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CPR II Week 3 > Drugs to Treat CHF > Flashcards

Drugs to Treat CHF Flashcards

1
Q

What ACE inhibitors are used to treat HF?

A

Captopril and other __prils

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2
Q

What angiotensin receptor blockers (ARBS) are used to treat HF?

A

Losartan and other __sartans

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3
Q

What is the prototypical beta-blocker used to treat HF?

A

Carvedilol

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4
Q

What is the prototypical aldosterone antagonist used to treat HF?

A

Spironolactone

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5
Q

What are the diuretics used to treat HF?

A

1) Furosemide (loop)

2) Thiazide

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6
Q

What are the direct vasodilators used to treat HF?

A

1) Nitroglycerin/isosorbide dinitrate
2) Nitroprusside
3) Hydralazine

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7
Q

What is the cardiac glycoside used to treat HF?

A

Digoxin

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8
Q

What are the adrenergic agonists used to treat HF?

A

1) Dobutamine

2) Dopamine

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9
Q

What is the phosphodiesterase inhibitor used to treat HF?

A

Milrinone

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10
Q

What type of left sided heart failure is systolic?

What is it due to?

A

1) Heart Failure reduced Ejection Fraction (HFrEF)

2) Failure of the pump function

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11
Q

What type of left sided heart failure is diastolic?

What is is due to?

A

1) Heart Failure preserved Ejection Fraction (HFpEF)

1) Ventricular hypertrophy

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12
Q

ACE inhibitors and ARBs both lead to?

A

Less angiotensin II

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13
Q

What does less angiotensin II lead to?

A

1) Less vasoconstriction (Decrease afterload)
2) Less aldosterone secretion and less sodium/water retention (Decrease preload)
3) Decrease cell proliferation and remodeling

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14
Q

What are the clinical applications of captopril?

A

1) HTN
2) HFrEF
3) Diabetic nephropathy

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15
Q

What toxicity is the most common reason why patients stop taking captopril?

What is the most deadly toxicity of captopril?

A

1) Cough (Due to bradykinin levels)

2) Angioedema

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16
Q

What benefit does other ACE inhibitors such as benazepril and lisinopril have over captopril?

A

They have a longer half life permitting 1 dose a day

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17
Q

What type of inhibitor is captopril to ACE?

A

Competitive

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18
Q

What advantage does ARBs have over ACE inhibitors?

A

They do not potentiate bradykinin so less coughing is seen

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19
Q

What type of inhibitor is losartan to angiotensin II receptor?

A

Competitive nonpeptide

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20
Q

What are the clinical applications of losartan?

A

1) Diabetic nephropathy
2) HTN
3) HF if intolerant of ACE inhibitors

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21
Q

What is the black box warning associated with captopril and losartan?

A

Fetal toxicity

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22
Q

Either ACEI or ARBs should be administered to all patients with LV systolic failure or LV dysfunction without heart failure unless?

A

1) Pregnant
2) Hypotensive
3) Serum creatinine > 3 mg/dL
4) Hyperkalemia

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23
Q

The blockage of neutral endopeptidase has what effect on ANP and BNP?

A

Prolongs half-life

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24
Q

What does sacubitril inhibit?

What does this cause?

What drug is it paired and co-crystallized with?

A

1) Neprilysin (neutral endopeptidase)
2) Increase levels of ANP and BNP
3) Valsartan

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25
Q

What toxicity is seen with sacubitril?

A

Angioedema

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26
Q

Carvedilol is non selective for what receptors?

A

Beta and alpha receptors

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27
Q

What is the clinical application for carvedilol?

A

Given to the clinically stable with history of MI and HFrEF to prevent symptomatic HF

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28
Q

Carvedilol is used to prevent down-regulation of?

A

β1 adrenergic receptors

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29
Q

How and to who is carvedilol prescribed?

A

Low doses and in stable patients

30
Q

Patients with what type of HF should be given carvedilol because they will benefit from a lower heart rate?

A

Diastolic HF

31
Q

Unless there are contraindications, carvedilol or metoprolol or bisoprolol should also be given along with ACE inhibitors to all patients with?

A

Left ventricular systolic dysfunction caused by MI to reduce mortality

32
Q

What are some contraindications for beta-blockers?

A

1) Bronchospastic disease like asthma

2) Symptomatic bradycardia

33
Q

What black box warning is associated with beta-blockers?

A

Beta-blocker therapy should not be withdrawn abruptly

34
Q

What does ivabradine inhibit?

Where?

A

1) Hyperpolarization-activated cyclic nucleotide gated (HCN) channels (If- channels)
2) SA node

35
Q

What effect does ivabradine have?

A

Disrupts If (funny current) to prolong diastole and slow HR

36
Q

What is the clinical applications for ivabradine?

It is used when there is a maximally tolerated dose to or contraindication to what drug?

A

1) Tx of resting HR greater than 70 bpm in patients with stable, symptomatic chronic heart failure with left ventricular ejection fraction ≤35%
2) Beta blockers

37
Q

What type of antagonist is spironolactone to aldosterone receptors?

A

Competitive

38
Q

What effect does spironolactone have?

A

1) K+ sparing diuretic

2) Antagonizes profibrotic effects of aldosterone

39
Q

What are the clinical applications for spironolactone?

