heart failure+ adenosine+angina+mi stuff - Sheet1 Flashcards
What are the main drug classes used to treat heart failure (HF)?
Beta blockers: Bisoprolol, Carvedilol, Metoprolol ARNI: Sacubitril/Valsartan ACE Inhibitors (ACEIs): Captopril, Enalapril, Lisinopril, Ramipril Angiotensin II Receptor Blockers (ARBs): Candesartan, Losartan, Valsartan Aldosterone Antagonists: Eplerenone, Spironolactone SGLT2 Inhibitors: Dapagliflozin, Empagliflozin Vasodilators: Hydralazine, Isosorbide dinitrate Others: Ivabradine, Digoxin
What is Sacubitril/Valsartan (ARNI)?
A combination drug replacing ACEI or ARB for HF treatment.
What are the adverse effects of ARNI (Sacubitril/Valsartan)?
Angioedema, hyperkalemia, hypotension, dizziness, cough, renal failure.
When should ARNI be avoided?
Pregnancy, lactation, hepatic impairment, use with ACEIs, ARBs, K+-sparing diuretics, NSAIDs, or lithium.
What is Digoxin used for?
Second-line treatment for HF and atrial fibrillation (A Fib).
How does Digoxin work?
Positive inotropic effect → increases myocardial contraction strength. Negative chronotropic effect → slows heart rate (HR).
What are Digoxin’s adverse effects (AEs)?
Cardiotoxicity/dysrhythmias, GI symptoms (early sign): anorexia, nausea, vomiting, abdominal pain. CNS symptoms: fatigue, weakness, vision changes (yellow-green halos, blurred vision).
What is the therapeutic range for Digoxin?
0.5 – 2 ng/mL
How should Digoxin be administered?
Same time daily, take apical pulse for 1 min before administration, hold if HR <60 bpm. Monitor potassium & digoxin levels.
When should Digoxin not be used?
Absolute contraindications: Ventricular fibrillation (V Fib), ventricular tachycardia (V Tach), 2nd or 3rd-degree heart block. Use cautiously in: Hypokalemia, partial AV block, advanced HF, renal impairment.
Which drugs interact with Digoxin?
Increase risk of toxicity: Thiazide/loop diuretics, ACEIs/ARBs, sympathomimetics (e.g., dopamine), quinidine, verapamil.
What are the steps for managing Digoxin toxicity?
- Stop Digoxin & K+-wasting diuretics 2. Monitor potassium (K+) levels 3. Treat dysrhythmias: Phenytoin or lidocaine 4. Treat bradycardia: Atropine 5. Remove toxic levels: Activated charcoal, cholestyramine, Digoxin immune Fab (antidote).
What is Adenosine used for?
Terminates paroxysmal supraventricular tachycardia (PSVT).
What are the adverse effects (AEs) of Adenosine?
Sinus bradycardia, hypotension, dyspnea, face flushing.
What is the half-life of Adenosine?
10 seconds – AEs are self-limiting
What are examples of organic nitrates used for angina?
Nitroglycerin (NTG), Isosorbide dinitrate (SL), Isosorbide mononitrate (PO).
What forms does Nitroglycerin (NTG) come in?
Oral ER capsules, SL tablet, translingual spray, topical ointment, transdermal patch, IV.
How does Nitroglycerin work?
Dilates veins → ↓ venous return (preload) → ↓ cardiac oxygen demand.
What are the AEs of Nitroglycerin?
Headache, orthostatic hypotension, reflex tachycardia, tolerance.
What precautions should be taken with Nitroglycerin?
Avoid phosphodiesterase type 5 inhibitors (e.g., sildenafil). Do not use in severe anemia, closed-angle glaucoma, or traumatic head injury (↑ ICP).
What is Ranolazine used for?
Chronic stable angina.
What are the AEs of Ranolazine?
QT prolongation, elevated BP.
What drugs interact with Ranolazine?
CYP450 inhibitors, quinidine, sotalol. Increases digoxin & simvastatin levels.
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ABCs (Airway, Breathing, Circulation)
