Drugs for heart failure.

Question 1

DRUGS FOR HEART FAILURE

Answer 1

• Diuretics
• R A AS inhibitors
• Angiotensin-converting enzyme inhibitors
• Angiotensin II receptor blockers
• Aldosterone antagonists
• Direct renin inhibitors
• Beta blockers
• Digoxin
• Dopamine
• Hydralazine

Question 2

DIURE TICS

Answer 2

Thiazide diuretics

• High-ceiling(loop)diuretics • Potassium-sparingdiuretics

Question 3

DRUGS THAT INHIBIT THE RAAS

Answer 3

• Angiotensin-converting enzyme (ACE) inhibitors
• Hemodynamic benefits
• Arteriolar dilation
• Venous dilation
• Suppression of aldosterone release
• Impact on cardiac remodeling
• ACE inhibitors have a favorable impact
• ACE inhibitors
• Adverse effects
• Hypotension
• Hyperkalemia
• Intractable cough
• Angioedema
• Renal failure if patient has bilateral renal artery stenosis
• Can cause fetal injury

Question 4

ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITOR: ENTRESTO

Answer 4

• Increasesnatriureticpeptideandsuppressnegativeeffects of RAAS.
• Betterendpoints:admissions,mortality
• ContainsanARBsoSEsimilar\
• Cannotusewithpreganancy
• Dose:24mg/26mgpoBID
• Start 36 hr ACE/ ARB stopped

Question 5

Spironolactone [Aldactone] and eplerenone [Inspra]

Answer 5

Aldosterone antagonists

• Current studies recommend adding an aldosterone antagonist to standard HF therapy in patients with moderately severe or severe symptoms

Question 6

BE TA BLOCKERS

Answer 6

• Action
• With careful control of dosage, can improve patient’s status
• Protect from excessive sympathetic stimulation
• Protect against dysrhythmias
• Adverse effects
• Fluid retention or worsening of HF
• Fatigue
• Hypotension
• Bradycardia or heart block

Question 7

CORLANOR

Answer 7

• Stable,symptomaticHFwithEF<35inNSR • HR>70bpm
• 2.5–7.5mgBID
• SE:visualdisturbance

Question 8

• Dopamine [Intropin]

Answer 8

• Sympathomimetics

• Catecholamine
• Activates beta1-adrenergic receptors in the heart,
kidney, and blood vessels
• Increases heart rate
• Dilates renal blood vessels
• Activates alpha1 receptors

Question 9

Dobutamine

Answer 9

Sympathomimetics

• Synthetic catecholamine
• Selective activation of beta1-adrenergic receptors

Question 10

• Milrinone [Primacor]

Answer 10

• Phosphodiesteraseinhibitors

• Inodilator: Increases myocardial contractility and promotes vasodilation
• Reserved for patients with severe reduction in cardiac output resulting in decreased organ perfusion
• Arrhythmias, myocardial ischemia

Question 11

VASODILATORS

Answer 11

Isosorbide dinitrate plus hydralazine
• Intravenous vasodilators for acute care
• Nitroglycerin
• Principal adverse effects
• Hypotension
• Resultantreflextachycardia
• Sodium nitroprusside [Nitropress]
• Principal adverse effect • Profoundhypotension
• Nesiritide [Natrecor] • Principal adverse effect
• Symptomatichypotension

Question 12

Digoxin[Lanoxin,Lanoxicaps,Digitek]

Answer 12

CARDIAC (DIGITALIS) GLYCOSIDES

• Naturally occurring compound
• Profound effects on mechanical and electrical properties of the heart
• Increases myocardial contractility
• Increased cardiac output
• Adverse effect
• Can cause severe dysrhythmias
• Effects
• Positive inotropic action on the heart
• Increases force of ventricular contraction
• Increases myocardial contractility
• Relationship of potassium to inotropic action
• Potassium levels must be kept in normal physiologic range
• Hemodynamic benefits • Increased cardiac output
• Decreased sympathetic tone
• Increased urine production
• Decreased renin release
• Neurohormonal benefits
• Modulates the activity of the neurohormonal system
• Suppresses renin release in the kidney
• Decreases sympathetic outflow from the CNS
• Increases sensitivity of cardiac baroreceptors
• Electrical effects
• Alters electrical properties of the heart
• Increases firing rate of vagal fibers
• Increases responsiveness of sinoatrial (SA) node to acetylcholine
• Adverse effects
• Cardiac dysrhythmias
• Predisposing factors
• Hypokalemia
• Elevated digoxin level
• Narrow therapeutic range • Heart disease
• Diagnosing digoxin-induced dysrhythmias
• Managing digoxin-induced dysrhythmias
• Noncardiac adverse effects
• Anorexia, nausea, vomiting, fatigue • Measures to reduce adverse effects
• Education
• Drug interactions
• Diuretics
• ACE inhibitors and ARBs
• Sympathomimetics
• Quinidine
• Verapamil
• Pharmacokinetics
• Absorption
• Distributed widely and crosses placenta
• Eliminated primarily by renal excretion
• Half-life about 1.5 days