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Drugs for Heart Failure Flashcards

1
Q

Symptoms of heart failure?

A

cardinal symptoms are dyspnea, fatigue, and fluid retention

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2
Q

Causes of HF are?

A 
Atherosclerosis
Hypertensive heart disease
Valvular heart disease
Congenital heart disease
and many more
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3
Q

What benefits do pharmacological interventions give for heart failure?

A

reduced myocardial work load
decreased extracellular fluid volume
improved cardiac contractility
reduced rate of cardiac remodeling

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4
Q

The force of contraction of the cardiac muscle is directly related to the concentration of ___________

A

free (unbound) cytosolic calcium

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5
Q

What are the five phases of an action potential of myocyte?

A 
Phase 0: Fast upstroke
Phase 1: Partial repolarization
Phase 2: Plateau
Phase 3: Repolarization
Phase 4: Forward current
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6
Q

What happens in phase 0?

A

Fast Upstroke: Na channels open resulting in fast inward current and ends as Na channels are rapidly inactivated

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7
Q

What happens in phase 1?

A

Partial Repolarization: The initial rapid phase of repolarization is due to

  1. Na channels are inactivated
  2. K channels open rapidly and close, causing a transient outward current
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8
Q

What happens in phase 2?

A

Plateau: Voltage sensitive Ca channels open, resulting in a slow inward depolarizing current that balances the slow outward (polarizing) leak of K+

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9
Q

What happens in phase 3?

A

Repolarization: Ca channels close.
1. K+ channels open, resulting in an outward current leading to membrane repolarization
2. Net result = Gain of Na & Loss of K
This imbalance is corrected by Na/K ATPase pump

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10
Q

What happens in phase 4?

A

Forward Current: Increasing depolarization results in sodium permeability
Spontaneous depolarization automatically brings the cell to the threshold of the next action potential (phase ) again)

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11
Q

Sodium current is blocked by antiarrhythmatic agents __________ (quinidine/amiodarone)

A

quinidine

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12
Q

What are the compensatory physiological responses in heart failure?

A

Increased sympathetic activity
Activation of RAAS
Activation of natriuretic peptides
Myocardial hypertrophy

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13
Q

____________(baroreceptors/chemoreceptors) sense a decrease in blood pressure and activate the sympathetic nervous system

A

Baroreceptors

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14
Q

What do stimulation of beta adrenergic receptors do?

A

Increased heart rate
Greater force of contraction of the heart muscle
Vasoconstriction enhances venous return

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15
Q

What are the effects of RAAS on the body?

A

Peripheral and pulmonary edema (water retention)

Remodeling, fibrosis, and inflammatory changes (due to angiotensin II)

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16
Q

Activation of the _____________ (angiotensin-aldosterone/natriuretic peptides) ultimately results in vasodilation, natriuresis, inhibition of renin and aldosterone release, and a reduction in myocardial fibrosis

A

natriuretic peptides

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17
Q

What is systolic failure?

A

When the ventricles are not able to pump the blood effectively (HFrEF)

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18
Q

What is diastolic failure?

A

When the ventricles are not able to relax properly due to structural changes like hypertrophy (HFpEF)

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19
Q

What are the symptoms of acute decompensated heart failure?

A 
dyspnea on exertion
orthopnea
paroxysmal nocturnal dyspnea
fatigue
peripheral edema
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20
Q

How is Chronic HF typically managed?

A
  1. Fluid limitations (less than 1.5 to 2 L daily)
  2. Low dietary intake of sodium (less than 2000 mg/d); 3. Treatment of comorbid conditions
  3. Judicious use of diuretics
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21
Q

Name the drugs/food that can exacerbate heart failure?

A

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Alcohol
Nondihydropyridine calcium channel blockers
Some antiarrhythmic drugs

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22
Q

____________ are reserved for acute signs and

symptoms of HF and are used mostly in the inpatient setting

A

Inotropic agents

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23
Q

What drugs can we use for HFrEF?

A

Inhibitors of the RAAS
Inhibitors of the sympathetic nervous system
Drugs that enhance activity of natriuretic peptides

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24
Q

What do ACE inhibitors do?

