Drugs for Heart Failure - Kruse

Question 1

Tx: digoxin

Answer 1

heart failure and atrial fibrillation

Question 2

T1/2: digoxin (healthy pt)

Answer 2

36-48 h (QD)

Question 3

T1/2: digoxin (kidney dz, elderly)

Answer 3

3.5-5 d

Question 4

drugs that increase renal digoxin clearance

Answer 4

vasodilators and sympathomimetics

Question 5

MOA: digoxin

Answer 5

• inhibits Na/K ATPase
• increases releasable Ca from SR
• improves contractility
• prolongs refractory period

Question 6

Heart AEs: digoxin

Answer 6

arrhythmias

Question 7

GI AEs: digoxin

Answer 7

anorexia, N/V/D

Question 8

CNS AEs: digoxin

Answer 8

GI s/s, disorientation, hallucinations, visual disturbances

Question 9

rare AE: digoxin (in men)

Answer 9

gynecomastia

Question 10

Tx for digoxin OD

Answer 10

antidigoxin immunotherapy

Question 11

What potentiates the toxic effects of digoxin?

Answer 11

hypokalemia

Question 12

What can reduce the effects of digoxin?

Answer 12

hyperkalemia

Question 13

What can increase the risk of a digoxin-induced arrhythmia?

Answer 13

hypercalcemia and hypomagnesemia

Question 14

bipyridines

Answer 14

inamrinone and milrinone

Question 15

T1/2: bipyridines (HF pts)

Answer 15

3-6 hours

Question 16

MOA: bipyridines

Answer 16

• selective PDE3 inhibition
• accelerates myocardial relaxation
• decreases LV afterload

Question 17

AE: inamrinone

Answer 17

N/V, arrhythmias, thrombocytopenia, and liver enzyme changes

Question 18

AEL milrinone

Answer 18

arrhythmias

Question 19

MOA: dobutamine

Answer 19

• beta-1 stim
• increases SV
• increases CO

Question 20

AE: dobutamine

Answer 20

• tachy

- arrhythmias

Question 21

MOA: dopamine

Answer 21

• D2 presynaptic stimulation
• cAMP dependent relazation
• high doses = peripheral aa & vv const

Question 22

AE: dopamine

Answer 22

• tachy

- possible ischemia in pt with CAD

Question 23

What do diuretics help with in HF pts?

Answer 23

• ‘congestive’ s/s

- reduces cardiac size = inproved pumping ability

Question 24

MC used diuretics in HF

Answer 24

loop: furosemind, bumetanide, torsemide

Question 25

effects of aldosterone in HF

Answer 25

• increased Na/H2O retention
• myocardial and vascular fibrosis
• baroreceptor dysfunction

Question 26

aldosterone antagonists

Answer 26

• spirinolactone

- eplerenone

Question 27

ADH antagonists role in HF

Answer 27

-decrease H2O retention

Question 28

AE: ADH antagnoists

Answer 28

• hypernatremia

- nephrogenic DI

Question 29

Major benefits of using ACEi’s and ARB’s in HF

Answer 29

-reduce preload AND afterload

Question 30

What do ACEi’s potentate the effects of in HF?

Answer 30

diuretics

Question 31

tx: isosorbide dinitrate

Answer 31

• acute and chronic HF

- angina

Question 32

MOA: isosorbide dinitrate

Answer 32

• NO release
• guanylyl cyclase activation
• venodilation

Question 33

AE: isosorbide dinitrate

Answer 33

• postural hypotension
• tachy
• HA

Question 34

Tx: hydralazine

Answer 34

reduces mortality in HF pts when used wit nitrates

Question 35

MOA: hydralazine

Answer 35

arteriolar vasodialtion

Question 36

AE: hydralazine

Answer 36

• tachy
• fluid retention
• lupus-like syndrome

Question 37

MOA: nitroprusside

Answer 37

• NO release
• gyanyly cyclase activation
• vasodilation = profound preload and adterload reduction

Question 38

Tx: nitroprusside

Answer 38

• acute cardiac decompensation

- HTN emergencies

Question 39

MOA: nesiritide

Answer 39

• increases cGMP
• smooth mm relaxation
• vasodilaiton, natriuresis, and diuresis

Question 40

AE: nesiritide

Answer 40

• xs hypotension
• renal damage
• death

Question 41

beta-blockers shown to reduce mortality

Answer 41

• bisoprolol
• carvedilol
• metoprolol

Question 42

first line therapy for CHF

Answer 42

• ACEi’s + diuretics

- use ARB only when pt can’t tolerate ACEi