Drugs to prevent deterioration of cardiac function - CHF

Question 1

What are 4 ACEi’s?

Answer 1

Captopril
Lisinopril
Benazepril
Enalapril

Question 2

What are 4 ACEi’s?

Answer 2

Captopril
Lisinopril
Benazepril
Enalapril

Question 3

MOA for ACEi’s?

Answer 3

(-) ACE (angiotensin converting enzyme) from converting Angiotensin 1 to Angiotensin 2

Question 4

Actions of Angiotensin 2?

Answer 4

• Cardiac hypertrophy
• Vasoconstriction of blood vessels to increase afterload
• Aldosterone release to increase preload

Question 5

What is the half life and side effects of Captopril?

Answer 5

(ACEi)
- half life = 1.7 hours
=> Angioedema, cough, fetal toxicity

Question 6

Which ACEi is used via IV?

Answer 6

Enalapril

Question 7

Which ACEi’s have longer half lives than Captopril?

Answer 7

Lisinopril

Benazepril

Question 8

What are 3 ARBs?

Answer 8

Losartan
Valsartan
Candsartan

Question 9

What are 3 ARBs?

Answer 9

Losartan
Valsartan
Candesartan

Question 10

MOA for ARBs?

Answer 10

Angiotensin 2 Receptor Blockers

Question 11

Which ARB is NOT a prodrug?

Answer 11

Valsartan

Question 12

Which ARB has high affinity for AT1 receptor of Angiotensin 2?

Answer 12

Losartan

Question 13

Which ARB binds irreversibly?

Answer 13

Candesartan

Question 14

Between ACEi and ARBs which are more favorable?

Answer 14

ACEi

Question 15

What are the contraindications for ACEi and ARBs?

Answer 15

• Pregnancy –> fetal toxicity
• Hypotension
• Hyperkalemia
• Serum Creatine > 3

Question 16

What are the contraindications for ACEi and ARBs?

Answer 16

• Pregnancy –> fetal toxicity
• Hypotension
• Serum Creatine > 3
• Hyperkalemia

Question 17

What drug can be added to Valsartan (ARB) to increase levels of ANP and BNP?

Answer 17

Sacubitril

Question 18

MOA for Sacubitril and what is added to and what it does?

Answer 18

MOA - (-) Neprilysin
- Added to Valsartan (ARB)
= Increases levels of ANP and BNP

Question 19

Valsartan and Sacubitril are both _____

Answer 19

Co-cyrstalized

Question 20

What are 3 beta blockers?

Answer 20

Carvedilol
Metoprolol
Bisaprolol

Question 21

What are 3 beta blockers?

Answer 21

Carvedilol
Metoprolol
Bisoprolol

Question 22

Carvedilol (beta blocker) can be used with the patient has a history of? And in what type of patients?

Answer 22

MI, ACS or HFrEF

– Low doses in STABLE patients

Question 23

What is the major warning when using Beta Blockers?

Answer 23

Do NOT withdraw them abruptly!!

- Must taper to avoid tachycardia, hypertension and ischemia

Question 24

MOA for Ivabradine and what that results in?

Answer 24

(-) funny channels within the SA node

= Prolongs diastole and slows HR

Question 25

MOA for Ivabradine and what that results in?

Answer 25

(-) funny channels in the SA node | = Prolongs diastole and slows HR

Question 26

When should Ivabradine be used?

Answer 26

To treat a HR above 70 in a stable patient with LVEF < 35% when they are: 1. maximally dosed with beta blockers or cannot take beta blockers!

Question 27

Spironolactone MOA?

Answer 27

Antagonist of Aldosterone receptors

Question 28

K+ sparing diuretic?

Answer 28

Spironolactone

Question 29

Spironolactone is a K+ sparing diuretic that can also antagonize?

Answer 29

Heart fibrotic effects of aldosterone at its receptors

Question 30

This drug can treat HTN and reduce fibrosis in HFrEF and post-MI HF

Answer 30

Spironolactone

Question 31

Describe the half life for Spironolactone?

Answer 31

Slow on and slow off -- long half life

Question 32

What side effects can Spironolactone cause?

Answer 32

Hyperkalemia Amenorrhea Gynecomastia

Question 33

What is a more selective Aldosterone receptor antagonist and what does it treat?

Answer 33

Eplerenone | - treats HTN and post-MI HF