Drugs for HF

Question 1

Beta blockers

Answer 1

Metoprolol, carvedilol, Labetalol 
Beta1 Beta2 antagonist 
Dec HR, conduction
Neg inoptrope 
Indications 
-tx MI, angina, htn by dec myocardial o2 demand and co

Question 2

ACEi

Answer 2

Ramipril, Captopril, enalopril
Inhibits conversion of angiotensin I to II
No vasoconstriction 
Dec BP, dec vasoconstriction, allow diuresis, void Na
Dec afterload 
Indications:
HTN
CHF
STEMI within 24hrs

Question 3

Milrinone

Answer 3

Positive Inotrope, vasodilator dec preload and afterload (including to pulm artery)
No chronotropic effects

Phosphodiesterase 3 enzyme inhibitor

Indications CHF

Onset 5-15 mins
Duration 3-5 hrs

Dose: load 50mcg/kg, then
Infuse 0.375-0.75mcg/kg/min

Question 4

Nitroglycerin

Answer 4

Vasodilation- covers to NO and effects vascular smooth muscle, causing primarily venous dilation reducing preload and therefore decreases myocardial workload, minor arterial vasodilation dec afterload and coronary vasodilation increasing myocardial oxygen supply

Onset 1-3 mins
Duration 3-5 mins IV, 30-60 mins sublingual

Dose IV infusion 5mcg/min, increase q3-5 mins based on response to 20mcg/min, then increase by 10-20mcg/min q3-5 mins. Max 200mcg/min. Dose based on hemodynamic response.

Adverse hypotension and dec CO

Question 5

Spironolactone

Answer 5

Aldosterone Receptor Antagonist
Reverses antidiuretic effects of aldosterone in RAAS pathway, therefore produces diuresis of Na and water

Indications: HF, HTN, hypokalemia

Onset 2-4h
Duration 2-3 days

Dose 25mg po daily

Question 6

Sodium Nitroprusside

Answer 6

Like Nitroglycerin, converts to NO to produce vascular smooth muscle relaxation and thus VD. Differently it produces vasodilation in arteries as well as venous, therefore decreasing afterload and preload. Includes vasodilation of coronary arteries. Vascular smooth muscle relaxation

Indication:
Hypertension, HF w/ inc PL and AL

Onset <2 mins
Duration 1-10 mins

Dose: Start 0.3mcg/kg/min, titrate Q5mins to desired BP to max 10mcg/kg/min

Adverse: dysrhythmias, restlessness

Question 7

Labetalol

Answer 7

Beta blocker - blocks Beta1 and 2, also alpha blocker receptor
Neg chronotrope, inotrope, dromotrope, vasodilation
Slows HR and dec afterload

Onset 2.5 mins
Duration 8-12h

Dose 20mg IV, then 40-80mg q10 mins until BP controlled, or infusion 1-2mg/min. Max 2400mg/day

Question 8

Hydralazine

Answer 8

Direct arterial vasodilator, no effect on venous
Dec afterload

Onset 5-20 mins
Duration 1-4h

Dose 20-40mg iv

Question 9

Metolazone

Answer 9

Inhibits reabsorption of sodium in distal tubules, causing increased excretion of water and of sodium, potassium, and hydrogen ions

Onset: Diuresis, 1 hr
Duration: 24 hr

2.5-5 mg PO once daily; may be increased to 20 mg once daily PRN