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D&T3 Test 1 > Drugs to treat CHF > Flashcards

Drugs to treat CHF Flashcards

1
Q

What vasodilator drugs help with CHF

A
  • Guanylyl Cyclase activators
  • ACE inhibitors
  • Angiotensin receptor blockers
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2
Q

What diuretics are used for CHF

A

Thiazides
Loop
K-sparing ( Sprionolactone, Eplereone)

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3
Q

What beta blockers are used for CHF

A

Carvedilol
Metoprolol
Bisoprolol

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4
Q

In normal patients what do arteriodilators do

A
  • decrease BP

- reflex increase HR and modestly increase CO

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5
Q

In CHF patients what do arterial dilators do ?

A
  • decrease TPR
  • decrease afterload
  • increase Stroke volume
  • increase Cardiac output
  • increase tissue perfusion
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6
Q

In CHF patients, CO and vasodilation does what to HR and BP

A

not much change

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7
Q

how do venodilators work in CHF patients

A
  • decrease preload
  • decrease LVEDV
  • decrease CO
  • decrease LVEDV
  • decrease edema
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8
Q

Nitroprusside MOA

A

balanced venou = arterial vasodilation

  • balanced decrease in preload and afterload
  • increase CO ,
  • HR and BP stay same
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9
Q

How is Nirtopursside administered for acute CHF

A

IV

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10
Q

organic nitrates dialate what

A

venodilation

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11
Q

Which vasodilators in CHF decrease mortality

A
  • hydralazine and ISDN
  • ACE inhibitors
  • Angiotensin Receptor blockers
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12
Q

how do organic nitrates work at low doses

A
  • preferential decrease in preload

- decrease congestion/edema ( decrease CO)

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13
Q

How do organic nitrates work at high doses

A
  • decrease preload and afterload

- maintain CO

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14
Q

What organic nitrate decreases mortality and what drug is is usually combined with?

A

Isosorbide dinitrate and Hydralazine

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15
Q

what do organic nitrates treat

A

acute and chronic CHF

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16
Q

Hydralazine dilates what? its effects

A

arteriodilator

  • prominent decrease afterload
  • increase SV
  • increase CO
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17
Q

what does hydralazine treat

A

chronic CHF

18
Q

what are the effects of ACEI and ATRA

A
  • decrease afterload
  • increase SV
  • increase CO
  • BP and HR same
19
Q

when are combination therapy used

A

when ACEIs /ARBs not tolerated

20
Q

ACEI and ARB dilate what and what does it treat

A

arteriodilation

Chronic CHF

21
Q

what is Nesiritide

A

newer drug

22
Q

what is Type III phosphodiesterase inhibitors impact on heart and vascular smooth muscle

A

increase cAMP
heart: increase heart contractility , increase CO

smooth muscle: vasodilation, increase CO

HR and BP same

23
Q

name a Type III phosphodiesterase inhibitor drug

24
Q

How is Milrinone administered and what does it treat

A
  • short- term IV

- severe refractory CHF

25
Adverse effects of Milrinone
Proarrhythmic | hypotension
26
what are 3 things we should know about beta-blockers
- initiate dosing gradually with careful monitoring - inhibit detrimental cardiac remodeling - decreases mortality in severe CHF
27
MOA for Digoxin
- direct effect increase contractility | - inhibition of Na-K ATPase, increase [Ca] intracellular, increase contractility
28
electrophysiological effects of Digoxin in heart
- vagomimetic effects | - direct effects
29
what are the vagomimetic effects of Digoxin
- -decrease automaticity in SA node, decreases HR | - - decrease AV nodal conduction ( increase PR interval may AV block)
30
What are direct effects of Digoxin
-induction of delayed afterdepolarizations, tachyarrhythmias
31
what is an important pharmacokinetics of Digoxin
Renal elimination
32
what are the effects of Digoxin in CHF patients
- increase cardiac contractility - increase CO - decrease venous pressure and heart size - decrease HR - diuresis - decrease O2 demand - decrease sympathetic tone, decreases TPR and BP same
33
what are therapeutic uses of Digoxin
CHF - particularly with A. fib | - decrease V rate in A flutter and fib
34
adverse effects of Digoxin
arrhythmia GI visual CNS
35
what are factors which enhance digoxin toxicity
- hypokalemia ( enhances Na-K ATPase inhibition by digoxin) | - decrease renal function ( decrease clearance of Digoxin)
36
what are drug interactions with Digoxin
- increases toxicity/plamsa levels associated with Diuretics: hypokalemia and sympathomimetics - decreases toxicity/plasma levels associated with Cholestyramine and colestipol
37
how do you treat Digoxin toxicity
- discontinue use - adjust K levels - Digoxin immune Fab antibody - treat arrhythmias - atropine
38
Name other positive inotropic drugs fro CHF
Dobutamine Dopamine Beta receptor agaonists
39
How does Dobutamine work
selective increase contractility relative to rate
40
how does Dopamine worke
D1 receptor agonist | - vasodilator

D&T3 Test 1 (11 decks)

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