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Pharmacology 2 > Exam 2: Heart Failure Drugs > Flashcards

Exam 2: Heart Failure Drugs Flashcards

1
Q

What is used to treat the problems associated with increased preload in HF?

* Increased SNS and RAAS = increased venous return, increased blood volume, and increased venous tone*

A

Venodilators

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2
Q

What is used to treat problems associated with afterload in HF?

* increased SNS and RAAS= increased peripheral resistance via arterial constriction*

A

Arteriodilators

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3
Q

What is used to treat the problems with decreased contractility in HF?

*myocardial fibers are stretched too much as ventricles become dilated

A

Inotropic drugs

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4
Q

In heart failure, what drugs are used to combat reflex tachycardia?

* decreased cardiac output= increased baroreflex activation= increased SNS stimulation at the heart*

A

B-blockers, will reduce cardiac work by slowing the HR

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5
Q

What are the 5 classes of drugs that decreased HF mortality?

A

Aldosterone antagonist, B-blockers, ARBs, ACE inhibitors, and ARNI

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6
Q

What are the 3 effects of angiotensin in the heart?

A

1) direct vasoconstriction, resulting in a rapid pressor response
2) Increase Na+ reabsorption, resulting in slow pressor response
3) Vascular and cardiac hypertrophy and remodeling

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7
Q

What is the MOA of ACE inhibitors?

A

Inhibit angiotensin from being formed by blocking ACE

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8
Q

What is the MOA of ARBS?

A

Angiotensin II antagonists, block ATII from binding to the AT1 receptor

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9
Q

What are the two types of RAS inhibitors?

A

ACE inhibitors and ARBs

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10
Q

What are the indications for RAS inhibitors?

A
  • Effective in treatment of HF
  • Reduce HF mortality
  • Diminish cardiac workload by decreasing afterload and preload
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11
Q

What is the DOC for HF treatment?

A

ACE inhibitors

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12
Q

What are the adverse effects of RAS inhibitors?

A

Cough with ACE, but not with ARB because of the reduction of bradykinin metabolism

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13
Q

What two drugs make up ARNI?

A

Sacubitril (neprilysin inhibitor)

Valsartan (ARB)

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14
Q

What does neprilysin do?

A

Degrades natriuretic peptides, bradykinin, and other

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15
Q

What are the indications for ARNI?

A

HF- better at reducing mortality in HF than ACE inhibitors alone

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16
Q

What effects does neprilysin inhibition have?

A
  • Decreased vasoconstriction
  • decreased sodium retention
  • decreased cardiac remodeling
17
Q

What are the adverse effects of ARNI?

A
  • Hypotension
  • Hyperkalemia (ARB) especially when used with K sparing diuretic
  • cough and angioedema
18
Q

What are the contraindications for ARNI?

A
  • Pregancy (teratogenic)

- Concurrent use with CE inhibitor due to risk of angioedema

19
Q

What are the effects of b-blockers?

A
  • Decreased mortality
  • decreased renin secretion
  • decrease HR
  • Decrease remodeling
20
Q

When are B-blockers useful in HF?

A

-Only in the early stages! They are dangerous in end stage HF due to negative inotropic effect

21
Q

What kind of drugs are sodium nitroprusside, isosorbide dinitrate, and hydralazine?

A

Vasodilators

22
Q

Why are vasodilators effective in treating HF?

A
  • Reduces preload and/or afterload

- Decrease damaging remodeling of the heart

23
Q

What kind of drug is dobutamine?

A

Selective B1 agonist, has inotropic effects

24
Q

When is dobutamine indicated?

A

Short term treatment of severe refractory HF

25
Q

When is Dopamine indicated?

A

Short term treatment of severe refractory HF and an increase in BP is needed?

26
Q

What does a low dose of dopamine do?

A

Activated D1 receptors in the kidney causing renal vasodilation

27
Q

What does a moderate dose of dopamine do?

A

Activates B1 receptors in the heart and has an inotropic effect

28
Q

What does a high dose of Dopamine do?

A

Activate Alpha receptors in the vessels causing vasoconstriction

29
Q

What is the MOA of Digoxin?

A

-Inhibition of membrane sodium pump, leading to increased intracellular Na, decreased expulsion of intracellular Ca leading to increased SR Ca stores, leading to increased actin-myosin interaction, and ultimately increased contractility

30
Q

What are the indications for Digoxin?

A
  • Last agent used in HF

- Decreases HR in arrhythmias

31
Q

What are the adverse effects of Digoxin?

A
  • All glycosides are toxic
  • Narrow margin of safety and can have toxicity at therapeutic doses
  • Early sign of toxicity is GI upset
  • CNS effects
  • Arrhythmias
32
Q

What is the treatment for minor and moderate Digoxin intoxication?

A
  • Minor: stop digoxin

- Moderate: PO or IV potassium, stop digoxin

33
Q

What is the treatment for severe digoxin intoxication?

A

Immunotherapy with Digitalis Immune Fab, along with potassium and stopping digoxin

Pharmacology 2 (12 decks)

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