Drugs for CHF Flashcards
What are the types of diuretics used to treat CHF?
- Thiazide
- Loop
- K-Sparing (Spironolactone)
What are the types of Beta Blockers used to treat CHF?
- Carvedilol
- Metoprolol
- Bisoprolol
What are the types of positive inotropic drugs used to treat CHF?
- Digoxin
2. B1-Agonists
What are the inotropic + Vasodilator drugs used to treat CHF?
- PDE Inhibitors
2. Milrinone
What are the broad classes of drugs used to treat CHF?
- Vasodilators
- Diuretics
- Positive Inotropic Drugs
- Beta Blockers
Describe the General Mechanism of Venodilators in treating CHF
venodilation –> dec. preload –> dec. LVEDV –> dec. CO –> dec. LVEDV –> Decreased Edema
Describe the General Mechanism of Arteriodilators in treating CHF
arteriodilation –> dec. TPR –> dec. afterload –> inc. SV –> inc. CO; inc. SV also –> dec. LVEDV –> dec. edema
What is the MOA of Nitroprusside? What is its clinical use?
Arteriodilation = Venodilation
Used for acute CHF (IV)
What is the MOA of Organic Nitrates? Describe the effects of dosing
MOA- mostly Venodilation
-At high dose also get arteriodilation
Which drug can organic nitrates be combines with to reduce mortality?
Hydralazine
What is the MOA of hydrazine?
Arteriodilation
How do ACE Inhibitors and Angiotensin Receptor Antagonists work to treat CHF?
- They cause arteriodilation and ventilation by inhibiting the RAAS and decreasing Na+ and water retention
- Also inhibit cardiac remodeling in CHF
* *Decrease mortality
What is Nesirtide? Describe its MOA and clinical use
Recombinant BNP
MOA- increases cGMP –> vasodilation (artery and veno)
Use- Tx of acute decompensated CHF
Describe the MOA of Type III PDE Inhibitors. What drugs are included in this class?
Result in increased cAMP
a) in heart –> increased contractility and CO
b) in vascular SM –> vasodilation –> increased CO
Drugs include Milrinone and Inamrinone
What is the use of Milrinone and Inamrinone? What are the associated side effects?
Use- short term IV for severe refractory CHF
SE- pro-arrhythmic, thrombocytopenia and hypotension
What are the Beta Blockers used for the treatment of CHF?
Carvedilol, Metoprolol and Bisoprolol
What is the MOA and effect of Beta Blockers in treating CHF?
Inhibit Cardiac Remodeling and decrease mortality in severe CHF
What are the positive inotropic drugs used in the treatment of CHF?
Digoxin, Dopamine and Dobutamine
What is the MOA of Digoxin?
Inhibition of the Na/K ATPase –> increased [Ca++] –> increased contractility
What is the net effect of Digoxin?
- Increased SV and CO
- Decreased LVEDV and heart size
- Decreased HR (vagomimetic effect and decreased sympathetics)
- Decreased Oxygen Demand
- Diuresis
What is the electrophysiological effect of Digoxin?
- Direct Effects
1. Decreased automaticity in the SA node
2. Decreased AV nodal conduction
3. Delayed afterdepolarizations and tachyarrhythmias
How is digoxin excreted? What is the consequence?
Renal, adjust dose
What is the clinical use of digoxin?
CHF with A. fib or flutter
What are the side effects of digoxin?
- Arrhythmias
- GI (anorexia, nausea, vomiting, diarrhea)
- Visual (blurriness, photophobia, abnormal color vision)
- CNS (lethargy, anxeity, nightmares, hallucinations and delerium)
