Drugs used in Heart Failure Flashcards by Jamaira Belmes

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

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Treatment for CHF

CHRONIC HF - diuretics (loop) + spironolactone + ACE (-)

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Left sided HF

orthopnea, PND, pulmonary congestion

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Right sided HF

Hepatomegaly, Edema, Engorged Neck Veins

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inhibits Na/K ATPase; increases intracellular Ca2+,increasing cardiac contractility

Digoxin

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The MC ECG changes seen in Digoxin toxicity

Premature Ventricular Contractions (PVCs)

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Drugs with Narrow Therapeutic Index

WALA na Cyang PaPa! VasTeD na!

Warfarin
Aminoglycosides
Lithium
Amphotericin B
Carbamazepine
Phenobarbital
Phenytoin
Vancomycin
Theophylline
Digoxin

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Digitalis toxicity is INCREASED by

HYPOkalemia
HYPOMg
HYPERCa

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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

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Drugs that are main stay treatment for CHRONIC heart failure

ABA

Ace inhibitors/ARBs
Beta blockers
Aldosterone Antagonists

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Effects of Cardiac Glycosides

(-) Na/K/ATPase

INCREASE contraction

VAGOMIMETIC effect – (+) parasympathetic – DECREASE HEART RATE

HYPOkalemia
HYPOmagnesemia
HYPERcalcemia

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MC ECG change seen in Digoxin Toxicity

Premature Ventricular Contractions (PVCs)

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DOC for arrhythmia caused by digitalis toxicity

LIDOCAINE

Phenytoin - Alternative Drug

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Treatment of choice for SEVERE OVERDOSE

Digoxin Antibodies/Digibind/Immune Fab

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First line therapy for both systolic and diastolic failure

DIURETICS

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For immediate reduction of the pulmonary congestion and severe edema associated with acute heart failure

FUROSEMIDE

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Have significant long term benefits and can reduce mortality in chronic failure

SPIRONILACTONE

EPLERENONE

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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