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CV II Exam 3 > Drugs Used in Heart Failure I > Flashcards

Drugs Used in Heart Failure I Flashcards

1
Q

heart failure

A

CO inadequate to proved O2 needed by body

CAD, MI, HTN, damaged valves, external pressure around heart, Vit B deficiency, cardiac muscle disease

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2
Q

decreased mortality in HF

A

ACE, ARBs, aldosterone antagonists, beta-blockers

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3
Q

Tx for symptoms of HF

A

volume overload - diuretics

myocardial dysfunction - positive inotropes

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4
Q

most efficacious for reducing volume overload

A

loop diuretics

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5
Q

loop diuretics

A

forusemide
bumetadine
ethacrynic acid (no sulfa)
torsemide

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6
Q

furosemide

A

loop diuretic
-inhibit Na, K, 2Cl cotransporter in thick ascending limb of loop of henle

decreased reabsorption of Ca and Mg

improve symptoms, NOT mortality

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7
Q

ethacrynic acid

A

loop diuretic - no sulfa allergy

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8
Q

adverse of loops

A 
hypokalemia
alkalosis
hypocalcemia
hypomagnesemia
hyperuricemia
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9
Q

hypercalcemic state

A

loop diuretic

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10
Q

nagging cough and swollen tongue

A

ACE inhibitor

angioedema

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11
Q

combination with furosemide to control BP and edema in CHF patient

A

losartan

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12
Q

ACE and ARBs

A

reduce mortality for CHF***

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13
Q

ANG II

A

blocked by ACE and ARB

vasoconstrictor
Na/water retention
increased aldosterone
catecholamine release
arrhythmias
hypertrophy of cardiac
myocyte death
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14
Q

HF drug - symptoms first worse and then better

A

beta blocker

3-6 months

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15
Q

beta blocker

A

reduce symptoms AND improve mortality in HF patients

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16
Q

beta blockers in HF

A

increased CO initially

  • dowregulation of beta receptors
  • reduced responsive myocardium

low dose beta blockers***
-increased EF, slow HR, reduce symptoms and mortality

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17
Q

spironolactone

A

aldosterone antagonist

18
Q

eplerone

A

aldosterone antagonist

19
Q

hydralazine and nitrate

A

reduce mortality
-improves quality of life

in HF patients

useful, especially in AA patients who have persistance symptoms regardless of ACE and beta blocker therapy

20
Q

aldosterone antagonists

A

reduce mortality with CHF

monitor for normal plasma K levels

21
Q

drug that may cause paroxysmal atrial tachycardia with block at high concentrations

A

digoxin

22
Q

digoxin

A

cardiac glycoside

inhibit Na/K ATPase and increase myocardial contractility

narrow therapeutic index

NO effect on mortality for HF
-only reduces symptoms

23
Q

mechanism of digoxin

A

block Na/K ATPase

  • decreased Na/Ca exchange
  • results in more Ca intracellular
  • stronger contraction
24
Q

effects of therapeutic digoxin

A

prolongation of AP with AP shortening
-increased intracellular calcium

-increased cardiac contractility

increased PS tone, decreased S tone

25
Q

effects of toxic digoxin

A

shortened AP with depolarizing afterpotentials**

  • results in premature ectopic beats
  • tachycardia may deteriorate into fibrillation

-toxic levels - sympathetic outflow increased

26
Q

digoxin at SA node

A

decreased rate

27
Q

digoxin on EKG

A

therapeutic - increased PR interval, decreased QT interval

toxic - tachycardia, fib, arrest at very high doses

28
Q

increased PR interval

A

seen with digoxin

29
Q

digoxin at AV node

A

decreased conduction velocity and increased refractory period

30
Q

potentiate toxic effects of digoxin

A

furosemide

-due to potassium levels

31
Q

hyperkalemia

A

can reduce effects of digoxin - especially the toxic effects

binds to competing site of Na/K ATPase

32
Q

hypokalemia

A

can potentiate toxic effects of digoxin***

33
Q

hypercalcemia and hypomagnesemia

A

increase risk of digoxin induced arrhythmia

hypercalcemia - accelerates overloading of intracellular Ca stores

34
Q

increase force of heart contraction and produce vasodilation

A

bipyridines

35
Q

inamrinone

A

bipyridine

36
Q

milrinone

A

bipyridine

37
Q

bipyridine

A

selective inhibition of PDE3 phosphodiesterase

PDE3 degrades cAMP

increases concentrations of cAMP in heart - stimulate myocardial contractility and accelerate relaxation

balance arterial and venous dilation

38
Q

PDE3 phosphodiesterase

A

inhibited by bipyridines

39
Q

short term support of circulation in advanced HF

A

bipyridines

40
Q

cAMP in cardiac vs. smooth muscle cells

A

smooth m - increased vascular smooth m contraction

CV II Exam 3 (21 decks)

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