Drugs for Heart Failure Flashcards
classes of drugs for acute HF
1) diuretics
2) vasodilators (CCB, hydralazine)
3) supplemental O2
4) beta receptor agonist: dobutamine
what are the classes of drugs for chronic HF
1) diuretics
2) ACE inhibitors (prils)
3) ARBS (sartans)
4) Beta blockers
5) Aldosterone receptor antagonists
6) cardiac glycosides (positive iontrops) - Digoxin
7) vasodilators (CCB and Hydralazine)
what are the drugs that are proven to have a reduction in mortality with HF patients?
1) ACE inhibitors
2) B blockers
3) Aldosterone receptor antagonist (Spironolactone and Eplerenone)
MOA of ACE inhibitor
inhibit Angiotensin converting enzyme which decreases angiotensin receptor activation resulting in increased cardiac output
what is the hemodynamic effects of ACE inhibitors
decreased preload and decreased afterload
what is the MOA of betta blockers for HF
decrease renin release from the kidneys which decrease workload and 02 consumption
what are the hemodynamic effects of Beta blockers
decreased preload and decreased afterload
what are the clinical notes for beta blockers and HF
may be contraindicated in severely decompensated HF
what is the MOA of Spironolactone and Eplerenone
antagonist at aldosterone receptor
what is the hemodynamic effect of spironolactone and eplerenone
decreased preload
what are the drugs that are used to improve symptoms of HF but do not increase mortality?
1) diuretics
2) Digoxin
3) organic nitrates
4) Dobutamine
5) milrinone
what is the MOA of digoxin
- inhibit Na+/K+ ATPase
- increase intracellular Ca2+
- increase contractility
what is the hemodynamic effect of digoxin
- increased contractility (positive iontrop)
what is the MOA of dobutamine
stimulates B receptors and increases HR
what is the Hemodynamic effect of dobutamine
- increased contractility (b1)
- decreased afterload (b2)
what is the MOA of milrinone
inhibit phosphodiesterase to have a B adrenegric effect
what are the hemodynamic effects of milrinone
- increased contractility
- decreased preload
- decreased afterload
what are the adverse effects of ACE inhibitors
1) persistent dry cough
2) renal insufficiency
3) hyperkalemia
4) postural hypotension
5) teratogenic (fetotoxic)
what are the hemodynamic effect of ARBs
decrease in preload and decrease in afterload by blocking the AT1 receptor in the heart
what are the adverse effects of ARBs
- hyperkalemia
- orthostatic hypotension
- teratogenic (fetotoxic)
what are the side effects of beta blaockers
- bradycardia
- hypotension
- fatigue
- dizziness
what receptors to bisoprolol and metoprolol work on?
B1
what receptor does carvedilol work on
beta and alpha
what is the most common types of diuretics used in HF
loop (semide, tanide, zone)
what are the adverse effects of vasodilators
- headache
- hypotension
- tachycardia
adverse effects of digoxin
- narrow therapeutic index
- anorexia, nausea, and vomiting
- blurred vision
- cardic arrhythmias
- hypokalemia
