Heart Failure Drugs (12b)

Question 1

What are the Primary goals of HF therapy?

Answer 1

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

Question 2

clinical signs of HF are?

Answer 2

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

Question 3

What are the medications that are loop diuretics?

Answer 3

Furosemide
Torsemide
Ethycrinic Acid

Question 4

What are the anti-aldosterone agents?

Answer 4

Spironolactone

Eplenerone

Question 5

What are the Beta Blockers

Answer 5

Metoprolol Succinate

Carvedilol

Question 6

What must you watch carefully in when giving diuretics?

Answer 6

Electrolytes, general dehydration

hypotension

Question 7

Why are diuretics effectives in HF?

Answer 7

decrease preload
increase renal blood flow
Promote sodium excretion

Question 8

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

Answer 8

Furosemide

Question 9

What is the MOA of the loop diuretics?

Answer 9

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

Question 10

The indications for Loop diuretics are?

Answer 10

Edema secondary to CHF
Renal Failure
Liver Failure

Question 11

Furosemide has what drug drug interactions?

Answer 11

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

Question 12

What is the equivalence in dosing of Torsemide to Furosemide?

Answer 12

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

Question 13

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

Answer 13

Ethacrynic acid

Question 14

Spironolactone and Eplerenone are in what class of med?

Answer 14

Aldosterone antagonist diuretic

Question 15

What is the MOA of Spironolactone and Eplerenone?

Answer 15

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

Question 16

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

Answer 16

They are potassium sparing!!

Question 17

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

Answer 17

• They are weak diuretic agents

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

Question 18

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

Answer 18

Eplerenone

Question 19

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

Answer 19

Gynecomastia

Elevated K+ (Spironolactone)

Question 20

The B Blockers used for heart failure include which drugs?

Answer 20

Carvedilol

Metoprolol

Question 21

What is the MOA of beta blockers?

Answer 21

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

Question 22

What is the site of action of the Beta blockers?

Answer 22

Heart

Kidney

Question 23

What are the major contraindications of beta blockers?

Answer 23

Asthma
Hypotension
HR

Question 24

Which of the metoprolol are used in heart failure?

Answer 24

Met Succinate

More convenient. Only has to be taken QD

Question 25

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

Answer 25

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

Question 26

What may be masked in Metoprolol?

Answer 26

hypoglycemia

Question 27

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

Answer 27

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

Question 28

What else is blocked by carvedilol?

Answer 28

Norepinephrine - additive effect of lowering blood pressure

Question 29

What is reduced by carvedilol?

Answer 29

Peripheral vascular resistance

Question 30

What are some dosing considerations and precautions of beta blockers?

Answer 30

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

Question 31

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

Answer 31

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

Question 32

What is the indication for the use of Aldosterone agonists?

Answer 32

``` Excessive aldosterone excretion HF HTN hypokalemia liver cirrhosis with edema/ascites nephrotic syndrome ```

Question 33

What are the indications for Metoprolol?

Answer 33

- HF (duh) (but only met succinate) - Angina - HTN - hemodynamically stable AMI

Question 34

What are the indications for the use of Carvedilol?

Answer 34

- HF - HTN - Angina (off label) - Stable post-MI

Question 35

What loop diuretic has the greatest risk for hypokalemia?

Answer 35

Furosemide

Question 36

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

Answer 36

Furosemide

Question 37

How can Torsemide be administered?

Answer 37

IV and PO - equally effective IV | What is the drug class?? Loop Diuretic