adverse effects

A

edema, nasal congestion, palpitations, abdominal pain, constipation

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78
Q

Bosentan clinical indications

A

treatment of pulmonary arterial hypertension (PAH) to improve exercise capacity and delay clinical worsening of PAH, also can be used to reduce digital ulceration in patients with scleroderma

79
Q

ACE inhibitors and ARBs contraindications

A

pregnancy

80
Q

Phenoxybenzamine MOA

A

irreversible noncompetitive inhibitor of peripheral alpha 1 and alpha 2 adrenergic receptors (nonselective)

81
Q

Phenoxybenzamine clinical indications

A

used in the treatment of sweating and HTN associated with pheochromocytoma, effectiveness limited due to reflex tachycardia

82
Q

Phentolamine MOA

A

reversible nonselective competitive inhibitor of alpha 1 and 2 receptors resulting in potent vasodilation

83
Q

Phentolamine clinical indications

A

used short-term to treat hypertensive emergencies associated with pheochromocytoma, abrupt withdrawal of clonidine, or ingestion of tyramine-containing foods in patients on MAOIs, also can be used to prevent dermal necrosis following extravasation of norepinephrine

84
Q

Phentolamine pharmacokinetics

A

administered parentally and effects last approximately 4 hours

85
Q

Prazosin MOA

A

selective inhibitor of alpha 1 receptors causing vasodilation and resulting in decreased peripheral vascular resistance and blood pressure by relaxation of both arterial and venous smooth muscle

86
Q

Prazosin clinical indications

A

treatment of BPH due to relaxation of urethral and prostate muscles and also can be used in treatment of PTSD-associated nightmares

87
Q

Prazosin adverse effects

A

orthostatic hypotension, dizziness, lack of energy, nasal congestion, headache, drowsiness

88
Q

Doxazosin

A

longest-acting selective alpha 1 receptor inhibitor with similar indications to Prazosin

89
Q

Propranolol clinical indications

A

used to treat performance anxiety, postural tremor, migraine prevention, thyrotoxicosis, and portal hypertension - does not reduce blood pressure in normotensive patients making it very useful for other things (does not have much anti-hypertensive potency compared to other beta blockers)

90
Q

Propranolol adverse effects

A

depression, dizziness, fatigue, weakness, hallucinations, short term memory loss, vivid dreams, and visual disturbances

91
Q

Nadolol clinical indications

A

approved for treatment of HTN and management of chronic (stable) angina but rarely used in practice

92
Q

Nadolol half-life

A

more potent than propranolol and has half-life of 14-24 hours

93
Q

Pindolol MOA

A

Nonselective beta blocker with partial agonist sympathomimetic activity at high doses causing limited epinephrine-like effects such as increased heart rate, blood pressure, and bronchodilation

94
Q

Pindolol contraindications

A

patients with prior MI or angina due to sympathomimetic effects

95
Q

Pindolol clinical indications

A

used to treat HTN only

96
Q

Pindolol half-life

A

3-4 hours

97
Q

Timolol clinical indications

A

primarily used in ophthalmic solution form to treat open-angle glaucoma and reduce the production of aqueous humor in the eye, can be used orally to treat HTN but not commonly used for this in the US

98
Q

Timolol half-life

A

4-6 hours

99
Q

Metoprolol MOA

A

cardioselective beta-1 receptor blocker that decreases heart rate, contractability, cardiac output, and blood pressure at rest and during exertion

100
Q

Metoprolol clinical indications

A

used to treat HTN, angina, acute MI, supraventricular tachycardia, ventricular tachycardia, congestive heart failure, and prevention of migraine headaches

101
Q

Metoprolol pharmacokinetics

A

extensively metabolized with half-life of 3-4 hours

102
Q

Atenolol MOA

A

cardioselective beta-1 receptor blocker that decreases heart rate, contractability, cardiac output, and blood pressure at rest and during exertion

103
Q

Atenolol clinical indications

A

has the same indication as metoprolol but is less effective at preventing complications of HTN

104
Q

Atenolol pharmacokinetics

A

excreted primarily in urine with half-life of 6 hours

105
Q

Nebivolol MOA

A

the most cardioselective beta-1 receptor blocker at low doses that loses some of that selectivity at higher doses, it also has a vasodilating effect in that it is nitric-oxide-potentiating and stimulates beta-3 receptors in peripheral vasculature

