Exam 5 Heart Failure Drugs

Question 1

Which drugs are positive inotropes, used for cardiac performance and increases heart contractility?

Answer 1

Cardiac Glycosides: Digoxin (Lanoxin)

Beta-Adrenoceptor Agonists: Dobutamine (Dobutrex)

Question 2

Which drugs are diuretics, used for preload and sodium removal?

Answer 2

Hydrochlorothiazide (caroline)
Furosemide (lasix)
Bumetanide (Bumex)
Spironolactone (Aldactone)

Question 3

Which drugs are angiotensin system inhibitors (ACE), used for after load and reduce heart burden/oxygen consumption?

Answer 3

ACE inhibitors : captopril and enapril

Angiotensin receptor antagonists: losartan, valsartan

Question 4

Which drugs are beta-adrenoceptor antagonists, used for contractility and reduce heart burden/oxygen consumption?

Answer 4

metoprolol

carvedilol

Question 5

Which drugs are vasodilators, used for heart rate and reduce heart burden/oxygen consumption?

Answer 5

isosorbide denitrate
nitroprusside
hydralazine

Question 6

Digoxin (lanoxin)

Answer 6

Class: cardiac glycosides
MOA: Na+/K+-ATPase inhibition results in reduced Ca++ expulsion and increased Ca++ influx into cardiac cells
Effects: Increases cardiac contractility,
Cardiac parasympatho mimetic effect (slowed sinus heart rate),
slowed atrioventricular conduction
Indications: Chronic symptomatic heart failure (for systolic CHF only), Atrial fibrillation
SE: Cardiac arrhythmias, due to increased Ca++ influx into cardiac cells and decreased K+ (hypokalemia), n/v/d

Question 7

Dobutamine (Dobutrex)

Answer 7

Class: positive inotropes: Beta1-adrenoceptor agonist
Indications: parental therapy for acute severe CHF
Adverse effects: (β1 active sympathomimetics): Hypertension, angina, arrhythmia, and tachycardia

Question 8

Hydrochlorothiazide (Carozide)

Answer 8

Class: Thiazide diuretic
MOA:
-Deplete body sodium stores and blood volume by acting on the various sites of the renal tubule transport systems
-Direct dilate arterioles and decrease TPR by unknown mechanism
Indications: Mainstay drugs in hypertension management, used alone or in combo with other types of antihypertensive drugs
SE:
-Potassium depletion (hypokalemia)
- Hyperuricemia (attack of gout)
- Hyperglycemia
- Hyperlipidemia

Question 9

Furosemide (Lasix)

Answer 9

Class: Loop diuretic 
MOA: 
-Deplete body sodium stores and blood volume by acting on the various sites of the renal tubule transport systems
-Direct dilate arterioles and decrease TPR by unknown mechanism
Indications: 
-High ceiling and potent diuretics
-CHF
-Used in hypertensive emergencies in conjunction with other antihypertensive agents
SE:  
-Hypokalemia
-Hypomagnesemia
-Ototoxicity
-Renal failure

Question 10

Bumetanide (Bumex)

Answer 10

Class: Loop diuretic 
MOA: 
-Deplete body sodium stores and blood volume by acting on the various sites of the renal tubule transport systems
-Direct dilate arterioles and decrease TPR by unknown mechanism
Indications: 
-High ceiling and potent diuretics
-CHF
-Used in hypertensive emergencies in conjunction with other antihypertensive agents
SE:  
-Hypokalemia
-Hypomagnesemia
-Ototoxicity
-Renal failure

Question 11

Spironolactone (Aldactone)

Answer 11

Class: Potassium sparing diuretic 
MOA: 
-Deplete body sodium stores and blood volume by acting on the various sites of the renal tubule transport systems
-Direct dilate arterioles and decrease TPR by unknown mechanism
Indications: 
-Less potent
-CHF
-Used in resistant hypertension
SE: 
-Hyperkalemia
-Acute renal failure

Question 12

Captopril (Capoten)

Answer 12

Class: ACE Inhibitor
MOA: 
-Inhibit the converting enzyme
-Decrease TPR
Indications:
-Hypertension
-Acute and chronic CHF
SE: Dry cough, Electrolytes: Hyperkalemia, CV: postural hypotension,
tachycardia, angioedema, CNS: headache, dizziness, fatigue, nervousness
Second and third trimesters of
pregnancy

