Heart failure drugs Flashcards
What is furosemides MOA?
inhibit Loop Na-K-2Cl transporter which will decrease preload
What is MOA of thiazides?
inhibit DCT NaCl transporter
What is the MOA for ACE inhibitors?
They block the ANG I from becoming ANG II
This allows for vasodilation which will decrease preload and afterload which allows the heart to work less and require less oxygen
What is the MOA for ARBs?
Same as ACE basically but this time they block ANGII from binding to any of its sites. so they also decrease preload and afterload
How do Neprilysin inhibitors work? (entresto)
Well with heart failure BNP is released which actually helps the heart but we have an enzyme that breaks it down. So Entresto which is Sacubitril and valsartan works by using Sacubitril to block the enzyme from breaking down BNP and Valsartan which is an ARB will block all ANGII receptors
BNP- widens blood vessels to help with ciculation
MOA of beta blockers?
Well B1 is stimulated by the SNS on the heart. If it is blocked the heart rate goes down. Heart goes down less stress on heart and less demand for O2.
In heart failure SNS will be stimulated because perfusion will be low so heart thinks it needs to pump more.
Between carvedilol, metoprolol and bisoprolol which one is non-selective?
carvedilol, this acts on alpha 1, beta 1, and beta 2
Between carvedilol, metoprolol and bisoprolol which one is more specific for beta 1 receptor?
bisoprolol
What is the MOA for hydralazine?
They open the arterial K+ channel which allows for vasodilation and decreases afterload
What is the MOA for isosorbide dinitrate?
the increase cGMP levels in veins causing vasodilation and decreasing preload
What is the MOA for digoxin
It blocks the Na/K+ pump. This allows Ca+ to stay in the cell longer increasing contractility
Also stimulates PNS which decreases HR
also desensitizes BR responses decreasing the SNS response
Would you give someone a beta blocker who is in decompensated HF
No absolutely not it can make it worse
what is the MOA for dobutamine?
it increases contractility by acting as a beta 1 agonist
What is the MOA for milrinone?
this is a PDE-3 inhibitor which increases cAMP levels which increases contractility and is also a vasodilator
What type of agents are dobutamine, milrinone, and digoxin
they are inotropic agents
What is the MOA for nitroprusside?
this converts NO in arterioles and veins which causes vasodilation and decreases preload and afterload
What is the MOA for nitroglycerin?
this works by increasing cGMP levels in veins causing venodilation which decreases preload
What drugs decrease preload and afterload?
- ARBs
- Nitroprusside
- ACE inhibitors
Could be more but from his guide these one specifically say they decrease both
Which of the two has a greater effect for blocking ANGII actions? The ACEi or ARB
The ARB does
Would you use a beta blocker as a first line choice in Hf?
no, first you would get them stable on an ACEi and then add if need be a beta blocker starting at a low dose and titrate up slowly
Which do you think digoxin would work better on. systolic heart failure or diastolic heart failure?
its systolic because it helps with contraction so the pumping out of blood
When would you think about adding on a vasodilator like hydralazine or isosorbide dinitrate?
pretty far down the road. When pts who are on an ACEi and beta blocker but still suffer from HF symptoms seems to be more indicated in african americans
Is dobutamine a drug you would use for any joe schmo who has heart failure?
No, it is generally used for pts who are in shock from severe decompensated HF. To help get these guys pumping some more blood “cold patient”
If a pt has Afib and HF can digoxin be used as a first line agent?
Yes, but it is usually added on to those with systolic HF and symptoms persist on standard Tx
