Drugs Used to Treat Heart Failure

Question 1

Sodium nitroprusside (2):

Answer 1

• Arteriodilation = venodilation

- IV for acute CHF

Question 2

Vasodilators that decrease mortality in CHF (3):

Answer 2

• Hydralazine + ISDN
• ACE inhibitors
• ARBs

Question 3

Hydralazine (2):

Answer 3

• Arteriodilation

- Chronic CHF

Question 4

Organic Nitrates (2):

Answer 4

• Venodilation > arteriodilation

- Acute and chronic CHF

Question 5

Hydralazine + ISDN is used when (2):

Answer 5

• ACEIs/ARBs are not tolerated

- Blacks that remain symptomatic with ACEI/ARB, Beta-blocker, aldosterone antagonist

Question 6

ACE inhibitors (3):

Answer 6

• Arteriodilation > venodilation
• Decreased salt and H2O retention
• Chronic CHF

Question 7

AT1 receptor antagonists (3):

Answer 7

• Arteriodilation > venodilation
• Decreased salt and H2O retention
• Chronic CHF

Question 8

Recombinant human B-type natriuretic peptide:

Answer 8

Nesiritide

Question 9

Nesiritide MOA:

Answer 9

Activates particulate GC –> increased cGMP –> vasodilation

- Decreases afterload and preload

Question 10

Nesiritide therapeutic use:

Answer 10

IV to treat acute decompensated CHF with dyspnea

Question 11

PDE inhibitors (2):

Answer 11

• Milronone

- Inamrinone

Question 12

PDE inhibitors MOA (2):

Answer 12

• Increased cAMP –> arterial and venous dilation

- Increased cAMP –> increased cardiac contractility

Question 13

PDE inhibitor therapeutic use:

Answer 13

Short-term treatment of severe acute CHF

Question 14

PDE inhibitor ADRs (3):

Answer 14

• Proarrhythmic
• Hypotension
• Thrombocytopenia

Question 15

Beta-blockers used to treat CHF post-MI:

Answer 15

Carvedilol

Question 16

Beta-blockers used to treat moderate-severe CHF (2):

Answer 16

• Metoprolol

- Bisoprolol

Question 17

Beneficial effects of beta-blockers in CHF (3):

Answer 17

• Inhibit detrimental cardiac remodeling
• Decrease myocardial O2 demand
• Antiarrhythmic effects

Question 18

Digoxin MOA:

Answer 18

Decreases Na+/K+ ATPase –> increased [Ca2+]i

- Increases myocardial contractility

Question 19

Digoxin therapeutic uses (2):

Answer 19

• CHF

- Slow ventricular rate in a-flutter and a-fib

Question 20

Digoxin ADRs (4):

Answer 20

• Arrhythmias
• GI: anorexia, nausea, vomiting, diarrhea
• Visual: blurriness, photophobia, abnormal color vision
• CNS: lethargy, anxiety, nightmares, hallucinations, delerium

Question 21

Factors which enhance digoxin toxicity (5):

Answer 21

• Hypokalemia
• Decreased renal function
• Hypercalcemia
• Acidosis
• Hypothyroidism

Question 22

Dobutamine (2):

Answer 22

• Increased contractility –> increased CO

- IV treatment for acute CHF

Question 23

Dopamine (3):

Answer 23

• Vasodilator
• Increased contractility –> increased CO
• IV treatment for acute CHF

Question 24

Aldosterone antagonists in CHF treatment (4):

Answer 24

• Moderate to severe CHF with < 35% LVEF
• Decreased mortality and morbidity
• Reduced cardiac remodeling
• GFR > 30 ml/min