Heart Failure and Congestive Heart Failure

Question 1

Digoxin

Answer 1

Positive Inotropic Drug.
Indications: RVR w/ Afib, Chronic symptomatic heart

MOA: Na/K+ ATPase inhibitor this Less Ca+ expelled

Effects: Increased cardiac contractility, PNS activation(decreased HR)

Adverse: NV, arrhythmia, gynomastia, SZ

Can cause toxicity use FAB.

Question 2

Dobutamine

Answer 2

Postive Inotropic IV Drug
**More preferred than Dopamine

MOA: DHP channel increased Ca2+ so more contractility.

Indications: Acute HF, Cardiogenic shock…. Improves symptoms Not survival

Question 3

Dopamine

Answer 3

Positive inotropic IV only drug Less Preferable to Dobutamine

Indication: increased RBF, higher doses increase Cardiac force.

MOA: acts on A1 and B1 receptor at high dosage…Low dosage on dopamine-1 to increased CAMP –> PKA —>increased Ca2+

Effect: Increased Ca2+ = Increased contractility

Interactions: only a few minutes can be additive w/ sympathomimetics

Question 4

Milrinone and Inamrinone

Answer 4

Positive Inotropic Drugs PDE3 Inhibitor IV Drug

Indication: Vasodilation and decrease TPR, increased Cardiac Contractility

MOA: Inhibits PDE-3 so increased CAMP… Prevents breakdown to AMP..

Effects: CAMP=contraction…Can be additive

Adverse: Arrhythmias, NV, thrombocytopenia…decreased survival yikes

Question 5

Catropril… PRIL

Answer 5

Angiotensin Inhibitors…ACE inhibitors.. ORAL

Indication: arteriolar and venous dilation…Decreased aldosterone secretion…Reduces cardiac modeling

MOA: Inhibits ACE so decreased in ATII

Effects: . can help decreased BV and then decrease pressure and after load and increase preload

Adverse: Leads to Hyperkalemia no Na/K transport

Question 6

Losartan
SARTAN

Answer 6

Angiotensin Receptor Blocker(ARBS)

Indication: Used for those who cant tolerate ACE inhibitors… Shown to reduce mortality

MOA: Antagonizes AIIon AT receptors…

Effects: Similar to ACE prevents Na+ uptake w/ decreased aldo secretion

Adverse: HyperK, Edema

Can used w/ AT antagonist

Question 7

Entresto

Answer 7

Combo of Sacubitril(ACE Inhibitor) and Valsartan(ARBs)

Indication: to reduce the risk of cardiac death w/ pt w/ HF… benefits w/ LVEF

MOA: Combo of ACEI and ARBs

Adverse: don’t use w/ angioedema, or hx w/ adverse effect realted to ACE inhibitors or ARBS

Black pts more likely to have angioedema

Question 8

Hydralazine

Answer 8

Arterial Diliator

Indication: Acute on chronic HF

MOA: Increased cGMP (Smooth muscle relaxation)

Effects: leads to decreased TPR leads to decreased after load

Adverse: leads to reflex tachycardia… Use B-blocker in combo
Can lead to orthostatic hypotension, Tachycardia, and HA

Additive w/ other vastdils and synergistic w/ PDE-5(increased camp)

Question 9

Isodinitrate

Answer 9

Venodiliator

Indication: Acute and chronic HF

MOA: released NO, and activates Gunnel cyclase = increase cGMP
Smooth Muscle

Effects: Increased Ca2+ so increased relaxation reduced TPR** leads to decreased **Afterload*

Adverse: postural hypotension, tachycardia and HA

Synergist w/ PDE Inhibitors

Question 10

Nitroprusside

Answer 10

Combined anterior and venous dil

Indications: Cardiac decompensation, hypertensive emergency IV Drug. Could lead to hypotension

MOA: Spontaneous NO relates which activates guanylyn cyclase increased cGMP

Effects: Reduced blood pressure leads to decreased after load and increased CO also preload

Advers: Hypotension can lead to increased diuresis

Question 11

Nesiritide

Answer 11

Natriuretic peptide.. Vasodilation and venodil

Indications: Acute decompensation.. IV Drug

MOA: activates BNP receptors and increased cGMP

Effects: decreased LV filling pressure and decreased TPR so decreases after load…

Advers: Renal damage due to increased natriuresis.
Dont used w/ have hypotension, or cardiogenic shock

Bridge therapy for those on transplant list

Question 12

Carvedilol — olol

Answer 12

Beta-Blocker

Indication: HF

MOA: competitively block B receptors

Effects: Slows HR, decreased BP, Can reduce HF mortality(Carvedilol)

Adverse: can lead to bronchospasm(non-selective, works on lungs), bradycardia, AV block

Metoprolol, bisopranolol, and nebivolol

Question 13

Spironolactone and Epleronone

Answer 13

Aldo antagonist and K+sparring

Indication: CHF, aldosteronism(cirrhosis, adrenal tumor) HTN… Can reduce mortality

MOA: Block ENAC channels in late DT and CD, decreasing Na/K ATPase activity.

Effects: Increased Na+ and Water exertion… Reduce mortality

Adverse: Hyper K+

epleronone: more selective than spironolactone

Question 14

Furosemide, butrtaninde and torsemide, Etharynic

Answer 14

Loop Diuretic IV drug

Indication: Acute on chronic HF, Sever hypertension, edema

MOA: Decreased NaCl and KCl reabsorb in the Ascending Limb

Effects: Increased NaCl and H20 excretion, leads to reduced cardiac preload and after load due to decreased peripheral edema

Adverse: HypoNa, HypoK, Hyperglycemia, HLD

SULFA ALLERGY don’t use

Ethrarynic acid no sulfa interaction

Question 15

Hydrochlorothiazide

Answer 15

DCT Diuretic.. ORAL

Indications: mild HF, and moderate HTN, no evidence of decreased mortality.

MOA: Decreased NaCl in the DCT

Effects:Increased NaCl and H20 excretion, leads to reduced cardiac preload and after load due to decreased peripheral edema

Adverse: Hypo