Exam 3, drugs used in HF DSA

Question 1

What are the drugs with positive ionotropic effects

Answer 1

cardiac glycosides- digoxin
Bypyridines- inamrinon and milrinone
beta adrenergic R agonists- dobutamine and dopamine

Question 2

What cardiac drugs do not have a positive ionotropic effect

Answer 2

diuretics, ACEI, ARBs, vasodilators, Beta blockers, Natriuretic peptide

Question 3

what are the loop diuretics

Answer 3

bumetanide
furosemide
torsemide

Question 4

what are the thiazide diuretics

Answer 4

HCTZ

Question 5

what are the aldosterone antagonists

Answer 5

eplerenon and spironolactone

Question 6

what are the vasopressin (ADH) antagonists

Answer 6

conivaptan, tolvaptan

Question 7

What drug class ends in “pril”

Answer 7

ACEI

Question 8

what drug class ends in “sartan”

Answer 8

ARB

Question 9

what drugs specifically venodilate

Answer 9

isosorbide dinitrate

Question 10

what drug is an arteriolar dilator

Answer 10

hydralazine

Question 11

what drug is a combined arteriolar and venodilator

Answer 11

nitroprusside

Question 12

what drug class ends in “olol”

Answer 12

beta blockers

Question 13

what drug do we have that is a ntriuretic peptide

Answer 13

nesiritide

Question 14

what drugs for HF have been proven to reduce HF mortality

Answer 14

ARB, ACEI, beta blocker, aldosterone R antagonist

Question 15

What occurs in systolic heart failure and what drug class is used

Answer 15

reduced CO and contractility
redced EF
typical of acute failure
responds to positive ionotropic agents

Question 16

What occurs in diastolic heart failure and what drug class is used

Answer 16

results from hypertrophy and stiffening of myocardium
CO is reduced
EF is normal
does not typically respond optimally to + ionotropic agents

Question 17

What are signs and dx of HF

Answer 17

tachy, decreased exercise tolerance, SOB, peripheral and pulmonary edema, cardiomegaly, decreased exercise tolerance is major direct consequence of diminished cardiac output while other manifestations result from compensatory adaptations

Question 18

what is digoxin used to Tx

Answer 18

HF and Afib

Question 19

How does digoxin work

Answer 19

inhibits Na K ATPase causing increased contraction of cardiac sarcomere
reduce Na extrusion and Ca efflux then is decreased too. more Ca in sarcoplasmic reticulum for more contractility

Question 20

how does digoxin change myocardial electrical potentials

Answer 20

brief prolongation of AP followed by shortening

increased potassium conductance(rapid repolarization)

Question 21

what are common cardiac manifestations of digoxin toxicity

Answer 21

AV junctional rhythm, premature ventricular depolarization, bigeminal rhythm, second degree AV block

Question 22

What are the therapeutic effects of digoxin on AV node

Answer 22

decrease conduction velocity

increase refractory period

Question 23

how does digoxin change EKG

Answer 23

increase PR interval and decrease QT interval

Question 24

where in the body are digoxin toxicity signs seen

Answer 24

GI - nausea, vomiting, diarrhea
and CNS - vagal and chemoR trigger zone stimulation can cause GI symptoms, disorientation, hallucinations and visual changes
can cause gynecomastia in men

Question 25

what can reduce toxic effects of digoxin

Answer 25

hyperkalemia

Question 26

what can potentiate toxic effects of digoxin

Answer 26

hypokalemia

Question 27

What ion levels increase risk of digoxin induced arrhythmia

Answer 27

hyperCa and hypoMg

Question 28

how do bipyridines work

Answer 28

selective inhibition of phosphodiesterase isozyme 3 PDE3 which increases cAMP directly stimulating myocardial contractility and acceleartaion of releaxation

Question 29

how does increased cAMP levels affect vasculature

Answer 29

balanced arterial and venous dilation with fall in systemic and pulmonary vascular R L and R filling P

Question 30

What are Sx of inamrinone toxicity

Answer 30

nausea, vomiting, arrhythmias, thrombocytopenia, liver enzyme changes

Question 31

what are Sx of Milrinone toxicity

Answer 31

arrhythmias

Question 32

When are bipyridines used

Answer 32

short term therapy

Question 33

what are dopamine and dobutamine used for

Answer 33

short term support for acute decompensated HF

Question 34

what are the hemodynamic effects of dobutamine

Answer 34

increase in SV from + ionotropic action and increased CO

Question 35

side effects of dobutamine

Answer 35

tachy and arrhythmias

Question 36

describe dopamine effects at low, intermediate and high doses

Answer 36

low- vasodilation intm- increases contractility and neural NE release high- peripheral arterial and venous constriction via alpha stimulation

Question 37

What are loop diuretics used to Tx

Answer 37

heart failure

Question 38

what are thiazide diuretics primarily used for

Answer 38

systemic HTN

Question 39

what are negative effects of increased aldosterone in system

Answer 39

increased Na and water retention | may also cause myocardial and vascular fibrosis and baroR dysfunction

Question 40

What is conivaptan used for, MOA?

Answer 40

HF, SIADH | antagonist at ADH R V1a and V2 in cortical collecting tubule

Question 41

how does tolvaptan differ from conivaptan

Answer 41

selective antagonist of V2 ADH R

Question 42

which diuretic decreases mortality in HF

Answer 42

aldosterone antagonist

Question 43

What is a big difference os ACEI and ARB

Answer 43

ACEI block degradation of bradykinin | ARBs are downstream of that

Question 44

what are sideeffects of ACEI

Answer 44

angioedema, cough, mild hyperkalemia

Question 45

what ACEI have been approved for use in patients with HF

Answer 45

captopril, enalapril, ramipril, lisinopril, quinapril, fosinopril

Question 46

Which R do ARBs selectively block

Answer 46

AT1 R

Question 47

how are vasodilators effective in acute HF

Answer 47

reduce preload and reduce afterload

Question 48

how does isosorbide dinitrate work

Answer 48

NO released when drug is metabolized, NO activates guanylyl cyclase reduce preload and ventricular stretch

Question 49

when is isosorbide dintrate used and what are side effects

Answer 49

used in acute and chronic HF as well as angina and HTN emergencies adverse effects= postural hypotension, tachy and HA

Question 50

How does hydralazine work

Answer 50

stimualtes release of NO from endothelium causing direct vasodolation of arterioles with little effect on vv dec BP and afterload, inc CO

Question 51

how does nitroprusside work

Answer 51

spontaneously converted to NO which activate guanylyl cyclase and causes vasodilation and profound reduction in preload and afterload used for acute cardiac decompensation and HTN emergencies

Question 52

How does nesiritide work

Answer 52

bindes to natriuretic peptide R on vascular smooth muscle and endothelial cells, increasing intracell cyclic GMP resulting in smooth muscle cell relaxation and endothelin production

Question 53

what beta blockers have been shown to reduce mortality

Answer 53

bisoprolol, carvedilol, metoprolol, nebivolol

Question 54

why are beta blockers started on low doses

Answer 54

acutely antagonize the supportive effects of catecholamines and can worsen HF

Question 55

how can hypokalemia be treated

Answer 55

ACEI or K sparing diuretic

Question 56

patients with high filling pressures with dyspnea what drug class would be most helpful

Answer 56

venous dilators