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CV > druggie drugs for heart failure (week 5) > Flashcards

druggie drugs for heart failure (week 5) Flashcards

1
Q

name examples of some inotrops and pressors

A
  1. dopamine
  2. dobutamine
  3. epinephrine
  4. norepinephrine
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2
Q

inotrope/vasopressor MOA

A
  1. beta adrenergic AGONISTS

increase the availability of intracellular calcium and thus increase the force of ventricular contraction (shift the Frank-Starling curve upwards)

increase SV and cardiac output at any end diastolic volume

  1. alpha adrenergic AGONISTS

increase vasoconstriction in periphery
norepi is more alpha 1
epi is more B1 and B2

overall: increase inotropy, chronotropy and vasoconstriction of periphery

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3
Q

what are inotropes/vasopressors used for

A

ACUTE CHF

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4
Q

indications for inotrops/vasopressors

A

very useful in patients with systolic ventricular dysfunction (as opposed to pure systolic failure)

administer thru IV for temporary hemodynamic support, in acutely ill, hospitalized patients

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5
Q

what type of CHF are diuretics used to treat

A

acute CHF

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6
Q

MOA of diuretics in CHF

A

promote elimination of sodium and water through the kidney and thus reduce intravascular volume

this means lower venous return, lower preload and thus lower diastolic pressure

goal is to REDUCE END DIASTOLIC PRESSURE WITHOUT AFFECTING SV–> its possible if patients are on “flat” portion of frank-starling curve

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7
Q

indications for diuretic use in heart failure

A

indicated when there is evidence of pulmonary congestion (rales) or peripheral interstitial edema

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8
Q

why do you have to be extra careful with diuretics in patients with LV diastolic dysfunction?

A

avoid over-diuresis because patients with this condition require a higher diastolic filling pressure to function

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9
Q

name some diuretics

A

loop: furosemide, torsemide, bumetanide
thiazide: hydrochlorothiazide, metolazone

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10
Q

name a nitrate used in CHF

A

nitroglycerin

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11
Q

what type of CHF is nitro used for

A

acute AND chronic

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12
Q

nitrate MOA in CHF

A

vasodilate primarily venous–> increased venous capacitance–> decrease venous return to heart–> decrease LV preload–> decrease LV diastolic pressure–> pulmonary hydrostatic pressure falls and pulmonary congestion improved

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13
Q

examples of ACEi

A

captopril
ramipril
enalapril
fosinopril

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14
Q

what type of CHF do you treat with ACEi

A

CHRONIC

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15
Q

why would you use ACEi to treat CHF?

A

because inhibits RAAS and Angiotensin II which is a vasoconstrictor

results in vasodilation of veins and arteries

also facilitates Na+ excretion and thus lower intravascular volume

increased bradykinin levels lead to vasodilation

effect is to decrease pulmonary congestion, limit maladaptive ventricular remodeling and decrease heart failure symptoms and need for hospitalization

improved survival in those with chronic CHF

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16
Q

name some ARBs

A

isosartan
candesartan
irbesartan

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17
Q

what type of CHF are ARBs used for

A

chronic

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18
Q

what type of CHF are beta blockers used for

A

chronic

CONTRAINDICATED IN ACUTE CHF

19
Q

why are beta blockers used in CHF

A

because despite their antagonism of the beta receptors they improve CO, reduce hemodynamic deterioration and increase survival

20
Q

how is acute CHF managed

A

diuretic (lasix–loop diuretic)
natriuretic peptides
inotropes/pressors
nitroglycerin

NOT beta blockers or ACEi
no nitro or diuretics if hypotensive

21
Q

how is chronic CHF managed

A

*ACEi–reduce preload and afterload
*beta blockers–reduce cardiac workload
ARBs–reduce preload and afterload
*diuretic
*digoxin–inotrope and negative chronotrope and antiarrhythmic

exercise training
salt/fluid restriction
weight management

22
Q

dopamine

A

inotrope/vasopressor

23
Q

nitroglycerin

A

nitrates

24
Q

losartan

A

ARB

25
Q

captopril

A

ACEi

26
Q

propanolol

A

beta blocker

27
Q

furosemide

A

loop diuretic

28
Q

metolazone

A

thiazide diuretic

29
Q

candesartan

A

ARB

30
Q

dobutamine

A

inotrope/vasopressor

31
Q

epinephrine

A

inotrope/vasopressor

32
Q

atenolol

A

beta blocker

33
Q

ramipril

A

ACEi

34
Q

torsemide

A

loop diuretic

35
Q

bumetanide

A

loop diuretic

36
Q

irbesartan

A

ARB

37
Q

metoprolol

A

beta blocker

38
Q

enalapril

A

ACEi

39
Q

norepinephrine

A

inotrope/vasopressor

40
Q

hydrochlorothiazide

A

thiazide diuretic

41
Q

fosinopril

A

ACEi

42
Q

lasix

A

loop diuretic

43
Q

goal of treatment in acute HF

A

REDUCE preload, pulmonary edema and wall stress

INCREASE cardiac output

MAINTAIN blood pressure

CV (9 decks)

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