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Pharmacology > Drugs used in Heart Failure > Flashcards

Drugs used in Heart Failure Flashcards

1
Q

Therapeutic Strategies for CHF

A

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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2
Q

Treatment for CHF

A

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

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3
Q

Left sided HF

A

orthopnea, PND, pulmonary congestion

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4
Q

Right sided HF

A

Hepatomegaly, Edema, Engorged Neck Veins

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5
Q

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

A

Digoxin

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6
Q

The MC ECG changes seen in Digoxin toxicity

A

Premature Ventricular Contractions (PVCs)

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7
Q

Drugs with Narrow Therapeutic Index

A

WALA na Cyang PaPa! VasTeD na!

Warfarin
Aminoglycosides
Lithium
Amphotericin B
Carbamazepine
Phenobarbital
Phenytoin
Vancomycin
Theophylline
Digoxin
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8
Q

Digitalis toxicity is INCREASED by

A

HYPOkalemia
HYPOMg
HYPERCa

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9
Q

Treatment of Digitalis Toxicity

A

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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10
Q

Drugs that are main stay treatment for CHRONIC heart failure

A

ABA

Ace inhibitors/ARBs
Beta blockers
Aldosterone Antagonists

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11
Q

Effects of Cardiac Glycosides

A

(-) Na/K/ATPase

INCREASE contraction

VAGOMIMETIC effect – (+) parasympathetic – DECREASE HEART RATE

HYPOkalemia
HYPOmagnesemia
HYPERcalcemia

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12
Q

MC ECG change seen in Digoxin Toxicity

A

Premature Ventricular Contractions (PVCs)

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13
Q

DOC for arrhythmia caused by digitalis toxicity

A

LIDOCAINE

Phenytoin - Alternative Drug

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14
Q

Treatment of choice for SEVERE OVERDOSE

A

Digoxin Antibodies/Digibind/Immune Fab

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15
Q

First line therapy for both systolic and diastolic failure

A

DIURETICS

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16
Q

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

A

FUROSEMIDE

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17
Q

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

A

SPIRONILACTONE

EPLERENONE

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18
Q

Useful in ACUTE HEART FAILURE

NOT appropriate for chronic failure because of tolerance, lack of oral efficacy and significant arrhythmogenic effects

A

Beta 1 Selective Sympathomimetics

DOBUTAMINE
DOPAMINE

19
Q

Phosphodiesterase Inhibitors

A

INAMRINONE

MILRINONE

20
Q

MOA of PDE - 3 (-)

A

increase cAMP by (-) its breakdown by PDE

increase intracellular calcium vasodilation

21
Q

INCREASE CONTRACTION

A

Cardiac Glycosides
* (-) NaKATPase

B1 agonist
*(+) adenylate cyclase

PDE (-)

22
Q

Common problem with Dobutamine

A

TACHYPHYLAXIS

23
Q

Carbonic Anhydrase Inhibitors

A

BAD

Brinzolamide
Acetazolamide
Dorzolamide

SPECIAL USES:
mountain sickness syndrome
glaucoma

24
Q

Side Effects of Carbonic Anhydrase Inhibitors

A

HYPONATREMIA
HYPOKALEMIA
metabolic ACIDOSIS

25
Q

LOOP Diuretics

A

Fun To BE

Furosemide
Torsemide
Bumetanide
Ethacrynic Acid

SPECIAL USES:
CHF/acute PE
acute hypercalcemia
HPN emergency

26
Q

Side Effects of Loop Diuretics

A

DEC Na/K/Mg/Ca
ototoxicity
hypovolemia
hyperuricemia

27
Q

Thiazide Diuretics

A

CHIC

Chlorothiazide
Hydrochlorothiazide
Indapamide
Chlorthalidone

SPECIAL USES:
HPN
renal stone formation
hypocalcemia

28
Q

Side Effects of Thiazide Diuretics

A 
DEC Na/K/Mg
INC Ca
HYPERlipidemia
HYPERglycemia
HYPERuricemia
29
Q

K-Sparing Diuretics

A

SEAT

Spironolactone
Eplerenone
Amiloride
Triamterene

SPECIAL USES:
Digoxin toxicity
hypokalemia
CONN syndrome

30
Q

Side Effects of K-Sparing Diuretics

A 
DEC Na
INC K
metabolic acidosis
impotence
gynecomastia - SPIRONOLACTONE
31
Q

Osmotic Diuretics

A

Sorbitol
Urea
Mannitol

SPECIAL USES:
INC ICP
lithium toxicity

32
Q

Side Effects of Osmotic Diuretics

A

hypovolemia

33
Q

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

A

(D) An increase in systolic cytoplasmic calcium levels

34
Q

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
A

(B) Increased intracellular calcium

35
Q

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
A

(D) Increased PR interval on ECG

36
Q

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
A

(B) Furosemide

37
Q

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
A

(E) Spironolactone

38
Q

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
A

(D) Sacubitril

39
Q

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
A

(B) Dobutamine

40
Q

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
A

(H) Furosemide

41
Q

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

(A) Carvedilol

42
Q

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

(A) Digoxin antibodies

43
Q

Treatment for ACUTE HF

A

Loop Diuretic

*if very severe use prompt acting positive inotropes (beta agonists or PDE inhibitors) and vasodilators

Pharmacology (72 decks)

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