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CPR 2 Cardiac Section > Drugs Used in Heart Failure > Flashcards

Drugs Used in Heart Failure Flashcards

1
Q

What is the mechanism of action of furosemide?

A

blocks the Na+/K+ 2Cl- cotransporter

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2
Q

What are the major clinical applications for furosemide?

A
  • edema associated w/ heart failure
  • HTN

-rapid relief of dyspnea d/t pulmonary edema by decreasing preload

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3
Q

True or False: furosemide works in pt’s with low GFR

A

True (unlike thiazides, such as HCTZ)

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4
Q

What is the average time of onset for furosemide to begin working?

A
  • 5 mins (IV)
  • 30 mins (IM)
  • 45 mins (PO)
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5
Q

What are side effects of furosemide (a loop diuretic)?

A
  • hypokalemia
  • hyponatremia
  • hypocalcemia (increases risk of kidney stones)
  • hypomagnesemia
  • hypochloremic metabolic alkalosis (b/c of K+ loss, the cells take H+ from serum to replace it)
  • hyperuricemia
  • ototoxicity
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6
Q

True or False: furosemide is a sulfa drug

A

True, use ethacrynic acid in pts with sulfa allergies

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7
Q

What are three indications for use of captopril?

A
  • HTN
  • HFrEF
  • diabetic nephropathy
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8
Q

What is the half-life of captopril?

A

-relatively short (1.7hrs)

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9
Q

What are the major side effects of ACEi’s?

A
  • cough (d/t increased bradykinin)
  • angioedema
  • altered taste (especially captopril)
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10
Q

What two things make enalapril special among ACEi’s?

A
  • prodrug available in IV form

- can be used for stroke prophylaxis

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11
Q

What is the dosing benefit of benazepril and lisinopril?

A

–longer half-life permits 1x daily dosing (unlike captopril w/ a relatively short half-life)

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12
Q

What are three K+ sparing diuretics?

A
  • amiloride and triamterene (Na+ channel blockers)

- spironolactone (aldosterone antagonist)

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13
Q

What is the mechanism of action of triamterene and amiloride?

A

-blocks ENaC in the collecting duct

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14
Q

What is the mechanism of action of spironolactone?

A

-aldosterone receptor antagonist

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15
Q

What is the mechanism of action of thiazides?

A

-blocks Na+/Cl- cotransporter in the DCT

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16
Q

What is the mechanism of action of loop diuretics?

A

-blocks Na+/K+/2Cl- cotransporter in the Loop of Henle

17
Q

Can HCTZ be used in pt’s with low GFR?

A

No

18
Q

What is an off-label use of HCTZ in regards to calcium?

A

-Tx of calcium nephrolithiasis, because thiazides actively pull calcium out of the tubule lumen

19
Q

What are side effects of HCTZ?

A
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • hypochloremic alkalosis
20
Q

Is HCTZ a sulfa drug?

A

Yes

21
Q

Why would chlorthalidone be a better thiazide to use than HCTZ?

A

chlorthalidone has a longer half-life (50hrs)

22
Q

What long-acting thiazide diuretic do cardiologists prefer as an adjunct diuretic in CHF?

A

-metolazone

23
Q

What is the initial set-up for a patient w/ Acute Decompensated Heart Failure?

A
  • seated position
  • pulse ox +/- O2
  • get BP
  • continuous cardiac monitoring
  • 2 IV’s
  • monitor urine output
24
Q

What is the pharmacological treatment of Acute Decompensated Heart Failure?

A

-increase diuretics

1) loop diuretic first
2) add K+ sparing diuretic next (ex: amiloride)
3) if more diuresis is needed, use a thiazide

25
Q

Can you use amiloride or triamterene in pt’s with a low GFR?

A

No, you should avoid the K+ sparing diuretics in pt’s with a GFR < 45 mL/min

26
Q

What is the mechanism of action of spironolactone?

A

-blocks the aldosterone receptor in the collecting duct

27
Q

What is a major side effect of amiloride?

A

-hyperkalemia

28
Q

What is a major clinical application of using spironolactone in post-MI patients?

A

–reduces fibrosis in HFrEF and post-MI heart failure

29
Q

Is spironolactone slow-acting or fast-acting?

A

slow

30
Q

What are some side effects of spironolactone?

A
  • hyperkalemia
  • amenorrhea, hirsutism
  • gynecomastia, impotence
31
Q

Is eplerenone a more selective or less selective aldosterone receptor antagonist than spironolactone?

A

MORE selective

-can be used to Tx hyperaldosteronism

CPR 2 Cardiac Section (6 decks)

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