Drugs for Heart Failure Flashcards
1
Q
List 5 drug options to decrease preload.
A
- Furosemide
- Spironolactone
- Hydrochlorothiazide
- Nitroprusside
- Nitroglycerine
2
Q
List 3 drug options to increase ionotope.
A
- Pimobendan
- Dobutamine
- Digoxin
3
Q
List 5 drug options to decrease afterload.
A
- Nitroprusside
- Enalopril
- Amlodipine
- Hydralazine
- Sildenafil
4
Q
What are the 5 drug options to optimize heart rate?
A
- Digoxin
- Diltiazem
- Atenolol
- Atropine
- Theophylline
5
Q
What are the 3 drug options to block RAAS/SNS?
A
- Enalopril
- Atenolol
- Spironolactone
6
Q
Where do thiazide diuretics work?
A
Distal convoluted tubule
7
Q
Where do loop diuretics work?
A
Ascending loop of henle
8
Q
Which transporter do loop diuretics effect?
A
Na+/K+/2Cl- transporter
9
Q
What transporter do thiazide diuretics effect?
A
Na+/Cl- transporter
10
Q
Where do K+ sparing diuretics work?
A
Late DCT and collecting duct
11
Q
What is the 1st line of defense for CHF?
A
Furosemide
12
Q
What class of diuretic is Furosemide?
A
Loop diuretic
13
Q
Where is the nephron does Furosemide work?
A
Ascending loop of henle
14
Q
On which transporter does Furosemide work?
A
Na+/K+/2Cl- cotransporter
15
Q
With Furosemide, what electrolyte values would be abnormal within the urine?
A
- Increased sodium
- Increased chloride
- Increased potassium
- Increased calcium
- Increased magnesium
16
Q
What are the 5 adverse side effects associated with Furosemide?
A
- Azotemia
- Metabolic alkalosis
- Hypochloridemia
- Hypomagnesemia
- Hypokalemia
17
Q
What is the 2nd line of defense for CHF?
A
Spironolactone
18
Q
What type of diuretic is Spironolactone?
A
K+ sparing diuretic
19
Q
Where in the nephron does Spironolactone work?
A
Late DCT and collecting duct
20
Q
On which specific receptor/transporter does Spironolactone bind?
A
Aldosterone/Na-H antiporter
21
Q
What are the 3 adverse side effects associated with Spironolactone?
A
- Azotemia
- Hyperkalemia
- Facial dermatitis (cats)
22
Q
What is the 3rd line of defense for CHF?
A
Hydrochlorothiazide
23
Q
What type of diuretic is Hydrochlorothiazide?
A
Thiazide
24
Q
Where is the nephron does Hydrochlorothiazide work?
A
DCT
25
On which transporter does Hydrochlorothiazide bind?
Na+/Cl- cotransporter
26
What are the 3 adverse side effects associated with Hydrochlorothiazide?
1. Azotemia
2. Hypercalcemia
3. Hypokalemia
27
What drug class does Enalopril fit in?
ACE inhibitor
28
What are 2 indications for using Enalopril?
1. Chronic CHF
| 2. Proteinuria
29
What are the 2 side effects associated with Enalopril?
1. Azotemia
| 2. Hypotension
30
What 3 factors determine stroke volume?
1. Preload
2. Afterload
3. Inotrope
31
What 1 reason would cause left sided heart failure due to too much afterload?
Systemic hypertension
32
What 1 reason would cause left sided heart failure due to too much preload?
Valvular disease (mitral, aortic)
33
What 2 reasons would cause left sided heart failure due to not enough contractility?
1. DCM
| 2. Myocarditis
34
What 1 reason would cause left sided heart failure due to not enough relaxation/filling?
HCM
35
What 1 reason would cause right sided heart failure due to too much afterload?
Pulmonary hypertension
36
What 1 reason would cause right sided heart failure due to too much preload?
Valvular disease (tricuspid)
37
What 2 reasons would cause right sided heart failure due to not enough contractility?
1. DCM
| 2. Myocarditis
38
What 1 reason would cause right sided heart failure due to not enough relaxation/filling?
Neoplasia
39
What are the clinical signs of low output heart failure?
1. Syncope
2. Prerenal azotemia
3. Cyanosis
4. Pallor
5. Hypokinetic pulses
40
What are the clinical signs of congestive heart failure?
1. Pulmonary edema
2. Pleural effusion
3. Pericardial effusion
4. Ascites
5. Hepatomegaly
6. Splenomegaly
41
With low output heart failure, what structure in the kidney recognizes the decreased renal perfusion?
