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Exam 3 > Drugs for Heart Failure > Flashcards

Drugs for Heart Failure Flashcards

1
Q

Definition of heart failure.

A

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

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2
Q

Heart failure leads to these 2 things:

A

1) Congestion

2) Edema

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3
Q

Congestion definition.

A

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

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4
Q

Swelling of the jugular vein in the neck indicates:

A

Congestion from heart failure.

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5
Q

What causes pulmonary edema?

A

Left-sided heart failure.

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6
Q

What causes peripheral edema?

A

Right-sided heart failure.

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7
Q

2 Major causes of heart failure?

A

1) Chronic hypertension

2) Myocardial Infarction

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8
Q

Preload definition.

A

How much a muscle stretches before it contracts.

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9
Q

Frank-Starling Law

A

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

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10
Q

How does Digoxin work?

A

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

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11
Q

Afterload definition

A

The force against which the ventricle ejects.

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12
Q

What is afterload determined by?

A

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

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13
Q

What is hypertension caused by?

A

An increase in peripheral resistance.

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14
Q

What is cardiac remodeling?

A

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

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15
Q

Examples of cardiac remodeling.

A

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

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16
Q

First line agents to treat heart failure.

A

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

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17
Q

Diuretics used to treat mild to moderate congestive heart failure.

A

Thiazide diuretics

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18
Q

Diuretics used to treat SEVERE congestive heart failure.

A

Loop diuretics

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19
Q

These diuretics counteract hypokalemia caused by other diuretics.

A

Potassium-sparing diuretics.

20
Q

Examples of potassium-sparing diuretics:

A

Spironolactone, Triamterene, Amiloride

21
Q

These diuretics cause HYPOkalemia.

A

Thiazide and loop diuretics.

22
Q

Adverse effect of potassium-sparing diuretics.

A

HYPERkalemia.

23
Q

MOA of spironolactone.

A

Blocks Aldosterone receptors.

24
Q

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

A

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

25
Q

End in “pril.”

A

ACE Inhibitor

26
Q

Ends in “sartan.”

A

Angiotensin Receptor Blocker

27
Q

How do diuretics work to treat heart failure?

A

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

28
Q

Renin-Angiotensin-Aldosterone Inhibitors all reduce ________ _______.

A

Cardiac remodeling

29
Q

Adverse effects of RAAS Inhibitors.

A

HYPERkalemia

30
Q

Beta blockers protect against _______ in heart failure.

A

Dysrrythmias by reducing sympathetic stimulation.

31
Q

Adverse effects of beta blockers.

A

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

32
Q

A cardiac glycoside used to treat heart failure.

A

Digoxin.

33
Q

How does Digoxin work?

A

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

34
Q

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

A

second

35
Q

Result of increased cardiac output from digoxin.

A

1) Decreased sympathetic tone.

2) Decreased Renin release

36
Q

Hemodynamic effects of Digoxin

A

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

37
Q

Cardiac adverse effects of Digoxin.

A

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

38
Q

Digoxin is considered a positive _________ agent.

A

ionotropic

39
Q

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

A

1) Sympathomimetics

2) Phosphodiesterase inhibitors

40
Q

Sympathomimetics used to treat heart failure.

A

Dobutamine and Dopamine

41
Q

How does Dobutamine work?

A

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

42
Q

How does Dopamine work?

A

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.

43
Q

Phosphodiesterase Inhibitors end in ________.

A

“Rinone”

44
Q

Examples of Phosphodiesterase Inhibitors

A

Inamrinone

Milrinone

45
Q

Isosorbide and Nesiritide are _________.

A

Vasodilators

Exam 3 (9 decks)

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