106
Q

Nebivolol half-life

A

10-12 hours

107
Q

Nebivolol clinical indications

A

used to treat HTN and heart failure

108
Q

Carvedilol MOA

A

mixed alpha-1, beta-1, and beta-2 receptor blocker with more blood pressure-lowering potential than many other beta-blockers due to combined alpha and beta-adrenoceptor blocking activity

109
Q

Labetalol MOA

A

mixed alpha-1, beta-1, and beta-2 receptor blocker with more blood pressure-lowering potential than many other beta-blockers due to combined alpha and beta-adrenoceptor blocking activity

110
Q

Carvedilol clinical indications

A

used primarily to treat heart failure and to decrease mortality in patients after myocardial infarction (MI), commonly co-prescribed with ACE inhibitors and diuretics and used second line as an anti-hypertensive

111
Q

Carvedilol pharmacokinetics

A

administered twice daily with half-life of 7-10 hours

112
Q

Labetalol clinical indications

A

used to treat hypertension associated with pheochromocytoma and in hypertensive emergencies, considered safe in pregnancy, and often also used to manage hypertension in pre-eclampsia

113
Q

Labetalol pharmacokinetics

A

administered orally, dosed up to 3 times per day, or in IV form which is advantageous for slow titration in the treatment of hypertensive emergencies

114
Q

Lebatalol half-life

A

4-6 hours

115
Q

Propranolol half-life

A

4-6 hours

116
Q

Metoprolol half-life

A

3-4 hours

117
Q

Verapamil MOA

A

non-dihydropyridine cardioselective calcium channel blocker with negative inotropic effect that decreases heart rate, slows AV conduction, and mainly affects the myocardium

118
Q

Verapamil clinical indications

A

used to treat atrial tachycardias like atrial fibrillation

119
Q

Verapamil contraindications

A

patients with sick sinus syndrome, AV nodal disease, and heart failure due to the potential of worsening heart failure and heart block

120
Q

Diltiazem MOA

A

non-dihydropyridine cardioselective calcium channel blocker with negative inotropic effect that decreases heart rate, slows AV conduction, and mainly affects the myocardium

121
Q

Diltiazem clinical indications

A

used mostly for its immediate anti-arrhythmic effects though can also lower blood pressure

122
Q

Diltiazem contraindications

A

patients with sick sinus syndrome, AV nodal disease, and heart failure due to the potential of worsening heart failure and heart block

123
Q

Nifedipine MOA

A

dihydropyridine vascular selective calcium channel blocker that is a potent vasodilator but has no effect on conduction through the AV node

124
Q

Nifedipine clinical indications

A

long-acting form used to treat HTN, angina, and Raynaud’s disease

125
Q

Nifedipine adverse effects

A

increases heart rate and poses a risk for tachycardia and increased oxygen demand, peripheral dilatory effects can decrease coronary perfusion

126
Q

Amlodipine MOA

A

dihydropyridine vascular selective calcium channel blocker that is a potent vasodilator but has no effect on conduction through the AV node

127
Q

Amlodipine clinical indications

A

used commonly to treat HTN

128
Q

Amlodipine contraindications

A

patients with heart failure

129
Q

Benefits of co-prescribing CCBs and ARBs

A

they complement each other’s functions where CCBs increase sympathetic nervous system and renin-angiotensin activity and ARBs decrease sympathetic nervous system and renin-angiotensin activity

130
Q

Nitroglycerin MOA

A

venous vasodilator that is converted to nitric oxide in the body

131
Q

Nitroglycerin clinical indications

A

used to treat chronic angina and severe HTN

132
Q

Nitroglycerin pharmacokinetics

A

administered sublingually usually but can also be administered through IV, ointment, or a patch forms - has short half-life and broken down by the liver

133
Q

Isosorbide dinitrate MOA

A

a nitrate which is a venous vasodilator that causes release of nitric oxide in the body when metabolized

134
Q

Isosorbide clinical indications

A

used in prophylaxis of acute angina and esophageal spasm, also used together with hydralazine in the treatment of heart failure in black patients

