Drugs to control CHF state Flashcards
There are 2 types of Diuretics, what are the types?
K+ sparing
K+ losing
What are the K+ sparing Diuretics?
Spironolactone
Eplerneone
What are the K+ losing Diuretic classes?
Loops
Thiazides
Where do K+ sparing Diuretics work?
Proximal to the late distal convoluted tubule
What are 4 Loops (K+ losing Diuretics)?
Furosemide
Torsemide
Bumetanide
Ethacrynic acid
What are 4 Loops (K+ losing Diuretic)?
Furosemide
Torsemide
Bumetanide
Ethacrynic acid
MOA for Loops?
Block Na, K, 2Cl cotransporters
What is the main thing that Diuretics can treat that is associated with CHF?
EDEMA – fluid removal!
What are the electrolyte changes that can occur with Loops, like Furosemide?
HYPO-kalemia, natremia, chloremia, calcemia
HYPER-glycemia, uricemia
What is a potential side effect of Furosemide?
Ototoxicity - vertigo, tinnitus, hearing impairment
Compared to other loops (K+ losing diuretics), Torsemide and Bumetanide have better?
Oral absorption
Loops are contraindicated in patients with a _____ allergy. Which loop can they take?
Sulfa allergy
– Can take ethacrynic acid
What are 3 Thiazides (K+ losing diuretics)?
Hydrochlorothiazide (HCTZ)
Chlorthalidone
Metolazone
What are 3 Thiazides (K+ losing Diuretics)?
Hydrochlorothiazide (HCTZ)
Chlorthalidone
Metolazone
MOA for Thiazides (K+ losing diuretics)?
Blocks NaCl cotransporter
Hydrochlorothiazide can treat HTN but is not effective in patients with a decreased ____
GFR
What are the electrolyte changes seen with Thiazides?
Hypo-electrolytes
HYPER-calcemia, glycemia, uricemia
In what patients are Thiazides and Loops contraindicated in?
Sulfa allergy
Which Thiazide is a favorite to treat CHF symptoms?
Metolazone
What are 4 Vasodilators to reduce cardiac work?
Isosorbide Dinitrate
Hydralizine
Nitroglycerin
Nitropursside
What are 4 Vasodilators to reduce cardiac work?
Isosorbide Dinitrate
Hydralazine
Nitroglycerin
Nitroprusside
Isosorbide Dinitrate vasodilates ____ to decrease ___
Veins to decrease preload
Hydralazine vasodilates ____ to decrease ____
Arteries to decrease afterload
What combination of Vasodilators works well on African Americans only?
Isosorbide Dinitrate + Hydralazine
What are possible side effects of Hydralazine?
Drug-induced lupus
Angina, flushing, edema
Nitroglyercin vasodilates ___
Veins
This Vasodilator can treat Angina pectoris and acute decompensated HF?
Nitroglycerin
What is 1 cardiac glycoside?
Digoxin
Digoxin MOA and what it results in?
(-) Na/K ATPase
=> increases contractility and suppresses AV node conduction
Digoxin MOA results in?
Increased contractility and suppression of AV node conduction
What must be normal in the patient before they are given Digoxin?
HR
Digoxin it taken orally and has a long half life. What does it need to be dosed with?
Loading dose
Digoxin is safe for pregnant women even though?
It crosses the placenta
Describe how Digoxin toxicity arises
- (-) Na/K ATPase
- DECREASED calcium movement out of cell
- INCREASED calcium in myocte
= spontaneous oscillatory release which contributes to twitchy arrhythmias
Which drug tends to uncouple the atria from the ventricles and can cause alarming ECG features?
Digoxin
What does Digoxin do to the AV node conduction, AV node refractory period, ventricular refractory period and purkinje automaticity?
AV node conduction = DECREASED
AV node refractory period = INCREASED
Ventricular refractory period = DECREASED
Purkinje automaticity = INCREASED
What vision changes can occur with Digoxin?
Halos, yellowish or greenish tint to objects
Diuretics that cause HYPOkalemia in combination with what drug can result in that drug’s toxicity?
Digoxin – hypokalemia increases Digoxin binding
= Digoxin toxicity
What is the order of Diuretics that should be given?
Loop
- Add K+ sparing
- Add Thiazide
