Drugs used in Heart Failure Flashcards
Therapeutic Strategies for CHF
ACE (-) - reduction of afterload and salt and water retention
Beta blockers - reduction of excessive sympathetic stimulation
Vasodilators - reduction of preload or afterload
Inotropic drugs (positive) - direct augmentation of depressed cardiac contractility
Treatment for CHF
CHRONIC HF - diuretics (loop) + spironolactone + ACE (-)
Left sided HF
orthopnea, PND, pulmonary congestion
Right sided HF
Hepatomegaly, Edema, Engorged Neck Veins
inhibits Na/K ATPase; increases intracellular Ca2+,increasing cardiac contractility
Digoxin
The MC ECG changes seen in Digoxin toxicity
Premature Ventricular Contractions (PVCs)
Drugs with Narrow Therapeutic Index
WALA na Cyang PaPa! VasTeD na!
Warfarin Aminoglycosides Lithium Amphotericin B Carbamazepine Phenobarbital Phenytoin Vancomycin Theophylline Digoxin
Digitalis toxicity is INCREASED by
HYPOkalemia
HYPOMg
HYPERCa
Treatment of Digitalis Toxicity
Correction of K or Mg deficiency
Antiarrhythmic drugs - LIDOCAINE; electronic
pacemaker - severe cases
Digoxin antibodies
- Fab fragments; Digibind
- Bile Acid Binding Resins
Drugs that are main stay treatment for CHRONIC heart failure
ABA
Ace inhibitors/ARBs
Beta blockers
Aldosterone Antagonists
Effects of Cardiac Glycosides
(-) Na/K/ATPase
INCREASE contraction
VAGOMIMETIC effect – (+) parasympathetic – DECREASE HEART RATE
HYPOkalemia
HYPOmagnesemia
HYPERcalcemia
MC ECG change seen in Digoxin Toxicity
Premature Ventricular Contractions (PVCs)
DOC for arrhythmia caused by digitalis toxicity
LIDOCAINE
Phenytoin - Alternative Drug
Treatment of choice for SEVERE OVERDOSE
Digoxin Antibodies/Digibind/Immune Fab
First line therapy for both systolic and diastolic failure
DIURETICS
For immediate reduction of the pulmonary congestion and severe edema associated with acute heart failure
FUROSEMIDE
Have significant long term benefits and can reduce mortality in chronic failure
SPIRONILACTONE
EPLERENONE
Useful in ACUTE HEART FAILURE
NOT appropriate for chronic failure because of tolerance, lack of oral efficacy and significant arrhythmogenic effects
Beta 1 Selective Sympathomimetics
DOBUTAMINE
DOPAMINE
Phosphodiesterase Inhibitors
INAMRINONE
MILRINONE
MOA of PDE - 3 (-)
increase cAMP by (-) its breakdown by PDE
increase intracellular calcium vasodilation
INCREASE CONTRACTION
Cardiac Glycosides
* (-) NaKATPase
B1 agonist
*(+) adenylate cyclase
PDE (-)
Common problem with Dobutamine
TACHYPHYLAXIS
Carbonic Anhydrase Inhibitors
BAD
Brinzolamide
Acetazolamide
Dorzolamide
SPECIAL USES:
mountain sickness syndrome
glaucoma
Side Effects of Carbonic Anhydrase Inhibitors
HYPONATREMIA
HYPOKALEMIA
metabolic ACIDOSIS
LOOP Diuretics
Fun To BE
Furosemide
Torsemide
Bumetanide
Ethacrynic Acid
SPECIAL USES:
CHF/acute PE
acute hypercalcemia
HPN emergency
Side Effects of Loop Diuretics
DEC Na/K/Mg/Ca
ototoxicity
hypovolemia
hyperuricemia
Thiazide Diuretics
CHIC
Chlorothiazide
Hydrochlorothiazide
Indapamide
Chlorthalidone
SPECIAL USES:
HPN
renal stone formation
hypocalcemia
Side Effects of Thiazide Diuretics
DEC Na/K/Mg INC Ca HYPERlipidemia HYPERglycemia HYPERuricemia
K-Sparing Diuretics
SEAT
Spironolactone
Eplerenone
Amiloride
Triamterene
SPECIAL USES:
Digoxin toxicity
hypokalemia
CONN syndrome
Side Effects of K-Sparing Diuretics
DEC Na INC K metabolic acidosis impotence gynecomastia - SPIRONOLACTONE
Osmotic Diuretics
Sorbitol
Urea
Mannitol
SPECIAL USES:
INC ICP
lithium toxicity
Side Effects of Osmotic Diuretics
hypovolemia
Which of the ff is the best documented mechanism of beneficial action of cardiac glycosides?