Juxtaglomerular apparatus
42
What are the long-term effects of the neurohormonal compensatory system in response to heart failure?
1. Myocardial remodeling
2. Myocardial fibrosis
3. Renal sclerosis
4. Aortic sclerosis
43
With low output heart failure, what within the SNS recognizes the low blood pressure?
Baroreceptors
44
Of the drugs discussed, which 6 are vasodilators?
1. Enalopril
2. Amlodipine
3. Hydrazaline
4. Sildenafil
5. Nitroprusside
6. Nitroglycerine
45
Name one indication to use Hydralazine (vasodilator).
Acute severe CHF
46
Name one indication to use Nitroprusside (vasodilator).
Acute severe CHF
47
Name one indication to use Nitroglycerine (vasodilator).
Acute severe CHF
48
Name two indications to use Amlodipine (vasodilator).
1. Systemic hypertension
| 2. Severe chronic CHF
49
Name one indication to use Sildenafil (vasodilator).
Pulmonary hypertension
50
What is Pimobendan's effect on the heart rate?
NO effect
51
What is Dobutamine's effect on the heart rate?
Increase
52
What is Digoxin's effect on the heart rate?
Decrease
53
What is the ONE specific indication for Pimobendan?
1st line CHF
54
What is the ONE specific indication for Dobutamine?
Cardiogenic shock
55
What is the ONE specific indication for Digoxin?
Atrial fibrillation
56
What is the ONLY positive inotrope that slows heart rate?
Digoxin
57
Does Diltiazem increase or decrease contractility?
Decrease
58
Does Digoxin increase or decrease contractility?
Increase
59
Does Atenolol increase or decrease contractility?
Decrease
60
What are the 3 NEGATIVE CHRONOTROPES discussed?
1. Diltiazem
2. Digoxin
3. Atenolol
61
What is a consistent adverse effect of all the negative chronotropes?
Bradycardia
62
What are the 3 adverse effects of the negative chronotrope Diltiazem?
1. Bradycardia
2. GI upset
3. Hypotension
63
What are the 3 adverse effects of the negative chronotrope Digoxin?
1. Bradycardia
2. V/D
3. Ventricular arrhythmias
64
What are the 3 adverse effects of the negative chronotrope Atenolol?
1. Bradycardia
2. Bronchospasm
3. Hypotension
65
What are the acute (in hospital) pharmacological treatments of CHF in dogs?
"FOPS"
1. Furosemide
2. Oxygen
3. Pimobendan
4. Sedation
66
What are the chronic (at hone) pharmacological treatments of CHF in dogs?
"DOG'S ARE FOR SPECIAL PEOPLE"
1. Dietary Na+ restriction
2. ACE inhibitor
3. Furosemide
4. Spironolactone
5. Pimobendan
67
What are the acute (in hospital) pharmacologic treatments for CHF in the cat?
" FOPS +/- T"
1. Furosemide
2. Oxygen
3. Pimobendan
4. Spironolactone
5. Thoracocentesis
68
What are the chronic (in home) pharmacologic treatments for CHF in cats?
"DON'T FORGET ABOUT CATS, PLEASE"
1. Dietary Na+ restriction
2. ACE inhibitor
3. Furosemide
4. ACE inhibitor
5. Clopidogrel
6. Pimobendan
69
What is the mechanism of action of class I antiarrhythmic drugs?
Block Na+ channels
70
What is the mechanism of action of class II antiarrhythmic drugs?
Beta-adrenergic blockers
71
What is the mechanism of action of class III antiarrhythmic drugs?
Block repolarizing K+ channels, prolonging action potentials
72
What is the mechanism of action of class IV antiarrhythmic drugs?
Block Ca2+ channels
73
What is the "go-to" acute treatment for ventricular tachyarrhythmias?
IV lidocaine
74
In controlling ventricular tacharrhythmias, what are your 3 longer-term oral options?
1. Sotalol
2. Mexiletine
3. Amiodarone
75
What is the "go-to" acute treatment for supraventricular tachyarrhythmias?
IV diltiazem
76
What are your 3 oral options for controlling supreventricular tachyarrhythmias long-term?
1. Diltiazem
2. Beta blocker
3. +/- Digoxin
77
What is the "go-to" acute treatment for bradyarrhythmias?
IV atropine
78
What is a normal VHS in most dog breeds?
8.5 - 10.5
79
What is a normal VHS in cats?
7.5 (
