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CVS II Drugs Used in Angina Pectoris > Heart Failure Drugs > Flashcards

Heart Failure Drugs Flashcards

1
Q

What is the goal of Treatment of Heart Failure?

A

1.Drugs that increase contractility
2.Drugs that decrease preload
3.Drugs that increase afterload
4.Drugs that reduce edema

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2
Q

What are the drugs used for HF? (There are five different classes)

A

1.Positively Inotropic drugs Digitalis Glycoside: Digoxin Adrenoreceptor Agonist: Dobutamine Phosphodiesterase inhibitors: Milrinone
2. Vasodilators
ACE Inhibitors: Enalapril, Lisinopril ARB: Valsartan, Candesartan Other Vasodilators:
Hydralazine, Isosorbide, Nesiritide
3. Aldosterone Antagonists Spironolactone, Eplerenone
4. Beta Adrenoreceptor Blocker: Carvedilol, Metoprolol, Bisoprolol
5. Diuretic
Furosemide, bumetanide and torsemide

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3
Q

Irene came with decrease in heart contractility. What drug will you give her and what is the MOA?

A
  1. Digoxin also known as cardiac glycosides
    Mechanism of Action:
    It inhibits the Na+/K+ ATPase pump
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4
Q

What is the direct and indirect of Digoxin?

A

Direct Effect:
Inhibits Na+/K+ ATPase pump leading to increase intracellular Na+ Ca++ Force of contraction
AV node digoxin decreases conduction velocity

Indirect Effect:
Inhibition of Neuronal Na+/K+ ATPase: 1.Activates cholinergic system Heart rate 2.Activates sympathetic system Contractility

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5
Q

What is the clinical use of Digoxins

A

1.CHF
2.Supraventricular tachycardia except WPW syndrome

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6
Q

Digoxin is displaced by what other drugs

A

Amiodarone, Propafenone, Quinidine and verapamil

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7
Q

What is the side effects of Digoxin

A

GI: Anorexia, nausea, vomiting and diarrhea
CNS: Headache, disorientation and visual halos
CVS: PVCs, AV block, sinus bradycardia and Inverted T waves

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8
Q

Digitalis Toxicity:

A

Triggered by:
Hypokalemia, hypomagnesemia, and hypercalcemia

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9
Q

What is the Antidote to digitalis Toxicity:

A

DigiFab (digibind)
Supportive therapy (electrolytes and antiarrhythmic drugs)

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10
Q

Drugs that cause Digitalis toxicity:

A

Loop diuretics, thiazide diuretics, quinidine, verapamil NSAIDS, amiodarone, and erythromycin

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11
Q

What are Bipyridines, clinical use?

A

Drugs ending in “rinone”
Inamrinone and Milrinone
Mechanism of action:
Inhibits PDE causing increase in cAMP——>Positive inotropy
increase in cGMP——>Vasodilation
Clinical use: Short term Rx of CHF Adverse effects: Hypotension Inamrinone: Thrombocytopenia

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12
Q

ER Treatment of Heart failure:

A

1.Sympathomimetic drug: Dobutamine
Indicated in acute decompensated heart failure
2. Diuretics: Loop and Thiazides
Reduction of congestion and edema
Spironolactone reduced mortality when combined with ACEI 3. ACE inhibitors: Lisinopril
4. CCB: Amlodipine and verapamil
5. BB: Carvedilol has proven to decrease mortality
Metoprolol increase survival in patients with CHF
6. Nesiritide: Recombinant B type natriuretic peptide (rhBNP) Increases cGMP leading to smooth muscle relaxation
Increases Natriuresis and decreases preload
Clinical use: To relieve dyspnea at rest in severe decompensated CHF

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13
Q

Pulmonary Hypertension and Core Pulmonale:

A

WHO classification of pulmonary HTN
Group 1: Idiopathic
Group 2: secondary to left-sided heart failure Group 3: Secondary to hypoxemia of lung diseases Group 4: Secondary to chronic thromboembolism Group 5: Secondary to other causes

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14
Q

Management of Pulmonary Hypertension

A

1.Treatment of underlying condition
2.CCB

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15
Q

Drugs used in Pulmonary Hypertension:

A

1.Endothelin Receptor Antagonists: Bosentan: Blocks ETa/ETb receptors Ambrisentan: Blocks Eta only Contraindicated in pregnancy
Side effects : Hypotension and flushing
2. PDE 5 inhibitors
Sildenafil and Tadalafil
Increase cGMP Vasodilation
3. Prostacyclin Analogs
Epoprostenol IV
Iloprost and Treprostinil given by inhalation
4. Oral soluble guanylate cyclase activator
Riociguat causing vasodilation

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16
Q

Pivotal drug for acute heart failure

A
  1. Carvedilol
  2. Furosemide
  3. Dobutamine
  4. Lisinopril
17
Q

Newly approved drugs in Heart Failure

A

Ivabradine
Sacubitril/Valsartan

18
Q

What is the drug for treatment of HF, MOA,

A

Use: Heart failure: Reduce the risk of hospitalization
For patients with EF< 35% in sinus rhythm with heart rate > 70 MOA: Inhibits F-channels with the SA-node leads to decrease (If) ion and reduce heart rate.

