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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

A

Milrinone

24
Q

How is Milrinone administered and what does it treat

A
  • short- term IV

- severe refractory CHF

25
Q

Adverse effects of Milrinone

A

Proarrhythmic

hypotension

26
Q

what are 3 things we should know about beta-blockers

A
  • initiate dosing gradually with careful monitoring
  • inhibit detrimental cardiac remodeling
  • decreases mortality in severe CHF
27
Q

MOA for Digoxin

A
  • direct effect increase contractility

- inhibition of Na-K ATPase, increase [Ca] intracellular, increase contractility

28
Q

electrophysiological effects of Digoxin in heart

A
  • vagomimetic effects

- direct effects

29
Q

what are the vagomimetic effects of Digoxin

A
  • -decrease automaticity in SA node, decreases HR

- - decrease AV nodal conduction ( increase PR interval may AV block)

30
Q

What are direct effects of Digoxin

A

-induction of delayed afterdepolarizations, tachyarrhythmias

31
Q

what is an important pharmacokinetics of Digoxin

A

Renal elimination

32
Q

what are the effects of Digoxin in CHF patients

A
  • 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
Q

what are therapeutic uses of Digoxin

A

CHF - particularly with A. fib

- decrease V rate in A flutter and fib

34
Q

adverse effects of Digoxin

A

arrhythmia
GI
visual
CNS

35
Q

what are factors which enhance digoxin toxicity

A
  • hypokalemia ( enhances Na-K ATPase inhibition by digoxin)

- decrease renal function ( decrease clearance of Digoxin)

36
Q

what are drug interactions with Digoxin

A
  • increases toxicity/plamsa levels associated with Diuretics: hypokalemia and sympathomimetics
  • decreases toxicity/plasma levels associated with Cholestyramine and colestipol
37
Q

how do you treat Digoxin toxicity

A
  • discontinue use
  • adjust K levels
  • Digoxin immune Fab antibody
  • treat arrhythmias - atropine
38
Q

Name other positive inotropic drugs fro CHF

A

Dobutamine
Dopamine
Beta receptor agaonists

39
Q

How does Dobutamine work

A

selective increase contractility relative to rate

40
Q

how does Dopamine worke

A

D1 receptor agonist

- vasodilator

D&T3 Test 1 (11 decks)

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