A

1) Counteracts K+ loss induced by other diuretics in the tx of HF
2) Reduce fibrosis in HFrEF and postMI heart failure

40
Q

What toxicity is associated with spironolactone?

A

Hyperkalemia

41
Q

What are common clinical reasons for administering diuretics?

A

1) Essential HTN

2) Edema associated with CHF

42
Q

Triamterene, amiloride, and spironolactone make up what class of diuretics?

Thiazides and loop diuretics make up what class of diruetics?

A

1) K+ sparing

2) K+ losing

43
Q

Why are K+ losing diuretics and digitalis not given together?

A

Because hypokalemia increases the toxicity of digitalis

44
Q

Where do loop diuretics act upon?

What do they block?

What is the prototypical loop diuretic?

A

1) Thick ascending limb of Henle
2) Na+-K+- 2Cl- cotransporter
3) Furosemide

45
Q

What is the clinical application for furosemide?

A

1) Edema associated with HF
2) HTN
3) Rapid dyspnea relief
4) Works in patients with low GFR

46
Q

What does furosemide decrease?

A

1) Decreases preload

2) Decreases extracellular volume

47
Q

What toxicities are associated with furosemide?

A

1) Low electrolytes
2) Ototoxicity
3) Sulfa allergy

48
Q

What loop diuretic can be used in patients with sulfa allergy?

A

Ethacrynic acid

49
Q

Which diuretic causes the largest Na+ loss and the smallest HCO3- loss?

A

Loop diuretics (furosemide)

50
Q

What is the order in which you should prescribe diuretics?

A

1) Use loop diuretics first
2) Add K+ sparing to correct possible hypokalemia
3) Use thiazide if more diuresis is needed

51
Q

What do diuretics accomplish by getting rid of excess volume?

A

Relieve the congestion and return ventricular fiber length to more optimal range

52
Q

Hydrochlorothiazide blocks what transporter?

What is its clinical application?

When is it not effective?

What is another long-acting thiazide diuretic that is a favorite of cardiologists for use as an adjunct diuretic in the treatment of congestive heart failure?

A

1) Na+ Cl- cotransporter
2) Antihypertensive
3) In patients with low GFR
4) Metolazone

53
Q

What is the vasodilator combination that is especially useful in African Americans?

A

Isosorbide dinitrate and Hydralazine

54
Q

What is the role of isosorbide dinitrate?

Of hydralazine?

A

1) Dilate veins and decrease preload

2) Dilate arteries and decrease afterload

55
Q

Nitroglycerin is a vasodilator that has effects on?

A

Veins

56
Q

Nitroglycerin and isosorbide dinitrate are similar drugs that have what clinical application?

A

1) Prevention of angina

2) Tx HF with reduced ejection fraction

57
Q

Digoxin works by inhibiting what?

A

Na+ K+ ATPase

58
Q

What are the effects of digoxin?

A

1) Increase myocardial contractility
2) Suppress AV node
3) Decrease ventricular rate

59
Q

What are the clinical applications for digoxin?

A

1) Control ventricular response rate in adults with chronic Afib
2) Tx heart failure by increasing myocardial contractility

60
Q

Digoxin cardiac toxicity occurs in part because myocytes become overloaded with?

A

Ca2+

61
Q

What hemodynamic benefits does digoxin cause?

What electrical effects does it have?

What effect does this electical change have?

A

1) Increases cardiac output
2) Increase firing rate of vagal fibers
3) Increase SA node response to ACh

62
Q

Toxic effect of digitalis on A-V conduction involves?

Toxic effect of digitalis on Purkinje automaticity and ventricular refractory period results in?

What is important to make sure of before administering digoxin?

A

1) AV dissociation (Lack of relationship between P and QRS)
2) Ectopic ventricular beats
3) HR must be normal

63
Q

What drug interaction is notable with digoxin?

What can happen?

A

1) Diuretics

2) If diuretics cause hypokalemia it can lead to increased digoxin binding causing toxicity

64
Q

What is recommended treatment regimen of HFrEF?

A

ACE inhibitor or ARB in conjunction with beta blockers and aldosterone antagonists

65
Q

What is the approach in treating HFpEF?

A

Treat the symptoms and associated conditions (ie give loop diuretics to treat edema)

66
Q

What drug should be given first for acute decompensated HF (ADHF)?

Why?

A

1) Diuretics

2) They are in volume overload

67
Q

If a ADHF patient is hypertensive what do you want to give them along with the loop diuretic?

A

Vasodilator

68
Q

What is indicated in the short term treatment of ADHF if the patients present with symptomatic hypotension with end-organ dysfunction despite adequate filling pressure?

A

Inotropic agents such as dobutamine or dopamine

69
Q

For patients with severe ADHF what is recommended with beta blockers?

A

Withhold

70
Q

Which sympathomimetic stimulates beta-1 and beta-2 adrenergic receptors?

Which activates beta-1 adrenergic receptors and alpha adrenergic receptors at high doses?

A

1) Dobutamine

2) Dopamine

71
Q

What inotropic therapy is pretty much the last resort for patients unresponsive to other acute HF therapies?

What does it inhibit?

This causes increase is?

A

1) Milrinone
2) Phosphodiesterase
3) cAMP

CPR II Week 3 (11 decks)

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