(A) A decrease in calcium uptake by the sarcoplasmic reticulum
(B) An increase in a late transmembrane sodium current
(C) A modification of the actin molecule
(D) An increase in systolic cytoplasmic calcium levels
(E) A block of cardiac β adrenoceptors
(D) An increase in systolic cytoplasmic calcium levels
After your patient has been receiving digoxin for 3 weeks, he presents to the emergency department with an arrhythmia. Which one of the following is most likely to contribute to the arrhythmogenic effect of digoxin?
(A) Increased parasympathetic discharge (B) Increased intracellular calcium (C) Decreased sympathetic discharge (D) Decreased intracellular ATP (E) Increased extracellular potassium
(B) Increased intracellular calcium
A patient who has been taking digoxin for several years for atrial fibrillation and chronic heart failure is about to receive atropine for another condition. A common effect of digoxin (at therapeutic blood levels) that can be almost entirely blocked by atropine is
(A) Decreased appetite (B) Headaches (C) Increased atrial contractility (D) Increased PR interval on ECG (E) Tachycardia
(D) Increased PR interval on ECG
A 65-year-old woman has been admitted to the coronary care unit with a left ventricular myocardial infarction. She develops acute severe heart failure with marked pulmonary edema, but no evidence of peripheral edema. Which one of the following drugs would be most useful?
(A) Digoxin (B) Furosemide (C) Minoxidil (D) Propranolol (E) Spironolactone
(B) Furosemide
A 72-year-old woman has long-standing heart failure. Which one of the following drugs has been shown to reduce mortality in chronic heart failure?
(A) Atenolol (B) Digoxin (C) Furosemide (D) Nitroprusside (E) Spironolactone
(E) Spironolactone
Which of the following drugs increases the plasma levels of endogenous BNP and also blocks angiotensin receptors?
(A) Furosemide (B) Losartan (C) Nesiritide (D) Sacubitril (E) Spironolactone
(D) Sacubitril
Which one of the following drugs is associated with clinically useful or physiologically important positive inotropic effect?
(A) Captopril (B) Dobutamine (C) Enalapril (D) Losartan (E) Nesiritide
(B) Dobutamine
A 68-year-old man with a history of chronic heart failure goes on vacation and abandons his low-salt diet. Three days later, he develops severe shortness of breath and is admitted to the local hospital emergency department with significant pulmonary edema. The first-line drug of choice in most cases of acute decompensation in patients with chronic heart failure is
(A) Atenolol (B) Captopril (C) Carvedilol (D) Digoxin (E) Diltiazem (F) Dobutamine (G) Enalapril (H) Furosemide (I) Metoprolol (J) Spironolactone
(H) Furosemide
Which of the following has been shown to prolong life in patients with chronic congestive failure in spite of having a negative inotropic effect on cardiac contractility?
(A) Carvedilol (B) Digoxin (C) Dobutamine (D) Enalapril (E) Furosemide
(A) Carvedilol
A 5-year-old child was vomiting and was brought to the emergency department with sinus arrest and a ventricular rate of 35 bpm. An empty bottle of his uncle’s digoxin was found where he was playing. Which of the following is the drug of
choice in treating a severe overdose of digoxin?
(A) Digoxin antibodies (B) Lidocaine infusion (C) Magnesium infusion (D) Phenytoin by mouth (E) Potassium by mouth
(A) Digoxin antibodies
Treatment for ACUTE HF
Loop Diuretic
*if very severe use prompt acting positive inotropes (beta agonists or PDE inhibitors) and vasodilators