A

Decreased conversion of angiotensin I to AT II

Increased levels of bradykinin (dry cough and angioedema)

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25
What is the effect of ACEIs on preload and afterload?
Decrease preload and afterload
26
__________ is the initial stretching of the cardiac myocytes (muscle cells) prior to contraction. It is related to ventricular filling
Preload
27
__________ is the force or load against which the heart has to contract to eject the blood.
Afterload
28
What is the effect of ACEIs on 1. preload 2. afterload 3. cardiac output
decreased preload decreased afterload increased cardiac output
29
ACE inhibitors also blunt the usual angiotensin II–mediated increase in _________ and _________seen in HF (hormone names?)
epinephrine | aldosterone
30
What are the therapeutic uses of ACEIs?
HFrEF (Systolic failure) (w/ or w/o symptoms) Left ventricular failure (all stages) HTN (w/ or w/o chronic kidney disease) Recent MI (to reduce ventricular remodelling) Patient at risk for cardiovascular events
31
How should ACEIs be administered for HFrEF?
Started at low doses and titrated to target or maximally tolerated doses
32
What is the ROA of ACEIs?
Oral and injectable (enalaprilat)
33
Food may decrease the absorption of ___________ (ACEI), so it should be taken on an empty stomach
captopril
34
All ACEIs except captopril and lisinopril are __________ (prodrug/drug)
prodrug
35
___________ is the only ACE inhibitor that is not eliminated primarily by the kidneys
Fosinopril
36
Plasma half-lives of active compounds (ACEIs) vary from _______ hours
2 to 12 hrs
37
What are the adverse effects of ACEIs?
``` Postural hypotension Renal insufficiency Hyperkalemia Persistent dry cough Angioedema Altered taste Skin rash ```
38
When on ACEIs, potassium supplements and potassium-sparing diuretics should be used with caution due to the risk of ______________
hyperkalemia
39
What should we monitor if ACEIs are being given to a patient?
Serum potassium | Serum creatinine
40
The potential for symptomatic hypotension with | ACE inhibitors is much more common if used concomitantly with a __________
diuretic
41
An increase in serum creatinine of up to _____ above baseline is acceptable and by itself does not warrant discontinuation of ACEIs.
30%
42
ACEIs _______ (can/cannot) be used in pregnant women.
cannot
43
Vasotec is the brand name for ____________ | it is injectable
enalapril
44
What is the brand name of lisinopril?
Prinivil | Zestril
45
What is the brand name of quinapril?
Accupril
46
Altace is the brand name for __________
Ramipril
47
Angiotensin receptor blockers (ARBs) are orally active compounds that are ____ (competitive/noncompetetive) antagonists of the angiotensin II type 1 receptor
competitive
48
ARBs _______ (do/do not) affect bradykinin levels
do not
49
ARBs block the ______ receptor
AT1
50
What does ARB do to the following? 1. preload 2. afterload 3. cardiac output
decrease preload decrease afterload increase cardiac output
51
When are ARBs used?
ARBs are a substitute for patients who cannot tolerate ACE inhibitors due to cough or angioedema
52
For what conditions, ARBs are used for?
Heart failure and HTN
53
Can we give a diabetic patient an ARB if he/she was having dry cough on taking ACEIs?
yes
54
ARBs are orally active and are dosed once daily, with the exception of __________, which is dosed twice daily
valsartan
55
ARBs _________ (are/are not) highly plasma protein bound
are
56
___________ differs in that it undergoes extensive first-pass hepatic metabolism, including conversion to an active metabolite
losartan
57
ARBs are excreted in __________ (urine only/feces only/both urine and feces)
both urine and feces
58
Can we give ARB to a pregnant woman?
No
59
Aldosterone antagonists are indicated in patients with ___________ and ______________
HFrEF (w/ or w/o symptoms) | Recent myocardial infarction
60
____________ (amiloride/spironolactone) also has affinity for androgen and progesterone receptors
spironolactone
61
What are the endocrine related adverse effects of spironolactone?
gynecomastia | dysmenorrhea
62
____________ (amiloride/spironolactone) has the additional benefit of diminishing the cardiac remodeling that occurs in heart failure
spironolactone

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