Heart Failure Flashcards
The pharmacology definition defines HFrEF or HFpEF?
HFrEF
Is HFrEF systolic or diastolic?
Is HFpEF systolic or diastolic?
HFrEF = systolic HFpEF = diastolic
What is the role of venodilator drugs in pts with HF?
↓ preload
block ↑ RAS activity and ↑ venous return
What is the role of arteriodilator drugs in pts with HF?
↓ afterload
block ↑ peripheral resistance (that occurs due to arterial constriction
What is the role of beta blockers in pts with HF?
↓ contractility
↓ cardiac work by slowing HR
(↓ energy expenditure)
What is the role of inotropic drugs in pts with HF?
↑ contractility
What is the main cardiac contractility determinant?
Sensitivity of contractile proteins to Ca2+ and availability of Ca2+
(also some effects of Na+)
Failed compensatory mechanisms become what in HF pts?
Signs and sxs
What cardiac factor is increased in HF pts due to increased blood volume and increased venous tone?
Preload
What cardiac factor is increased in HF pts due to increased aortic impedence and increased arterial constriction?
Afterload
What cardiac factor is decreased in HF pts due to ventricular dilation which reduces pumping force?
Contractility
What cardiac factor is increased in HF pts due to reflex tachycardia caused by sympathetic hyperactivity?
HR
What drugs have been shown to reduce mortality rate in HF pts?
Spironolactone and eplerenone
What drugs are included in the class of ACE inhibitors for HF pts?
Enalapril
RAS inhibitor
What drugs are included in the class of Angiotensin II Receptor Blockers (ARBs) for HF pts?
Losartan
RAS inhibitor
What drugs are included in the class of ARNIs for HF pts?
Sacubitril (Neprilysin inhibitor)/ Valsartan (ARB)
aka Entresto
What drugs are included in the class of Beta Blockers for HF pts?
Metoprolol, Carvedilol
Combined 𝛼-β blockers
What drugs are included in the class of Vasodilators for HF pts?
Sodium nitroprusside, isosorbide dinitrate, hydralazine
What drugs are included in the class of Sympathomimetics for HF pts?
Dobutamine (B1), Dopamine
What drugs are included in the class of Digitalis for HF pts?
Digoxin
ATII alters peripheral resistance resulting in rapid pressor response which ultimately increases what?
Afterload
ATII alters renal function resulting in slow pressor response which ultimately increases what?
Preload
ATII alters CV structure resulting in vascular and cardiac hypertrophy and remodeling which ultimately increases what?
Remodeling
What is the MOA of ARBs?
Block ATII from binding to the ATI receptor
What is the current DOC for HF?
ACE inhibitors
What is the adverse effect of ACE inhibitors
Dry cough
Sacubitril (Neprilysin inhibitor)/ Valsartan (ARB)
(aka Entresto - ARNI) is better at reducing mortality in HF pts compared to what drug alone?
Enalapril
What is the greatest effect of Neprilysin inhibition?
Decrease cardiac remodeling
The following are adverse effects for what HF drug?
Hypotension
Hyperkalemia (esp with K+ sparing diuretic)
Cough and angioedema
Sacubitril/ Valsartan (Entresto)
What are the c/i’s of Sacubitril/ Valsartan (Entresto)?
Pregnancy
Concurrent use with ACE inhibitor (angioedema)
Carvedilol and Metoprolol ↓ renin secretion, HR, and remodeling, in addition to what other thing?
Mortality
Why are beta blockers only effective in the early stages of HF?
Dangerous in severe, end-stage HF due to negative inotropic effect
Which HF drug is a selective beta-1 agonist (inotropic effect), is used in short-term treatment of severe refractory HF and is given IV?
Dobutamine
Besides Dobutamine, what other HF drug can be used for short-term treatment of severe refractory HF that can also increase BP if needed?
Dopamine
What drug is a cardiac glycoside isolated from plants?
Digitalis (Digoxin)
The MOA of Digoxin involves inhibition of what pump to lead to cardiac effects such as ↑ IC Na+, Ca2+, actin-myosin interaction, contractility, and ↓ expulsion of IC Ca2+?
Inhibition of Na/K ATPase pump
If a HF pt has all benchmarks met with other meds but is still feeling sluggish, what drug can be added?
Digoxin
What is the primary indication for Digoxin besides HF?
Arrhythmias
What is the effect of Digoxin on HR?
Reduced/ slowed
↑ myocardial contractility leads to sympathetic tone ↓
What HF drug is orally bioavailable and is primarily excreted by the kidneys?
Digoxin
What are adverse effects of Digoxin? (4)
All glycosides are toxic
Narrow margin of safety
CNS SE’s
Cardiac
What are the first signs of toxicity with Digoxin?
GI (disappear after discontinuation)
What SE of Digoxin is the most common cause of death?
Ventricular fibrillation
What drug has common and dangerous cardiac adverse effects including sinus bradycardia, ectopic ventricular beats, AV block, and bigeminy?
Digoxin
If minor intoxication occurs with Digoxin (exhibited as GI effects), what should you do?
D/c or ↓ dose
If moderate intoxication occurs with Digoxin (exhibited as arrhythmias), what should you do?
Oral/ IV K+ and d/c or ↓ dose
If severe intoxication occurs with Digoxin (exhibited as overdose/ life threatening arrhythmias), what should you do?
Immunotherapy with Digitalis Immune Fab + Oral/ IV K+ and d/c or ↓ dose
What shouldn’t be used in the treatment of Digoxin intoxication?
Cardioversion (unless ventricular fibrillation)
What leads to increased Digoxin toxicity? (3)
Hypokalemia
Further ↓ of SA/ AV node activity
Myocardial sensitization to Digoxin
What leads to decreased Digoxin effectiveness?
CCBs causing ↓ contractility
What beneficial lifestyle effect does Digoxin have?
↑ exercise tolerance