135
Q

Isosorbide pharmacokinetics

A

administered sublingually or as an immediate-release tablet with sublingual administration having a quicker onset of action - 2-5 minutes but shorter duration of action - 1-2 hours (risk for tolerance if taken daily)

136
Q

Hydralazine MOA

A

arterial vasodilator thought to cause the release of nitric oxide from drug or endothelium primarily affecting arterioles and decreasing afterload

137
Q

Hydralazine clinical indications

A

used in combination with nitrates to treat HFrEF in patients who can’t tolerate ACEIs or ARBs or in African American patients to improve mortality, can also be used to treat HTN in pregnancy

138
Q

Hydralazine adverse effects

A

headache, hypotension, tachycardia, nausea, anorexia, palpitations, sweating and flushing, and lupus-like syndrome including glomerulonephritis at high doses is also possible

139
Q

Hydralazine pharmacokinetics

A

absorbed and rapidly metabolized by the liver during first-pass metabolism

140
Q

Diazoxide MOA

A

long-acting potassium channel opener that causes arterial vasodilation and salt and water retention

141
Q

Diazoxide clinical indications

A

used to treat acute or malignant HTN and hypoglycemia in hyperinsulinism or insulinoma due to inhibition of insulin release from pancreas

142
Q

Diazoxide adverse effects

A

excessive hypotension which in some cases can result in stroke and MI

143
Q

Minoxidil MOA

A

arterial vasodilator which causes hyperpolarization of cell membranes through the opening of potassium channels allowing for greater blood flow and oxygenation to hair follicles

144
Q

Minoxidil clinical indications

A

used topically (Rogaine) as a stimulant for hair growth

145
Q

Nitroprusside MOA

A

venous and arterial vasodilator that causes relaxation of vascular smooth muscle and dilation of peripheral arteries and veins

146
Q

Nitroprusside clinical indications

A

administered IV in hypertensive emergencies

147
Q

Nitroprusside adverse effects

A

hypotension, cyanide toxicity, and hepatotoxicity

148
Q

Clonidine MOA

A

a centrally acting agonist of centrally-located alpha-2 adrenoreceptors reducing sympathetic outflow from the brainstem and inhibiting release of norepinephrine - slows heart rate and reduces renin and aldosterone levels

149
Q

Clonidine clinical indications

A

used to treat HTN, menopausal flushing, opioid or alcohol withdrawal, Tourette’s syndrome, and second-line for ADHD

150
Q

Clonidine adverse effects

A

risk of rebound hypertension due to major vasoconstriction if stopped abruptly

151
Q

Methyldopa MOA

A

a prodrug that is a centrally acting agonist of alpha-2 adrenoreceptors that reduces peripheral vascular resistance

152
Q

Methyldopa clinical indications

A

used primarily to treat HTN during pregnancy

153
Q

Methyldopa adverse effects

A

sedation most common, occasional lactation associated with increased prolactin secretion in both men and women, if used for > 12 months it can lead to reversible autoimmune hemolytic anemia

154
Q

First-line agents used in the treatment of HTN in patients with no other comorbidities

A

thiazide diuretic, ACE inhibitor or ARB, or dihydropyridine CCB

155
Q

When combination drug therapy should be used for HTN

A

if BP is greater than 20 mmHg above systolic BP goal or 10 mmHg above diastolic BP goal or if BP is inadequately controlled

156
Q

Drugs safe to use in treatment of HTN in patients with CKD

A

ACE inhibitors or ARBs

157
Q

Drugs safe to use in treatment of HTN in patients with history of recurrent stroke

A

ACE inhibitors

158
Q

Drugs safe to use in treatment of HTN in patients with previous myocardial infarction

A

beta-blockers, ACE inhibitors, and aldosterone receptor antagonists

159
Q

Drugs safe to use in treatment of HTN in patients with diabetes

A

diuretics, ACE inhibitors, and ARBs

160
Q

Drugs safe to use in treatment of HTN in patients with high-risk angina pectoris

A

beta-blockers and CCBs

161
Q

heart failure

A

a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood

162
Q

common causes of heart failure

A

ischemia (CAD), valvular defect, alcohol, viral illnesses, peripartum, stress, chemotherapy, familial, congenital, idiopathic

163
Q

AHA/ACC stage A HF

A

cardiac risk factors no structural heart disease

164
Q

AHA/ACC stage B HF

A

structural heart disease without HF (asymptomatic)