Question 13

Enalapril (Vasotec)

Answer 13

Class: ACE Inhibitor
MOA: 
-Inhibit the converting enzyme
-Decrease TPR
Indications:
-Hypertension
-Acute and chronic CHF
SE: Dry cough, Electrolytes: Hyperkalemia, CV: postural hypotension,
tachycardia, angioedema, CNS: headache, dizziness, fatigue, nervousness
Second and third trimesters of
pregnancy

Question 14

Losartan (Cozaar)

Answer 14

Class: Angiotensin II Receptor blockers
MOA: Blockade of AT1 receptor
Indications: Similar to ACE inhibitors
SE: Similar to ACE inhibitors, but cough and angioedema are less common, Second and third trimesters of pregnancy

Question 15

Valsartan (Diovan)

Answer 15

Class: Angiotensin II Receptor blockers
MOA: Blockade of AT1 receptor
Indications: Similar to ACE inhibitors
SE: Similar to ACE inhibitors, but cough and angioedema are less common, Second and third trimesters of pregnancy

Question 16

Metoprolol (Lopressor)

Answer 16

Class: Beta- adrenergic receptor blockers
MOA: Nonselective β adrenoceptor antagonists
or Block β1 > β2
Indications: Decrease heart rate, blood pressure, and myocardial oxygen demand
SE: Bradycardia, Heart block, Asthma
fatigue, sedation, sleep disturbance, Dry mouth, nausea, vomit, constipation, Sexual dysfunction

Question 17

Carvedilol (Coreg)

Answer 17

Class: Beta- adrenergic receptor blockers
MOA: Nonselective β adrenoceptor antagonists
or Block β1 > β2
Indications: Decrease heart rate, blood pressure, and myocardial oxygen demand
SE: Bradycardia, Heart block, Asthma
fatigue, sedation, sleep disturbance, Dry mouth, nausea, vomit, constipation, Sexual dysfunction

Question 18

Isosorbide Dinitrate (Isordil)

Answer 18

Class: Arterial/Venous Vasodilator
MOA: Releases nitric oxide in smooth muscle cells, which activates guanylyl cyclase and increases cGMP
Effects:
-Smooth muscle relaxation, especially in vessels (other smooth muscle is relaxed but not as markedly)
-Vasodilation decreases venous return and heart size
-May increase coronary flow in some areas
Indications: CHF, IV form for acute coronary syndrome
SE: Orthostatic hypotension, tachycardia, headache (increased intracranial pressure)

Question 19

Hydralazine (Apresoline)

Answer 19

Class: Arterial Vasodilator
MOA: Stimulates nitric oxide (NO) > guanylate cyclase  cGMP pathway
Concerns:
-Directly act on vascular smooth muscle
-Do not interfere with the ongoing sympathetic tone
-Significant reflex compensatory response in heart function
(tachycardia), renin release, and water and salt retention
Indications:
-CHF
-Hypertensive emergency
-Refractory hypertension
SE: Reflex compensatory response:
-CNS: tremor, nausea, headache, palpitations, sweating
-CV: Angina attack and ischemic arrhythmias
-Lupus-like syndromes

Question 20

Sodium Nitroprusside (Nitropress)

Answer 20

Class: Arterial/Venous Vasodilator
MOA: Sodium nitroprusside releases NO into smooth muscle tissue > ^ cGMP> vasodilation (reduces both total peripheral resistance and venous return)
Concerns: Significant reflex compensatory response in heart function (tachycardia), renin release, and water and salt retention
Indications: A powerful parenterally administered vasodilator (short duration and has to be prepared freshly)
• CHF
• Hypertensive emergency
SE:
-Related to the metabolism of the drug
-Sodium nitroprusside  cyanide (released by red blood cells  thiocyanate (liver)
-Toxicity of cyanide: excessive hypotension, metabolic acidosis, arrhythmias, and even death
-Toxicity of thiocyanate: weakness, disorientation, psychosis, muscle spasms, and convulsions

Question 21

Which drugs DO NOT decrease mortality?

Answer 21

• diuretics
• positive inotropes
• nitrates & vasodilators
• supportive care: O2, morphine

Question 22

Which drugs decrease mortality?

Answer 22

• ACE inhibitors
• Beta blockers
• Spironolactone