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Pharm > Heart Failure Drugs (12c) > Flashcards

Heart Failure Drugs (12c) Flashcards

1
Q

What group of people are not as benefitted by the use of ACE inhibitors?

A

Afro-Americans

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2
Q

All patients with _____ _____ _____ should be started on ACE inhibitors

A

Left Ventricular Dysfunction

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3
Q

What is an important thing to know about the use of ACEIs in patients with heart failure?

A

They improve the symptoms and survival

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4
Q

What are the ACEIs

A

Captopril Lisinopril Fosinopril

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5
Q

What is the site of action of the ACEIs?

A

Renal Renin-Angiotensin

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6
Q

The MOA of ACEIs

A

Inhibit conversion of Angiotensin I into Angiotensin II, lowering arteriolar resistance and increasing venous capacity, cardiac output and volume Also Lower renovascular resistance

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7
Q

The ACEIs reduce _______ and ________

A

after load and preload

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8
Q

By reducing Afterload, the ACEIs are enhancing what?

A

Stroke volume and ejection fraction

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9
Q

By reducing preload, the ACEs decrease what specifically?

A

Pulmonary and systemic congestion and edema

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10
Q

What are the target doses of the ACEI drugs?

A

Enalopril - 20mg BID Captopril 50mg TID Lisinopril 40 mg QD

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11
Q

How often can you increase the dose of ACEs (as long as the patient remains stable)?

A

Every 2 weeks

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12
Q

What are the major ADR for ACEIs and are therefore contraindicated?

A

Cough Angiogenic Edema!!!

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13
Q

What labs should be monitored on patients on ACEIs?

A
  • Creatinine and K+ within 2 wks of initiation and after increased dose - Then in 3-4 wks if stable - Then 1x to 2x per year unless Cr changes
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14
Q

What are contraindications to ACEIs?

A

Pregnancy (Teratrogenic) Renal Artery stenosis

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15
Q

What is responsible for the cough caused by ACEIs?

A

Increased Bradykinin

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16
Q

What drugs can you not use with ACEIs?

A

ARBs Aliskirin

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17
Q

What do you need to watch for when starting ACEIs?

A

first dose hypotension

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18
Q

What are the indications of ACEIs?

A

HTN

HF

Left Ventricular dysfunction after MI Diabetic nephropathy

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19
Q

What is the Angiotensin Receptor Blocker that we will prescribe?

A

Losartan

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20
Q

What is the site of action of ARBs?

A

Smooth muscle cells of blood vessels

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21
Q

What is the MOA of ARBs?

A

Blocks Angiotensin 1 and Angiotensin 2 receptors, relaxing smooth muscle cells and dilating blood vessels which ini turn causes decreased BP

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22
Q

When do you use ARBs over ACEIs?

A

In patients who can’t tolerate ARBs

Afro-americans

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23
Q

Can you take ARBs and ACEIs together?

A

NO!!

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24
Q

What are adverse side effects of ARBs?

A

Diarrhea

Muscle cramps

Dizziness

Cough (although not as much as ACEIs)

Increased K+

Impotence

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25
Q

Contraindications of ARBs

A

Pregnancy

Severe renal disease

Elevated K+

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26
Q

What is losartan used for?

A

HTN

diabetic nephropathy in T2DM

Stroke risk reduction in HTN

LVH

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27
Q

Losartan blocks which angiotensin with a greater affinity?

A

Angiotensin 1 (1000x greater)

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28
Q

What drugs should you not use with ARBs?

A

Direct renin inhibitors

ACEI

Aliskerin

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29
Q

Losartan increases the excretion of what compound?

A

Uric Acid! Additive benefit for gout pts

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30
Q

What are the Vasodilator drugs used for Heart Failure?

A

Dihydropyridine Ca++ channel blockers Hydralazine/Isosorbide Dinitrate

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31
Q

What is important to remember about amlodipine in regards to HF?

A

That is is not used directly for HF, but it is used in HF patients for treatment of angina and HTN

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32
Q

Can you use Non-dihydropyradines for HF?

A

NO!! They decrease cardiac contractability

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33
Q

What is the site of action for the DCCBs?

A

Vascular smooth muscle

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34
Q

What is the MOA for the DCCBs?

A

Blocks Ca++ channel, decreasing/preventing contraction resulting in vascular relaxation and decreased Total peripheral resistance - Vasodilation of the coronary arteries

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35
Q

What are some adverse effects of CCBs? (only at high doses)

A
  • Increased mortality in patients post-MI - High doses increase risk of AMI
36
Q

Indications for Amlodipine?

A

Angina

HTN

Can be used in Patients with HF with HTN/angina

37
Q

What is a major contraindication for Amlodipine?

A

Recent AMI

38
Q

What does amlodipine do?

A

Vasodilates coronary arteries

39
Q

The combination drug used for HF is what?

A

BiDil - hydralazine + Isosorbide dinitrate

40
Q

What is the site of action for BiDil?

A

Vascular smooth muscle

41
Q

What does BiDil do specifically in Heart failure?

A

It reduces the after load and strongly reduces the peripheral resistance

42
Q

What group of people is BiDil highly recommened in?

