Drugs for Heart Failure

Question 1

Definition of heart failure.

Answer 1

Heart is unable to pump the blood that’s brought to it.

Question 2

Heart failure leads to these 2 things:

Answer 2

1) Congestion

2) Edema

Question 3

Congestion definition.

Answer 3

Blood backs up in the veins and causes them to swell, seen in the jugular vein in the neck!

Question 4

Swelling of the jugular vein in the neck indicates:

Answer 4

Congestion from heart failure.

Question 5

What causes pulmonary edema?

Answer 5

Left-sided heart failure.

Question 6

What causes peripheral edema?

Answer 6

Right-sided heart failure.

Question 7

2 Major causes of heart failure?

Answer 7

1) Chronic hypertension

2) Myocardial Infarction

Question 8

Preload definition.

Answer 8

How much a muscle stretches before it contracts.

Question 9

Frank-Starling Law

Answer 9

The greater the preload, the greater the heart’s force of contraction.

Question 10

How does Digoxin work?

Answer 10

It inhibits the Na/K pump in the heart, allowing intracellular Calcium to increase, and this increases the force of the heart contraction.

Question 11

Afterload definition

Answer 11

The force against which the ventricle ejects.

Question 12

What is afterload determined by?

Answer 12

1) Peripheral Resistance (most important)
2) Blood viscosity
3) Blood volume in the arterial system

Question 13

What is hypertension caused by?

Answer 13

An increase in peripheral resistance.

Question 14

What is cardiac remodeling?

Answer 14

Structural changes in the heart to compensate for heart failure, which leads to diminished function.

Question 15

Examples of cardiac remodeling.

Answer 15

1) Increase in heart size
2) Fibrosis
3) Shape changes
4) Cardiac output declines

Question 16

First line agents to treat heart failure.

Answer 16

1) Diuretics
2) ACE Inhibitors and ARB’s
3) Aldosterone inhibitors
4) Beta blockers

Question 17

Diuretics used to treat mild to moderate congestive heart failure.

Answer 17

Thiazide diuretics

Question 18

Diuretics used to treat SEVERE congestive heart failure.

Answer 18

Loop diuretics

Question 19

These diuretics counteract hypokalemia caused by other diuretics.

Answer 19

Potassium-sparing diuretics.

Question 20

Examples of potassium-sparing diuretics:

Answer 20

Spironolactone, Triamterene, Amiloride

Question 21

These diuretics cause HYPOkalemia.

Answer 21

Thiazide and loop diuretics.

Question 22

Adverse effect of potassium-sparing diuretics.

Answer 22

HYPERkalemia.

Question 23

MOA of spironolactone.

Answer 23

Blocks Aldosterone receptors.

Question 24

Renin-Angiotensin-Aldosterone inhibitors used in the tx of heart failure.

Answer 24

1) ACE Inhibitors
2) ARB’s (Angiotensin Receptor Blockers)
3) Aldosterone Receptor Blockers (Spironolactone)

Question 25

End in "pril."

Answer 25

ACE Inhibitor

Question 26

Ends in "sartan."

Answer 26

Angiotensin Receptor Blocker

Question 27

How do diuretics work to treat heart failure?

Answer 27

1) Decreased blood volume 2) Decreased pulmonary and peripheral edema 3) Decreased preload 4) Decreased afterload 5) Decreased cardiac dilation

Question 28

Renin-Angiotensin-Aldosterone Inhibitors all reduce ________ _______.

Answer 28

Cardiac remodeling

Question 29

Adverse effects of RAAS Inhibitors.

Answer 29

HYPERkalemia

Question 30

Beta blockers protect against _______ in heart failure.

Answer 30

Dysrrythmias by reducing sympathetic stimulation.

Question 31

Adverse effects of beta blockers.

Answer 31

1) Worsen heart failure 2) Bradycardia 3) Heart block

Question 32

A cardiac glycoside used to treat heart failure.

Answer 32

Digoxin.

Question 33

How does Digoxin work?

Answer 33

It inhibits the Na/K pump, which causes Calcium to build up inside the cell, and this increases the force of contraction.

Question 34

Digoxin is considered a _________-line agent in the tx of heart failure.

Answer 34

second

Question 35

Result of increased cardiac output from digoxin.

Answer 35

1) Decreased sympathetic tone. | 2) Decreased Renin release

Question 36

Hemodynamic effects of Digoxin

Answer 36

1) Preload is decreased 2) Afterload is decreased 3) Renal blood flow increases- so urine output increases 4) Edema is reduced

Question 37

Cardiac adverse effects of Digoxin.

Answer 37

Cardiac dysryhthmias! 1) Decreased SA node (pacemaker) activity 2) Decreased AV conduction 3) Spontaneous activity of Purkinje fibers 4) Shortening of the effective refractory period of the ventricles

Question 38

Digoxin is considered a positive _________ agent.

Answer 38

ionotropic

Question 39

Ionotropic agents (other than Digoxin) used to treat heart failure.

Answer 39

1) Sympathomimetics | 2) Phosphodiesterase inhibitors

Question 40

Sympathomimetics used to treat heart failure.

Answer 40

Dobutamine and Dopamine

Question 41

How does Dobutamine work?

Answer 41

Is a beta 1 receptor agonist to increase contractility and cardiac output.

Question 42

How does Dopamine work?

Answer 42

1) Binds to Dopamine receptors in the kidney to increase renal blood flow and urine output. 2) Causes NE release to increase Beta activation of the heart.

Question 43

Phosphodiesterase Inhibitors end in ________.

Answer 43

"Rinone"

Question 44

Examples of Phosphodiesterase Inhibitors

Answer 44

Inamrinone | Milrinone

Question 45

Isosorbide and Nesiritide are _________.

Answer 45

Vasodilators