165
Q

AHA/ACC stage C HF

A

structural heart disease with HF (symptomatic)

166
Q

AHA/ACC stage D HF

A

end-stage HF (symptomatic even at rest)

167
Q

patients considered high risk for HF or stage A

A

patients with HTN, atherosclerotic disease, DM, obesity, metabolic syndrome, or family history of cardiomyopathy

168
Q

drugs used for stage A HF

A

ACEI or ARB and statins as appropriate

169
Q

drugs used for stage B HF

A

ACEI or ARB and beta-blockers as appropriate

170
Q

drugs used for stage C HFrEF

A

diuretics, ACEI or ARB, beta-blockers, and aldosterone antagonists

171
Q

most common cause of HF

A

coronary artery disease resulting in myocardial infarction

172
Q

common causes of heart failure

A

CAD/MI, HTN, cardiomyopathy, and valvular dysfunction

172
Q

overall result of RAAS activation

A

increases sodium and water retention (increases preload) and increases peripheral vascular tone (increases afterload)

173
Q

short-term effects of RAAS

A

initial boost in cardiac output (increases preload and afterload)

174
Q

long-term effects of RAAS

A

left ventricular remodeling

175
Q

common causes of diastolic HF

A

untreated sleep apnea and untreated HTN

176
Q

ACEI indications for HF

A

used to treat asymptomatic and symptomatic HFrEF

177
Q

benefits of ACEIs in HF

A

improves morbidity and mortality outcomes, reduces cardiac remodeling, and slows the progression of kidney disease, especially in diabetics, increases potassium reabsorption in patients on diuretics

178
Q

ACEI and ARB contraindications

A

pregnancy

179
Q

aldosterone antagonists indications for HF

A

used to treat stage C and D HFrEF to improve mortality and reduced remodeling

180
Q

Sacubitril (Entresto = Sacubitril + Valsartan) MOA

A

inhibits neprilysin which is an endopeptidase that degrades BNP, ANP, and angiotensin II resulting in increased diuresis and vasodilation when combined with an ARB like Valsartan

181
Q

Sacubitril adverse effects

A

hypotension, hyperkalemia, dizziness, renal failure, cough, and angioedema

182
Q

Sacubitril contraindication

A

pregnancy

183
Q

Digoxin MOA

A

cardiac glycoside that inhibits the Na-K-ATPase causing an increase in intracellular Ca2+ and cardiac contractability and an increase in parasympathetic tone (vagal tone) resulting in decreased renin release and slowed SA node firing and AV conduction

184
Q

Digoxin clinical indications

A

recommended only for patients with stage C and D HF with EF <25%, reduces morbidity at low concentrations by improving symptoms, increasing exercise tolerance, and reducing hospital admission rates (can be useful for the treatment of HF and Afib simultaneously)

185
Q

goal therapeutic digoxin level in treatment of HF

A

0.5 - 1.1 ng/mL

186
Q

factors that increase risk of digoxin toxicity

A

Digoxin has a narrow therapeutic window - things that increase risk of toxicity include renal insufficiency, increased age, drug interactions (amiodarone and verapamil), hypokalemia, hypomagnesemia, hypernatremia, hypercalcemia, and acid-base disturbances

187
Q

Signs of digoxin toxicity

A

bradycardia, AV blocks, and tachyarrhythmias/ventricular arrhythmias

188
Q

Symptoms of digoxin toxicity

A

fatigue, nausea, vomiting, delirium, blurred vision, anorexia, diarrhea, abdominal pain, headache, dizziness, confusion

189
Q

Milrinone MOA

A

phosphodiesterase III inhibitor (PDEi) that decreases the breakdown of cAMP resulting in increased cAMP levels and calcium influx in cardiac myocytes and vasodilation in vascualr smooth muscle

190
Q

Milrinone clinical indications

A

used short-term for acute hemodynamic and symptomatic relief in patients with advanced HFrEF or stage C or D HF

191
Q

Dobutamine MOA

A

beta-1 adrenergic receptor agonist with positive inotropic activity

192
Q

Drugs to avoid with sulfa allergy

A

Loop diuretics and acetazolamide

Pharmacology II (5 decks)

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