Heart Failure

Question 1

Carvedilol MOA

Answer 1

Both Beta 1 and Alpha 1 blocker

Question 2

Carvedilol Clinical Application

Answer 2

• Chronic HF

- Reduces mortality in moderate and severe HF

Question 3

Carvedilol Toxicity

Answer 3

• Bronchospasm
• Bradycardia
• AV block
• Acute cardiac decompensation

Question 4

Isosorbide dinitrate MOA

Answer 4

Release NO

Question 5

Isosorbide dinitrate effects

Answer 5

• Venodilation

- Reduce preload and ventricular stretch

Question 6

Isosorbide dinitrate clinical application

Answer 6

Acute and chronic heart failure

Angina

Question 7

Isosorbide dinitrate toxicity

Answer 7

1. Postural hypotension
2. Tachycardia
3. Headache

Question 8

Isosorbide dinitrate interaction

Answer 8

Synergistic with phosphodiesterase type 5 inhibitors

Question 9

Hydralazine MOA

Answer 9

Increase NO synthesis

Question 10

Hydralazine effects

Answer 10

Reduces afterload and BP

Increases CO

Question 11

Hydralazine clinical applications

Answer 11

• Chronic HF in African Americans

- Hydralazine + Nitrates reduces mortality

Question 12

Hydralazine toxicity

Answer 12

1. Lupus-like syndrome
2. Tachycadia
3. Fluid retention

Question 13

Nitroprusside MOA

Answer 13

-Rapid, powerful vasodilation -reduces preload and afterload

Question 14

Nitroprusside clinical application

Answer 14

1. Hypertensive emergency

2. Acute cardiac decompensation

Question 15

Nitroprusside toxicity

Answer 15

Cyanide Toxicity

Thicyanate toxicity

Question 16

Digoxin MOA

Answer 16

• Inhibits Na+/K+ ATPase pump

- Increased intracellular Ca2+

Question 17

Digoxin effects

Answer 17

• Increases cardiac contractility

- Increases parasympathetic outflow: slowed HR, slowed AV conduction

Question 18

Digoxin clinical applications

Answer 18

1. Chronic symptomatic HF

2. Rapid ventricular rate in A-fib

Question 19

Digoxin toxicity

Answer 19

1. GI upset: N/V/D

2. Cardiac arrhythmia

Question 20

Name cardiac glycoside

Answer 20

Digoxin

Question 21

Acute heart failure heart failure drugs

Answer 21

1. Bipyridines
2. Natriuretic peptide
3. Beta-adrenoceptor agonists

Question 22

Beta-adrenoceptor agonists

Answer 22

1. Dobutamine

2. Dopamine

Question 23

Dobutamine MOA

Answer 23

Beta-1 selective agonist

Question 24

Dobutamine effects

Answer 24

1. Increases cardiac contractility

2. Increase CO

Question 25

Dobutamine clinical application

Answer 25

Acute decompensated HF

Question 26

How is Dobutamine given?

Answer 26

IV only

Question 27

Dopamine MOA

Answer 27

1. Dopamine receptor agonist

2. Higher doses activate Beta and Alpha adrenoreceptors

Question 28

Dopamine effects

Answer 28

1. Increases renal blood flow

2. Higher doses increases cardiac force and BP

Question 29

Dopamine clinical application

Answer 29

1. Acute decompensated HF

2. Shock

Question 30

How is Dopamine given?

Answer 30

IV

Question 31

Milrinone MOA

Answer 31

• Phosphodiesterase type 3 inhibitor

- Increased levels of cAMP

Question 32

Milrinone effects

Answer 32

1. Vasodilator
2. Decrease PVR
3. Increase cardiac contractility

Question 33

Milrinone clinical application

Answer 33

Acute decompensated heart failure

Question 34

Milrinone toxicity

Answer 34

Arrhythmias

Question 35

Nesiritide MOA

Answer 35

Activates BNP receptors

Increases cGMP

Question 36

Nesiritide effects

Answer 36

vasodilation

diuresis

Question 37

Nesiritide clinical application

Answer 37

Acute decompensated failure

Question 38

Nesiritide toxicity

Answer 38

Renal damage

Question 39

List a natriuretic peptide

Answer 39

Nesiritide

Question 40

List a Bipyridine

Answer 40

Milrinone

Question 41

Ivabradine MOA

Answer 41

• HCN, if current inhibitor
• Prolongs diastolic time
• Reduces HR

Question 42

Ivabradine clinical applications

Answer 42

1. Sx’s of HF that are STABLE
2. Normal heart beat with a resting HR @ 70 bpm
3. Taking beta-blocker @ highest dose

Question 43

Overall goal of Ivabradine

Answer 43

Reduce risk of hospitalization for worsening HF

Question 44

Ivabradine contraindications

Answer 44

1. BP <90/50
2. Acute HF
3. Bradycardia arrhythmias