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Cardiovascular Medicine-Unit 2 > Drugs For Heart Failure (Kruse) > Flashcards

Drugs For Heart Failure (Kruse) Flashcards

1
Q

What are some adverse effects of loops?

A

HypoK
Alkalosis
Sulfonamide hypersensitivity (not ethacrinic acid)

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2
Q

This cardiac glycoside is used in the tx of heart failure, tachyarrhythmias, and shock. It is well absorbed and widely distributed

A

Digoxin

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3
Q

What is the MOA of digoxin?

A

Inhibits membrane-bound Na/K ATPase and increase myocardial contractility (50-100% in individuals with HF)

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4
Q

Digoxin-induced elevated intracellular Ca increases the activity of Ca-dependent ___ channels.

A

K

Increased Ca-dependent K channel activity promotes K efflux and a more rapid repolarization

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5
Q

The most common cardiac manifestation of digoxin toxicity is ___

A

Arrhythmia

If allowed to progress, the tachycardia may deteriorate into fibrillation that could be fatal unless corrected

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6
Q

At toxic doses of digoxin, what occurs in the atrial muscle?

A

Decreased refractory period

Arrhythmias

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7
Q

At toxic doses of digoxin, what occurs at the AV node?

A

Decreased refractory period

Arrhythmias

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8
Q

At toxic doses of digoxin, what occurs in the purkinje system and ventricular muscle?

A

Extrasystoles
Tachycardia
Fibrillation

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9
Q

Describe the ECG findings when digoxin is effective at a therapeutic, non-toxic dose:

A

Increased PR interval

Decreased QT interval

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10
Q

At high doses, what type of drug (or drug name) can potentiate the toxic effects of digoxin?

A

Furosemide (loop diuretic)

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11
Q

Digoxin and K bind to competing sites on the ___

A

Na/K ATPase

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12
Q

What class of agents can increase both the force of heart contraction and produce vasodilation?

A

Bipyridines

i.e., Milrinone

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13
Q

Milrinone is a ___

A

Bipyridine

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14
Q

What is the MOA of bipyridines?

A

Cause selective inhibition of PDE3 phosphodiesterase enzyme (PDE3 degrades cAMP)

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15
Q

What are bipyridines approved for?

A

SHORT-TERM support of circulation in ADVANCED HF

Chronic tx does not show improvement in quality or length of life and may increase mortality

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16
Q

What is the 1st step in the tx of heart failure?

A

Control HTN, hyperlipidemia, glucose metabolism (diabetes), obesity

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17
Q

How does digoxin ultimately increase myocardial contractility?

A

Increasing the releasable Ca from the SR (more accumulates in SR d/t its MOA)

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18
Q

Parasympathomimetic effects of digoxin are inhibited by __

A

Atropine

19
Q

Where is cholinergic innervation more concentrated in the heart?

A

The atria

Increased actions of digoxin on atrial and AV nodes comapred to purkinje or ventricular function

20
Q

What is the most common site of digoxin toxicity outside of the heart?

A

GI –> anorexia, nausea, vomitting, and diarrhea

21
Q

___kalemia can reduce the effects of digoxin (especially the toxic effects

___kalemia can potentiate the toxic effects of digoxin

A

Hyper

Hypo

22
Q

How are bipyridines administered?

A

Only available for parenteral

23
Q

These compounds are non-specific PDE inhibitors and their use in HF is limited by their lack of specificity and concomitant side effects

A

Caffeine and theophylline

24
Q

What toxicity is associated with Milrinone?

A

Arrhythmias

25
Q

What are the prototypical B-adrenergic and dopaminergic agonists?

A

Dobutamine (B agonist)

Dopamine (Dopaminergic agonist)

26
Q

What are the MOA of B-adrenergic and dopaminergic agonists?

A

Act via stimulation of cardiac myocyte dopamine D1 receptor (Dopamine) and B1-adrenergic receptor (Dobutamine)

27
Q

___ is the B agonist of choice for management of pts with systolic dysfunction and HF. It increases stroke volume d/t its positive inotropic action and an increase in CO

A

Dobutamine

28
Q

At high doses ___ causes peripheral arterial and venous constriction via a-adrenergic receptor stimulation, which may be desirable in pts where circulatory failure is the result of vasodilation (sepsis, anaphylaxis)

A

Dopamine

29
Q

These diuretics are widely used in the treatment of heart failure

A

Loops –> furosemide, bumetanide, and torsemide are most commonly used

30
Q

These diuretics are most frequently used in tx of systemic HTN and have a more restricted role in tx of HF

A

Thiazides

31
Q

What are the prototypical aldosterone antagonists?

A

Spironolactone and eplerenone

32
Q

This ADH antagonist can tx HF and SIADH and is administered parenterally with a 1/2 life of 5-10 hrs

A

Conivaptan

33
Q

This ADH antagonist is a selective antagonist of V2 ADH rcepetors that is given PO

A

Tolvaptan

34
Q

What toxicities are associate with ADH antagonists?

A

Conivaptan can cause hypernatremia, nephrogenic DI

35
Q

What drug class can be given to potentiate the effects of diuretics in HF?

A

ACE inhibitors

The -pril’s

36
Q

What drug class can be given to potentiate the effects of diuretics in HF if a pt is intolerant to a specific drug class that causes a characteristic cough and angioedema?

A

ARB’s

The -sartan’s

Act through AT1 receptors

37
Q

What is the MOA of Isosorbide dinitrate?

A

Releases NO and activates guanylyl cyclase; is a VENODILATOR

Used in acute and chronic HF as well as angina

38
Q

What arteriolar dilator is used in combo with nitrates to reduce mortality in pts w/ HF? What are its toxicities?

A

Hydralazine

Tachycardia, fluid retention, lupus-like syndrome

39
Q

This drug is used for acute cardiac decompensation and hypertensive emergencies (malignant HTN)

A

Nitroprusside

Combined arteriolar and venodilator

40
Q

___ is a recombinant form of human BNP that has been approved for tx of acutely decompensated HF with dyspnea at rest or with minimal activity

A

Nesiritide

41
Q

What is the MOA of Nesiritide?

A

Binds to GC receptor on vascular smooth muscle and endothelial cells, increasing intracellular cGMP, resulting in smooth muscle relaxation

Given IV

42
Q

___=B1 selective blocker, off-label use for HF in USA
___=Nonselective B blocker and a-1 selective blocker
___=B1 selective blocker, mild-to-moderate HF

A

Bisprolol
Carvedilol
Metoprolol

43
Q

What are the prototypical loop diuretics?

A

Furosemide and ethacrynic acid

Cardiovascular Medicine-Unit 2 (11 decks)

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