Heart Failure Flashcards by anu pokharel

Vasodilators

ACE-I
AT-RB
Hydralazine
organic nitrates
Nitroprusside
Nisiritide

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Diuretics

Thiazides
Loop
K-sparing (Spironolactone, Eplerenone)

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Beta-blockers

Carvedilol
Metoprolol
Bisoprolol

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Positive inotropic drugs

Digoxin (vagomimetic)
Dobutamine
Dopamine (adrenergic agonist)

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positive inotropic + vasodilator drugs

PDE inhibitors

Milrinone

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used for acute CHF but not chronic

Sodium nitroprusside

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Effect of sodium nitroprusside on SV in normal indiv

Decrease

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Effect of sodium nitroprusside on SV in ptn with severe CHF

Increase

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Decreased mortality

Hydralazine + ISDN
ACE-I
ARB

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Chronic CHF

Hydralazine
ACE-I
ARB

arterio > veno

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Acute and chronic CHF

Organic nitrates

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Combination used

ACEI / ARBs not tolerated

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African americans remain sx with

ACEI/ARB, BB, aldo antagonist

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Nesiritide

Recombinant human B-type natriuretic peptide

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Tx acute decompensated CHF with dyspnea

Nesiritide

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MOA Nesiritide

activates GC – inc cGMP – vasodilation – dec afterload and preload

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inc cAMP in heart vs vascular

heart - contractility

BV - vasodilation

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PDE-I MOA

inhibit breakdown of cAMP

Short term tx of severe acute CHF

ADR?

Milronone, Inamrinone

Proarrhythmic
hypotension
thrombocytopenia

tx of compensated CHF

Beneficial effect of BB in CHF

antiarrhythmic effects (prevent a-fib)
inh cardiac remodeling
dec myocardial oxygen demand

what’s important to keep in mind regarding dosing of BB

dose gradually with careful monitoring

Direct effect on myocardial contractility

Digoxin

How does intracellular calcium increase with Digoxin

inhibit Na/K ATPase, no sodium gradient for the NCX to work – inc calcium inside

Vagomimetic effects seen in

Digoxin

SA node with digoxin

vagomimetic | dec automaticity, dec HR

AV node with digoxin

direct and vagomimetic | dec AV nodal conduction and causes AV nodal block

How does decreased AV nodal conduction help CHF patients

Controls ventricular rate (keeps it from going too high) when patients go into A-fib

EKG on digoxin

increased PR interval

does digoxin improve mortality?

How is digoxin eliminated?

Renally | - must be monitored

How is digoxin's absorption affect its use?

Incomplete absorption with narrow therapeutic index - a small shift in dose can have negative effects

Tx of digoxin

CHF | Slow ventricular rate in A flutter and fib

ADR digoxin

GI Visual CNS - nightmares, hallucinations

Enhance digoxin toxicity

``` hypokalemia dec renal function hypercalcemia Acidosis Hypothyroidism ```

Drug interaction Digoxin inc tox

K-depleting diuretics | Sympathomimetics

dec tox with Digoxin

Chestyramine, colestipol (Resins) - prevents its absorption

Tx of toxicity with Digoxin

Digoxin immune Fab ABs | Tx arrhythmias - lidocaine, atropine

what drug decreases vagomimetic effects of Digoxin

atropine

Increases contractility, no change in HR. Acts on Beta-1 Tx of decompensated acute CHF

Dobutamine

Control congestion

Diuretics - thiazides and loops

what is used as an adjunct with diuretics in control of congestion? why?

K-sparing diuretics - prevent hypokalemia

Moderate to severe CHF with less than 35% LVEF

ARB | - spironolactone and eplerenone