Heart Failure Flashcards
What are the 4 beta-blockers indicated in the treatment of heart failure?
Carvedilol
Bisoprolol
Metoprolol
Nebivolol
What enzyme does sacubitril inhibit?
Neprilysin
What is the MOA of sacubitril?
Sacubitril inhibits neprilysin, preventing the breakdown of brain natriuretic peptide (BNP). Since BNP antagonises RAAS, the prolonged BNP effects will have protective effects on the heart
Why is valsartan given in combination with sacubitril?
Neprilysin breaks down both BNP and angiotensin II
Valsartan is an ARB which helps block the effects of angiotensin II
What is the clinical indication for sacubitril-valsartan?
Heart Failure with reduced Ejection Fraction (HFrEF)
What are the adverse effects of sacubitril-valsartain?
- Hypotension
- Hyperkalemia
- Renal failure
- Cough & angioedema
# FootnoteLiterally the same as ACEI
Why does sacubitril-valsartan cause cough & angioedema?
Sacubitril inhibits neprilysin, which breaks down bradykinin
Loop diuretics inhibit the luminal ________ in the ________, causing an increase in the excretion of ________ & ________.This increases the ________ of the luminal tubular fluid, decreasing ________
Loop diuretics inhibit the luminal Na+/K+/2Cl- transporter in the Loop of Henle, causing an increase in the excretion of Mg2+ & Ca2+.This increases the tonicity of the luminal tubular fluid, decreasing H2O reabsorption
Name the most important loop diuretic
Furosemide
What DDIs do loop diuretics have?
NSAIDs reduce renal PG synthesis and hence interfere with the action of loop diuretics
What is the duration of effect for furosemide?
2-3 hours; extremely rapid diuretic response following IV injection
What are the clinical indications for furosemide?
- Hyperkalemia
- Acute pulmonary edema/other edema
- Anion overdose
- Acute renal failure
What are the adverse effects of furosemide?
- Hypokalemic metabolic alkalosis
- Ototoxicity (avoid with aminoglycosides)
- Hyperuricemia
- Hypomagnesemia
Which class of diuretics act on the collecting tubule?
Potassium-sparing diuretics
________ & ________ block the aldosterone receptors in the collecting tubule
Spironolactone & eplerenone block the aldosterone receptors in the collecting duct
________ & ________ block the activation of the Na+ channels in the collecting tubule
Triamterene & amiloride block the activation of the Na+ channels in the collectube tublule
Potassium-sparing diuretics have a faster onset of action than loop diuretics.True/False
False.Potassium-sparing diuretics have a slow onset and require several days before they can exert their full therapeutic effect
What is the MOA of hydralazine?
Direct arteriole vasodilator –> reduces afterload
Induces a compensatory release of NE –> increased venous return through venous vasoconstriction + cardiac output
What are the clinical indications for hydralazine?
1.HFrEF (in combination with ISDN)
2.Second-line antihypertensive
3.Acute onset post-partum htn
What group of individuals is hydralazine contraindicated in?
Patients with coronary artery disease## FootnoteHydralazine stimulates sympathetic NS –> increased CO & O2 demand
What are the adverse effects associated with hydralazine?
- Flushing, hypotension, tachycardia
- Hydralazine-induced Lupus Syndrome (HLS)
Digitalis inhibit the ________, reducing the efficiency of the ________ as intracellular-[Na+] increases, leading to ________. Hence, this increases the ________ of the heart.
Digitalis inhibit the Na+/K+ ATPase, reducing the efficiency of the Na+/Ca2+ exchanger as intracellular-[Na+] increases, leading to less Ca2+ efflux. Hence, this increases the contractility of the heart.
Is digitalis used in early or late-stage heart failure?
Late-stage
What are the clinical indications for digitalis?
- Systolic dysfunction
- AFib
What are the adverse effects of digitalis?
- Progressively more severe dysrhythmia
- GI effects
- CNS effects - headache, confusion, blurred vision
Why do drugs that treat early-stage heart failure tend to reduce workload on the heart?
To preserve heart function
What antibiotics should NOT be given with furosemide (loop diuretics)?
Aminoglycosides due to ototoxicity
What is the MOA of the potassium-sparing diuretics?
They block aldosterone receptors/Na+ channels, preventing Na+ from being reabsorbed in the collecting ductThis increases H2O excretion by the kidney
Which drug induces a compensatory release of NE?
Hydralazine
