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D&T3 Cardiology > Drugs for CHF > Flashcards

Drugs for CHF Flashcards

1
Q

What are the types of diuretics used to treat CHF?

A
  1. Thiazide
  2. Loop
  3. K-Sparing (Spironolactone)
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2
Q

What are the types of Beta Blockers used to treat CHF?

A
  1. Carvedilol
  2. Metoprolol
  3. Bisoprolol
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3
Q

What are the types of positive inotropic drugs used to treat CHF?

A
  1. Digoxin

2. B1-Agonists

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4
Q

What are the inotropic + Vasodilator drugs used to treat CHF?

A
  1. PDE Inhibitors

2. Milrinone

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5
Q

What are the broad classes of drugs used to treat CHF?

A
  1. Vasodilators
  2. Diuretics
  3. Positive Inotropic Drugs
  4. Beta Blockers
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6
Q

Describe the General Mechanism of Venodilators in treating CHF

A

venodilation –> dec. preload –> dec. LVEDV –> dec. CO –> dec. LVEDV –> Decreased Edema

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7
Q

Describe the General Mechanism of Arteriodilators in treating CHF

A

arteriodilation –> dec. TPR –> dec. afterload –> inc. SV –> inc. CO; inc. SV also –> dec. LVEDV –> dec. edema

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8
Q

What is the MOA of Nitroprusside? What is its clinical use?

A

Arteriodilation = Venodilation

Used for acute CHF (IV)

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9
Q

What is the MOA of Organic Nitrates? Describe the effects of dosing

A

MOA- mostly Venodilation

-At high dose also get arteriodilation

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10
Q

Which drug can organic nitrates be combines with to reduce mortality?

A

Hydralazine

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11
Q

What is the MOA of hydrazine?

A

Arteriodilation

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12
Q

How do ACE Inhibitors and Angiotensin Receptor Antagonists work to treat CHF?

A
  1. They cause arteriodilation and ventilation by inhibiting the RAAS and decreasing Na+ and water retention
  2. Also inhibit cardiac remodeling in CHF
    * *Decrease mortality
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13
Q

What is Nesirtide? Describe its MOA and clinical use

A

Recombinant BNP
MOA- increases cGMP –> vasodilation (artery and veno)
Use- Tx of acute decompensated CHF

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14
Q

Describe the MOA of Type III PDE Inhibitors. What drugs are included in this class?

A

Result in increased cAMP
a) in heart –> increased contractility and CO
b) in vascular SM –> vasodilation –> increased CO
Drugs include Milrinone and Inamrinone

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15
Q

What is the use of Milrinone and Inamrinone? What are the associated side effects?

A

Use- short term IV for severe refractory CHF

SE- pro-arrhythmic, thrombocytopenia and hypotension

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16
Q

What are the Beta Blockers used for the treatment of CHF?

A

Carvedilol, Metoprolol and Bisoprolol

17
Q

What is the MOA and effect of Beta Blockers in treating CHF?

A

Inhibit Cardiac Remodeling and decrease mortality in severe CHF

18
Q

What are the positive inotropic drugs used in the treatment of CHF?

A

Digoxin, Dopamine and Dobutamine

19
Q

What is the MOA of Digoxin?

A

Inhibition of the Na/K ATPase –> increased [Ca++] –> increased contractility

20
Q

What is the net effect of Digoxin?

A
  1. Increased SV and CO
  2. Decreased LVEDV and heart size
  3. Decreased HR (vagomimetic effect and decreased sympathetics)
  4. Decreased Oxygen Demand
  5. Diuresis
21
Q

What is the electrophysiological effect of Digoxin?

A
  • Direct Effects
    1. Decreased automaticity in the SA node
    2. Decreased AV nodal conduction
    3. Delayed afterdepolarizations and tachyarrhythmias
22
Q

How is digoxin excreted? What is the consequence?

A

Renal, adjust dose

23
Q

What is the clinical use of digoxin?

A

CHF with A. fib or flutter

24
Q

What are the side effects of digoxin?

A
  1. Arrhythmias
  2. GI (anorexia, nausea, vomiting, diarrhea)
  3. Visual (blurriness, photophobia, abnormal color vision)
  4. CNS (lethargy, anxeity, nightmares, hallucinations and delerium)
25
Q

What factors lead to Digoxin toxicity?

A
  1. Hypokalemia
  2. Decreased Renal FXN
  3. Acidosis
  4. Hypercalcemia
  5. Hypothyroidism
26
Q

What are the drug interactions to watch for with digoxin?

A

Increase levels/toxicity:
1. Diuretics (hypokalemia)
Decrease levels/toxicity
1. Resins

27
Q

Describe the treatment for digoxin toxicity

A
  1. Stop digoxin
  2. Adjust and monitor K+
  3. Give Digoxin immune Fab fragments
  4. treat arrhythmias (lidocain and atropine)
28
Q

What are the B Receptor Agonists used in the treatment of CHF? What is their clinical use?

A

Dobutamine and Dopamine

Use- Tx of Acute CHF

29
Q

Describe the MOA of Dobutamine

A

B1 Agonist (Alpha agonist/antagonist) that results in increased Contractility

30
Q

Describe the MOA of Dopamine

A

Vasodilator (D1) and positive inotrope (B1)

31
Q

What is the role of K-sparing diuretics in CHF?

A

Prevent hypokalemia

32
Q

What is the role of Thiazides and Loop diuretics in CHF?

A

Decrease LVEDP and control congestion

33
Q

What is the MOA of Spironolactone and Eplerenone?

A

Decrease Cardiac remodeling and reduce mortality in CHF patients

34
Q

What is an adverse effect of Spironolactone?

A

Hyperkalemia

35
Q

What physiological property is necessary prior to use of Spironolactone?

A

GFR > 30mL/min

D&T3 Cardiology (7 decks)

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