A

Afro-americans

43
Q

What are some adverse effects caused by BiDil?

A

Elicits a reflex sympathetic stimulation of heart

Loss of appetite

Diarrhea/HA

44
Q

What are the contraindations to Hydralazine?

A

CAD

Mitral Valve Rheumatic HD

45
Q

What can Hydralazine cause?

A

Lupus!

46
Q

What drug is the DOC for tx of hypertensive emergency in preganc women?

A

Hydralazine

47
Q

What is the MOA of Hydralazine?

A

Diract acting arteriolar vasodilators

48
Q

What are the indications for the use of BiDil?

A

Adjunctive tx of HF, esp in afroamericans

49
Q

What type of agent is Digoxin?

A

Positive Inotropic agents: Cardiac Glycosides

50
Q

Cardiac glycosides have a propensity to cause _______ changes

A

EKG

Prolonged PR interval

Inverted T wave

ST segment Depression

Shortened QT interval

51
Q

What is the MOA of digoxin?

A

Inhibits Na/K ATPase pump in myocardial cells promoting influx Ca++ leading to increased contractility

Also, direct suppressor of AV node decreases ventricular rate

52
Q

The cardiac glycososides increase _______ tone, resulting in slowed HR

A

Vagal

53
Q

True or false: carciac glycosides should be used for the initial tx of acute HF

A

False!

54
Q

What may happen as a result of using Cardiac glycosides, specifically as a result of increasing intracellular calcium

A

Arrhythmias, specifically PVCs

55
Q

Can you use Beta blockers with digoxin?

A

You can, but you should try to avoid it if possible

56
Q

What are some side effects of using digoxin?

A

Delirium

Visual disturbances

AV Block/EKG changes

Toxic psychosis

57
Q

What is an interesting fact about the glycosides regarding how long they have been used and where they originate from?

A

3000 years!

Milkweed, Lily of valley, foxglove, Oleander

58
Q

What is Digoxin indicated for?

A

Mild to Moderate HF

Afib control

59
Q

Digoxin causes an influx in what Ion, leading to increased contractility?

A

Ca++

60
Q

Why should Digoxin be avoidedin the elderly?

A

Can have a proarrhythmic effect

61
Q

The positive Ionotropic Agents that are B agonisits includes what drug?

A

Dobutamine

62
Q

When do you use Dobutamine?

A

NOT recommended in acute HF, but it is still used in critical situations

Gives End stage HF patients improved Quality of life while awaiting transplant

63
Q

What are the adverse effects of Dobutamine?

A

Cardiac arrhythmia

Precipitate angina in patients with CAD

64
Q

What is Dobutamine used for?

A

Short term managment of cardiac decompensation

65
Q

What is the MOA of Dobutamine?

A

Stimualtes B1 adrenergic receptors increasing cardiac contracility and HR

Little impact on B2/alpha receptors

66
Q

Dobutamine should not be used in patients who have a history of what type of allergery?

A

Sulfa

67
Q
A
68
Q

How do you administer Dobutamine?

A

IV

69
Q

What is the Positive Ionotropic Agent PDE inhibitor?

A

Milrinone

70
Q

What is the MOA of Milrinone

A

Incrases cAMP in heart and vascular muscle, positive inotrope and vasodilator

71
Q

Why do you use Milrinone?

A

For Refractory HF to improve quality of life in end stage disease

72
Q

Milrinone is contraindicated when?

A

AMI

Severe obstructive/pulmonic valv disease

73
Q

How do you administer Milrinone?

A

IV

74
Q

What are side effects of Milrinone?

A

Hypotension

Arrhythmias

75
Q

Nesiritide is what class of drug?

A

B-type naturetic peptide (BNP)

76
Q

When do you use Nesiritide

A

Acutely decompensated HF with dyspnea at rest or with minimal activity

77
Q

What is the MOA of Nesiritide

A

Increases intracell GMP in vasc smooth muscle cells and endothilium causing smooth muscle relaxation and reducing Pulm cap wedge pressure and systemic arterial pressure

78
Q

Side effects of nesiritide include…?

A

Hypotension, increased serum creatinin, arrhythmias

79
Q

What is the direct renin inhibitor drug

A

Aliskiren

80
Q

How does aliskerin work?

A

It directly inhibits renin, lowering BP

(blocks conversion of angiotesinogen to angiotensin 1, reducing conversion to angiotesin II, producing arteriolar vasodilartion

81
Q

In what patients should you not use Aliskirin?

A

DM or Renal disease

82
Q

Why do you prescribe aliskirin?

A

For the Tx of hypertension

83
Q

Ivabradine is used for what?

A

HF in patients with EF of <35% who are on max tolerated Bblocker dose/unable to take Bblocker

Off label for angina

84
Q

Ivabradine is contraindicated in which patients?

A

Severe hepatic disease

85
Q

What do you need to monitor occurance for in patients who take Ivabradine?

A

Visual changes - May see peripheral floaters

86
Q

What is Ivabradine contraindicated in?

A

Acute Decomensated HF

SSS

Low BP

Low HR

Pacemaker

Hepatic impairment

87
Q
A

Pharm (12 decks)

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