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Pharm II > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

The pharmacology definition defines HFrEF or HFpEF?

A

HFrEF

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2
Q

Is HFrEF systolic or diastolic?

Is HFpEF systolic or diastolic?

A 
HFrEF = systolic
HFpEF = diastolic
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3
Q

What is the role of venodilator drugs in pts with HF?

A

↓ preload

block ↑ RAS activity and ↑ venous return

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4
Q

What is the role of arteriodilator drugs in pts with HF?

A

↓ afterload

block ↑ peripheral resistance (that occurs due to arterial constriction

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5
Q

What is the role of beta blockers in pts with HF?

A

↓ contractility
↓ cardiac work by slowing HR
(↓ energy expenditure)

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6
Q

What is the role of inotropic drugs in pts with HF?

A

↑ contractility

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7
Q

What is the main cardiac contractility determinant?

A

Sensitivity of contractile proteins to Ca2+ and availability of Ca2+

(also some effects of Na+)

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8
Q

Failed compensatory mechanisms become what in HF pts?

A

Signs and sxs

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9
Q

What cardiac factor is increased in HF pts due to increased blood volume and increased venous tone?

A

Preload

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10
Q

What cardiac factor is increased in HF pts due to increased aortic impedence and increased arterial constriction?

A

Afterload

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11
Q

What cardiac factor is decreased in HF pts due to ventricular dilation which reduces pumping force?

A

Contractility

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12
Q

What cardiac factor is increased in HF pts due to reflex tachycardia caused by sympathetic hyperactivity?

A

HR

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13
Q

What drugs have been shown to reduce mortality rate in HF pts?

A

Spironolactone and eplerenone

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14
Q

What drugs are included in the class of ACE inhibitors for HF pts?

A

Enalapril

RAS inhibitor

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15
Q

What drugs are included in the class of Angiotensin II Receptor Blockers (ARBs) for HF pts?

A

Losartan

RAS inhibitor

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16
Q

What drugs are included in the class of ARNIs for HF pts?

A

Sacubitril (Neprilysin inhibitor)/ Valsartan (ARB)

aka Entresto

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17
Q

What drugs are included in the class of Beta Blockers for HF pts?

A

Metoprolol, Carvedilol

Combined 𝛼-β blockers

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18
Q

What drugs are included in the class of Vasodilators for HF pts?

A

Sodium nitroprusside, isosorbide dinitrate, hydralazine

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19
Q

What drugs are included in the class of Sympathomimetics for HF pts?

A

Dobutamine (B1), Dopamine

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20
Q

What drugs are included in the class of Digitalis for HF pts?

A

Digoxin

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21
Q

ATII alters peripheral resistance resulting in rapid pressor response which ultimately increases what?

A

Afterload

22
Q

ATII alters renal function resulting in slow pressor response which ultimately increases what?

A

Preload

23
Q

ATII alters CV structure resulting in vascular and cardiac hypertrophy and remodeling which ultimately increases what?

A

Remodeling

24
Q

What is the MOA of ARBs?

A

Block ATII from binding to the ATI receptor

25
Q

What is the current DOC for HF?

A

ACE inhibitors

26
Q

What is the adverse effect of ACE inhibitors

A

Dry cough

27
Q

Sacubitril (Neprilysin inhibitor)/ Valsartan (ARB)

(aka Entresto - ARNI) is better at reducing mortality in HF pts compared to what drug alone?

A

Enalapril

28
Q

What is the greatest effect of Neprilysin inhibition?

A

Decrease cardiac remodeling

29
Q

The following are adverse effects for what HF drug?
Hypotension
Hyperkalemia (esp with K+ sparing diuretic)
Cough and angioedema

A

Sacubitril/ Valsartan (Entresto)

30
Q

What are the c/i’s of Sacubitril/ Valsartan (Entresto)?

A

Pregnancy

Concurrent use with ACE inhibitor (angioedema)

31
Q

Carvedilol and Metoprolol ↓ renin secretion, HR, and remodeling, in addition to what other thing?

A

Mortality

32
Q

Why are beta blockers only effective in the early stages of HF?

A

Dangerous in severe, end-stage HF due to negative inotropic effect

33
Q

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?

A

Dobutamine

34
Q

Besides Dobutamine, what other HF drug can be used for short-term treatment of severe refractory HF that can also increase BP if needed?

A

Dopamine

35
Q

What drug is a cardiac glycoside isolated from plants?

A

Digitalis (Digoxin)

36
Q

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+?

A

Inhibition of Na/K ATPase pump

37
Q

If a HF pt has all benchmarks met with other meds but is still feeling sluggish, what drug can be added?

A

Digoxin

38
Q

What is the primary indication for Digoxin besides HF?

A

Arrhythmias

39
Q

What is the effect of Digoxin on HR?

A

Reduced/ slowed

↑ myocardial contractility leads to sympathetic tone ↓

40
Q

What HF drug is orally bioavailable and is primarily excreted by the kidneys?

A

Digoxin

41
Q

What are adverse effects of Digoxin? (4)

A

All glycosides are toxic
Narrow margin of safety
CNS SE’s
Cardiac

42
Q

What are the first signs of toxicity with Digoxin?

A

GI (disappear after discontinuation)

43
Q

What SE of Digoxin is the most common cause of death?

A

Ventricular fibrillation

44
Q

What drug has common and dangerous cardiac adverse effects including sinus bradycardia, ectopic ventricular beats, AV block, and bigeminy?

A

Digoxin

45
Q

If minor intoxication occurs with Digoxin (exhibited as GI effects), what should you do?

A

D/c or ↓ dose

46
Q

If moderate intoxication occurs with Digoxin (exhibited as arrhythmias), what should you do?

A

Oral/ IV K+ and d/c or ↓ dose

47
Q

If severe intoxication occurs with Digoxin (exhibited as overdose/ life threatening arrhythmias), what should you do?

A

Immunotherapy with Digitalis Immune Fab + Oral/ IV K+ and d/c or ↓ dose

48
Q

What shouldn’t be used in the treatment of Digoxin intoxication?

A

Cardioversion (unless ventricular fibrillation)

49
Q

What leads to increased Digoxin toxicity? (3)

A

Hypokalemia
Further ↓ of SA/ AV node activity
Myocardial sensitization to Digoxin

50
Q

What leads to decreased Digoxin effectiveness?

A

CCBs causing ↓ contractility

51
Q

What beneficial lifestyle effect does Digoxin have?

A

↑ exercise tolerance

Pharm II (13 decks)

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