Exam 5 Heart Failure Drugs Flashcards
Which drugs are positive inotropes, used for cardiac performance and increases heart contractility?
Cardiac Glycosides: Digoxin (Lanoxin)
Beta-Adrenoceptor Agonists: Dobutamine (Dobutrex)
Which drugs are diuretics, used for preload and sodium removal?
Hydrochlorothiazide (caroline)
Furosemide (lasix)
Bumetanide (Bumex)
Spironolactone (Aldactone)
Which drugs are angiotensin system inhibitors (ACE), used for after load and reduce heart burden/oxygen consumption?
ACE inhibitors : captopril and enapril
Angiotensin receptor antagonists: losartan, valsartan
Which drugs are beta-adrenoceptor antagonists, used for contractility and reduce heart burden/oxygen consumption?
metoprolol
carvedilol
Which drugs are vasodilators, used for heart rate and reduce heart burden/oxygen consumption?
isosorbide denitrate
nitroprusside
hydralazine
Digoxin (lanoxin)
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
Dobutamine (Dobutrex)
Class: positive inotropes: Beta1-adrenoceptor agonist
Indications: parental therapy for acute severe CHF
Adverse effects: (β1 active sympathomimetics): Hypertension, angina, arrhythmia, and tachycardia
Hydrochlorothiazide (Carozide)
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
Furosemide (Lasix)
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
Bumetanide (Bumex)
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
Spironolactone (Aldactone)
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
Captopril (Capoten)
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
Enalapril (Vasotec)
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
Losartan (Cozaar)
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
Valsartan (Diovan)
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
Metoprolol (Lopressor)
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
Carvedilol (Coreg)
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
Isosorbide Dinitrate (Isordil)
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)
Hydralazine (Apresoline)
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
Sodium Nitroprusside (Nitropress)
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
Which drugs DO NOT decrease mortality?
- diuretics
- positive inotropes
- nitrates & vasodilators
- supportive care: O2, morphine
Which drugs decrease mortality?
- ACE inhibitors
- Beta blockers
- Spironolactone
