Heart Failure Flashcards
Vasodilators
ACE-I AT-RB Hydralazine organic nitrates Nitroprusside Nisiritide
Diuretics
Thiazides
Loop
K-sparing (Spironolactone, Eplerenone)
Beta-blockers
Carvedilol
Metoprolol
Bisoprolol
Positive inotropic drugs
Digoxin (vagomimetic)
Dobutamine
Dopamine (adrenergic agonist)
positive inotropic + vasodilator drugs
PDE inhibitors
Milrinone
used for acute CHF but not chronic
Sodium nitroprusside
Effect of sodium nitroprusside on SV in normal indiv
Decrease
Effect of sodium nitroprusside on SV in ptn with severe CHF
Increase
Decreased mortality
Hydralazine + ISDN
ACE-I
ARB
Chronic CHF
Hydralazine
ACE-I
ARB
arterio > veno
Acute and chronic CHF
Organic nitrates
Combination used
ACEI / ARBs not tolerated
African americans remain sx with
ACEI/ARB, BB, aldo antagonist
Nesiritide
Recombinant human B-type natriuretic peptide
Tx acute decompensated CHF with dyspnea
Nesiritide
MOA Nesiritide
activates GC – inc cGMP – vasodilation – dec afterload and preload
inc cAMP in heart vs vascular
heart - contractility
BV - vasodilation
PDE-I MOA
inhibit breakdown of cAMP
Short term tx of severe acute CHF
ADR?
Milronone, Inamrinone
Proarrhythmic
hypotension
thrombocytopenia
tx of compensated CHF
BB
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?
no
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
