Heart Failure Flashcards
Dobutamine
Inotrope
beta-1 agonist, increases cardiac output
Treats Acute HF
AE’s: Arrhythmia
IV admin, short duration (minutes)
Inotropes
Dobutamine
Digoxin
Milrinone
Digoxin
Inotrope
Na/K ATPase inhibitor, effectively blocking Na+ extrusion from cell, resulting in increased Ca++ storage in SR and increased contractility and CO
Treats: CHF and arrhythmias
AE’s: Arrhythmia, nausea, malaise, diarrhea, vision problems
small therapeutic window - worsened w/ hypokalemia (can be caused by diuretics which reduce window more)
Milrinone
Inotrope
selective, reversible phosphodiesterase-3 inhibitor. Blocks cAMP degradation –> increased Gs, cAMP, and PKA signaling –> increases CO, and vasodilation to decrease after load
Treats acute HF
AE’s: Arrhythmia
IV short duration (minutes)
Vasodilators
Isosorbide dinatrate
Sacubitril
Hydralazine
Isosorbide dinitrate
Vasodilator
Nitrovasodilator/NO donor. Release of NO stimulates cGMP production by guanylyl cyclase, increasing PKG signaling, activating MLC-phosphatase, opening K+ channels, and relaxing vascular smooth muscle –> vasodilation and decreased after load
Treats acute HF
AE’s: Tachycardia and hypotension
Combine w/ hydrazine for HF treatment
Sacubitril
Vasodilator
Neprilysin inhibitor, metabolizes ANP. Blocking neprilysin degradation increases ANP stimulated vasodilation and salt/water excretion, lowering after load
Treats CHF
AE’s: Hyperkalemia, cough, hypotension
Combined with valsartan
Hydralazine
Vasodilator
Vascular K+ channel opener. When open, K+ rapidly leaves the cell and decreases RMP. Thus, voltage-gated Ca++ channels are more difficult to open, leading to vascular smooth muscle relaxation, vasodilation, and decreased after load
Treats: CHF and angina
AE’s: Tachycardia, hypotension, headache
oral, long duration of action, combined with isosorbide dinitrate for HF
Furosemide
Loop diuretic
Inhibits Na+, K+, 2Cl- cotransporter (NKCC2) in the loop of Henle (loop diuretic)
Treats: Edema in CHF, cirrhosis, nephrotic syndrome, HTN, HyperCa++
AE’s: Hypokalemia, ototoxicity, dehydration
Rapid onset (minutes)
Metoprolol
beta-1 antagonist
inhibition of beta stimulated renin release and cardiomyocyte hypertrophy
Treats: CHF, HTN, angina
AE’s: Bradycardia, AV block, CNS sedation
reduces mortality in HF, commonly used for stage I/II HTN
Beta-blockers
Carvedilol (alpha-1 and non-selective beta antagonist)
Metoprolol
Carvedilol
alpha-1 and non-selective beta antagonist
inhibition of beta stimulated renin release and cardiomyocyte hypertrophy
Treats: CHF, HTN, angina
AE’s: Bradycardia, AV block, CNS sedation
reduces mortality in HF, 4 stereoisomers
Catopril
ACE inhibitor - lisinopril
Inhibits ACE which converts angiotensin I –> Angiotensin II (potent vasoconstrictor and increases aldosterone release and SNS activity). Decrease after load, decrease pre-load, decrease CVS remodeling.
Treats: Stage I/II HTN, CHF
AE’s: Hyperkalemia, teratogenic, cough
Bradykinin metabolizer –> persistent dry cough
Losartan
Angiotensin receptor blocker (ARB)
Bind angiotensin II type I (AT1) receptor. Blocks any AT-II signaled process: vasoconstriction, aldosterone and vasopressin release, enhanced SNS activity, CVS remodeling. Decreased afterload and preload
Treats: Stage I/II HTN, CHF
AE’s: Hyperkalemia, teratogenic,
NO COUGH
Spironolactone
Aldosterone-receptor antagonist
Competitive aldosterone receptor antagonist. Aldosterone is a steroid hormone released from the adrenal cortex following AT-II stimulation. It increases salt/water retention to increase BP. It works at mineralocorticoid nucelar receptors. Lowers TPR, afterload, preload
Treats: Hyperaldosteronism, CHF, HTN
AE’s: Hyperkalemia, endocrine effects (gynecomastia)
Used in combo with loop/thiazides to prevent hypoK, eplerenone lacks anti-androgen effects
