Heart Failure 2 Flashcards
Which drug?
- Competitively blocks B1 receptors and alpha 1 receptors
- Slows HR
- Reduces HF mortality
- Used in Chronic HF (to slow progression)
- Should be taken w/ food
- HTN and CHF med
Carvedilol (beta blocker)
Which BB is effective in both systolic and diastolic HF?
(HFrEF & HFpEF)
Nebivolol
Which drug?***
- MOA: releases nitric oxide (NO)
- Effects: Venodilation - reduces preload and ventricular stretch
- Used in: acute and chronic HF (angina)
- Toxicity: postural hypotension, tachycardia, HA
- Synergistic w/ phosphodiesterase type 5 inhibitors
Isosorbide dinitrate
Which drug?***
- Used for chronic HF in African Americans
- Indicated in conjunction w/ standard HF therapy to improve survival/reduce hospitalizations in self identified African American pts
Hydralazine Isosorbide Dinitrate (Bidil)
***Which drug?*****
- MOA: probably increases Nitric Oxide (NO) synthesis in endothelium
- Reduces BP and afterload
- Results in increased CO
- W/ nitrates has reduced mortality
- Toxicity: tachycardia, fluid retention, lupus like syndrome
Hydralazine (arteriolar dilator)
Which drug?
- Rapid, powerful vasodilation which reduces preload/afterload
- Used in acute severe decompensated HF
- Toxicity: excessive hypotension, thiocyanate and cyanide toxicity
Nitroprusside (vasodilator)
Which drug?
- Cardiac glycoside
- MOA: Na/K ATPase inhibition results in reduced Ca expulsion and increased Ca stored in sarcoplasmic reticulum
- Effects: increases contractility, cardiac parasympathomimetic effect (slowed sinus HR, slowed atrioventricular conduction)
- Used in: chronic symptomatic HF and rapid ventricular rate in atrial fibrillation
- REDUCE dose in elderly
- Nausea, vomiting, diarrhea
- Cardiac arrhythmias
Digoxin
(not show to reduce mortality w/ HFrEF)
(Digibind: dig antibodies)
Diuretics used in acute or chronic HF?
Both
Beta Blockers used in acute or chronic HF?
Chronic HF
Vasodilators used in acute or chronic HF?
Both
Used in acute or chronic HF?
- Cardiac glycosides
- Angiotensin receptor blockers
- Angiotensin-converting enzyme inhibitors
- Aldosterone receptor antagonists
Chronic HF
**Used in acute or chronic HF?****
- Bipyridines
- Natriuretic peptide
- HCN, /f current inhibitor
Acute HF
Which drug?***
- MOA: Beta-selective agonist (increases cAMP synthesis)
- Increases cardiac contractility, output
- Used in acute decompensated HF
- Intermittent therapy in chronic failure reduces sxs
- IV only!!!
Dobutamine
(Beta adrenoceptor agonists)
Which drug?***
- MOA: Dopamine receptor agonist
- Higher doses activate Beta and alpha adrenoceptors
- Increases renal blood flow
- Higher doses increase cardiac force and BP
- Used in acute decompensated HF and shock
- IV only!!
- no renin release
Dopamine
(Beta adrenoceptor agonists)
Which drug?
- MOA: Phosphodiesterase type 3 inhibitors (decrease breakdown of cAMP)
- Vasodilators; lower periph vasc resistance
- Increase contractility
- Used in acute decompensated HF
- Increase mortality in chronic HF
- IV only!!
- Toxicity: arrhythmias
- Inamrinone
- Milrinone
(Bipyridines)
Which drug?
- MOA: activates BNP receptors, increases cGMP
- Vasodilation (diuresis)
- Used in acute decomp failure
- NOT shown to reuce mortality
- IV only!!
- Toxicity: renal damage***
Nesiritide
(Naturiuretic Peptide)
Which drug?
- MOA: prolongs diastolic time by inhibiting f current within HCN channel (reducing HR)
- Indication: sxs of HF that are stable
- **Hopefully reduces risk of being hospitalized for worsening HF***
Ivabradine
(HCN f Current Inhibitor)
What are the 4 SE of Ivabradine?
- Dizziness
- Fatigue
- Less common: increased BP and A. fib
- Ivabradine can be used in people w/ HR of at least ___ BPM.
- Only used for stable HF
- Don’t use in people w/ HR
- at least 70
- Not under 60
3 toxicities of Ivabradine
- SSS (sick sinus syndrome)
- 3rd degree AV block
- Severe hepatic impairment
In patients w/ NYHA class 2 and 3 heart failure and iron deficiency, what might be reasonable to give for improvement of functional status?
IV iron replacement
In patients w/ HF, the optimal BP in those with HTN should be less than ____ mmHg
130 / 80
In patients w/ CVD and obstructive sleep apnea, what may be reasonable to improve sleep quality and daytime sleepiness?
CPAP (Continuous positive airway pressure)
Case:
- 65 yr male, w/ SOB on exertion several weeks after viral illness
- Swelling of feet/ankles and increasing fatigue
-
PE: mild SOB lying down, better upright
- Pulse 105/regular
- BP: 90/60
- Crackles bilateral bases
- JVP elevated
- Liver enlarged
- 3+ edema of anles/feet
- Echo: dilated, poorly contracting, Left EF reduced
- Dx: cardiomyopathy secondary to viral infection (stage C class 3 HF)
- Do you tx HF or HTN first?
- Steps of therapy?
- Tx HF first! Then carefully control HTN
-
Initially tx w/ diuretic: Furosemide
- this improved SOB on exertion/orthopnea
-
ACE-I was added
- felt better
- Digoxin added to improve exercise tolerance
- BP stabilized at 150/90
- Educate pt on HTN and HF and BP control
- Consider adding BB (metoprolol)
- Monitor blood lipids
