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Pharm > Heart Failure Drugs (12b) > Flashcards

Heart Failure Drugs (12b) Flashcards

1
Q

What are the Primary goals of HF therapy?

A
  1. improve cardiac function
  2. Reduce the clinical symptoms
  3. Reduce hospitalizations
  4. Reduce risk of death
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2
Q

clinical signs of HF are?

A
  • fatigue
  • weakness
  • exercise intolerance
  • JVD
  • polyuria, noturia
  • dependent edema
  • dyspnea, orthopnea
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3
Q

What are the medications that are loop diuretics?

A

Furosemide
Torsemide
Ethycrinic Acid

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4
Q

What are the anti-aldosterone agents?

A

Spironolactone

Eplenerone

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5
Q

What are the Beta Blockers

A

Metoprolol Succinate

Carvedilol

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6
Q

What must you watch carefully in when giving diuretics?

A

Electrolytes, general dehydration

hypotension

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7
Q

Why are diuretics effectives in HF?

A

decrease preload
increase renal blood flow
Promote sodium excretion

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8
Q

Which Loop diuretic carries the highest risk of hypokalemia and dehydration?

A

Furosemide

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9
Q

What is the MOA of the loop diuretics?

A

Inhibits Na+-K+-2Cl- symporter in the thick ascending loop and distal tubule

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10
Q

The indications for Loop diuretics are?

A

Edema secondary to CHF
Renal Failure
Liver Failure

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11
Q

Furosemide has what drug drug interactions?

A
  • Increase impact of anti-hypertensives by decreasing vascular volume
  • Corticosteroids increase furosemide impact
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12
Q

What is the equivalence in dosing of Torsemide to Furosemide?

A

You can use 10-20mg of torsemide to 40mg of Furosemide

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13
Q

Of the Loop diuretics, which are NOT contraindicated with sulfa drugs?

A

Ethacrynic acid

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14
Q

Spironolactone and Eplerenone are in what class of med?

A

Aldosterone antagonist diuretic

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15
Q

What is the MOA of Spironolactone and Eplerenone?

A

Inhibit sodium reabsorption by disrupting the aldosterone-dependent Na+/K+ pump

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16
Q

What is important to note about the aldosterone agents (compared to the loop diuretics)?

A

They are potassium sparing!!

17
Q

In regards to its diuretic properties, what should be considered when it comes to Spironolactone and Eplerenone?

A
  • They are weak diuretic agents

- Used more for anti-aldosterone activity in reducing cardiac fibrosis

18
Q

Of the two aldosterone antagonists, which one has more specific aldosterone receptor antagonistic properties in the kidney, heart, blood vessels and brain?

A

Eplerenone

19
Q

What are some adverse S/E of the aldosterone antagonisits?

A

Gynecomastia

Elevated K+ (Spironolactone)

20
Q

The B Blockers used for heart failure include which drugs?

A

Carvedilol

Metoprolol

21
Q

What is the MOA of beta blockers?

A
  • Antagonist at B adrenergic receptors
  • Decrease HR
  • Decrease Stroke volume
  • Decrease Total peripheral resistance by decreasing Renin and angiotensin II
22
Q

What is the site of action of the Beta blockers?

A

Heart

Kidney

23
Q

What are the major contraindications of beta blockers?

A

Asthma
Hypotension
HR

24
Q

Which of the metoprolol are used in heart failure?

A

Met Succinate

More convenient. Only has to be taken QD

25
Q

When it comes to the dosing of Metoprolol, what do you need to remember about its selectivity of B1 receptors

A

If you dose above 100mg daily, it is no longer selective to just B1 receptors

26
Q

What may be masked in Metoprolol?

A

hypoglycemia

27
Q

Carvedilol is the other Beta blocker. Is it selective or not selective?

A

It is not selective. It will block B1, B2 and A1 receptors

28
Q

What else is blocked by carvedilol?

A

Norepinephrine - additive effect of lowering blood pressure

29
Q

What is reduced by carvedilol?

A

Peripheral vascular resistance

30
Q

What are some dosing considerations and precautions of beta blockers?

A
  • start at very low doses (3.125 BID)
  • monitor wt gain
  • HF symptoms may increase for 4-10 wks before any improvement noted
31
Q

Most loop diuretics are ________ based, so you need to be cautious in patient with CERTAIN (hint) allergies

A

Sulfa! Be careful when prescribing Loop diuretics to patients who have a sulfa allergy

32
Q

What is the indication for the use of Aldosterone agonists?

A 
Excessive aldosterone excretion
HF
HTN
hypokalemia
liver cirrhosis with edema/ascites
nephrotic syndrome
33
Q

What are the indications for Metoprolol?

A
  • HF (duh) (but only met succinate)
  • Angina
  • HTN
  • hemodynamically stable AMI
34
Q

What are the indications for the use of Carvedilol?

A
  • HF
  • HTN
  • Angina (off label)
  • Stable post-MI
35
Q

What loop diuretic has the greatest risk for hypokalemia?

A

Furosemide

36
Q

What is the most potent diuretic in patients with Renal Failure (especially stage 3 or 4)?

A

Furosemide

37
Q

How can Torsemide be administered?

A

IV and PO - equally effective IV

What is the drug class?? Loop Diuretic

Pharm (12 decks)

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