19
Q

Sacubitril/Valsartan MOA for HF?

A

Neprilysin inhibitor/ARB
Use: Heart failure in place of ACEI or ARB
MOA:
Sacubitril: Inhibits Neprilysin (neutral endopeptides) NEP leading to increase Natriuretic peptide
Valsartan: Direct antagonist of Angiotensin II receptors

20
Q

Electrophysiology of the Heart (List 4)

A

1.Responsiveness
Capacity of a cell to depolarize
Depends on the # of channels in ready state
2. Conductance
Rate of spread of an impulse (conduction velocity) Depends on Vmax, threshold potential and resting Membrane potential
3. Automaticity
Ability to spontaneously depolarize
4. Refractoriness
The inability to respond to a stimulus

21
Q

Class 1: ________ Channel blockers

A

Na+

22
Q

List of the drugs Class 1A

A

Quinidine, Procainamide and Disopyramide

23
Q

What is the anticholinergic effect and Alpha blocking effect of Quinidine

A

Anticholinergic effect: Increase heart rate and conduction Alpha blocking effect: Vasodilation and reflex tachycardia

24
Q

What is the side effects of Class 1A drugs

A

Cinchonism: Tinnitus, loss of hearing, GI upset, diplopia Increase QT interval (Torsades de pointes)
Displaces Digoxin from tissue binding sites VD Antacids will increase its absorption and toxicities

25
Q

What is the side effects of Procainamide, what class is it ?

A

Less anticholinergic
No alpha blocking activity
Active metabolite NAPA (N-Acetyl procainamide)

26
Q

In Class 1A is the most anticholinergic?

A

Disopyramide

27
Q

What are the Class IB?

A

Lidocaine, Tocainide, Mexiletine

28
Q

What class of drug of the Antiarrhythmia preference of ischemic tissue

A

Class IB

29
Q

Winnie the Pooh comes in to ER with Vtac after MI what do you give him and what is the side effects?

A

Lidocaine

Adverse effects:
Drowsiness
Paresthesia
Convulsions in toxic doses

30
Q

What is the name of the drugs in Class IB, which ones are orally given?

A

Lidocaine
Tocainide orally
Mexiletine orally

31
Q

What class of drugs is Flecainide, Propafenone, Moricizine, MOA, clinical sue, and side effects

A

Class IC
Work on both Na+ Channels
Marked decrease of Vmax, but no effect on APD
Clinical use:
Life threatening Vtac and Vfib Refractory SVTs
Adverse effects:
Proarrhythmic effect: can worsen existing arrhythmia Can increase in sudden death and cardiac arrest
by decrease LV function after MI

32
Q

What are Class II drugs, MOA, clinical use, side effects?

A

Class II: Beta Blockers
Metoprolol, Propranolol, Acebutolol and Esmolol
SA and AV nodal conduction
Decrease the slope of phase 4 depolarization
Clinical use:
Prophylaxis for ventricular arrhythmias Post MI Rx of SVTs
Adverse effects:
Proarrhythmic: can cause AV block
Esmolol has a t1/2 of 8 minutes Given IV for emergency Rx of SVT

33
Q

What are class 3 Antiarrhythmic drug, MOA, Clincial use, side effects

A

Amiodarone, Dofetilide, Ibutilide, Sotalol, dronaderone
APD and ERP
Prolong repolarization and lengthen Phase 2
Amiodarone
Mimics Class 1, 2, 3, and 4
Binds to Na+ Channel (inactivated)
Blocks K+ and Ca++ channels Non-competitive inhibitor of Beta receptors Long t1/2: 25 – 60 days
Clinical use:
Atrial fibrillation Ventricular Tachycardia Adverse effects:
Pulmonary fibrosis
Hepatotoxicity
Smurf skin (bluish discoloration of skin) Hypothyroidism 5% and Hyperthyroidism 25 May cause Torsades de pointes

34
Q

Selectively block outward potassium channel Ibutilide and Dofetilide?

A

Selectively block outward potassium channel called delayed rectifier potassium channels.
Prolong Ventricular Repolarization and increase the QT interval
Used for pharmacological cardioversion of atrial fibrillation and flutter

35
Q

Which class 3 drug is a beta and K+ blocker, clinical use, side effects

A

Sotalol
Beta blockers and K+ channel blocker
Class 2: Decrease heart rate and AV conduction Class 3: Prolongs APD and ERP
Clinical use:
Atrial fibrillation and life-threatening Ventricular arrhythmias
Adverse effects
Torsades de pointes
Headache, depression and impotence Caution with asthmatics

36
Q

What class 4 Antiarrhythmic? Clinical use? Side effects, MOA?

A

Diltiazem and Verapamil
SA and AV nodal conduction Slope of phase 4
Clinical Use: PSVT due to AV nodal re-entry
Adverse effects:
Orthostatic hypotension Reduce cardiac output Lower extremity edema Constipation
Verapamil displaces digoxin, increasing its toxicity Proarrhythmic AV block if used with beta blockers Caution: Atrial tachycardia due to WPW

37
Q

What is adenosine MOA, clinical use, side effects

A

Adenosine
Miscellaneous drugs
Rapid acting AV nodal blocker when given IV T1/2 is less that 30 seconds
Adenosine receptors:
A1: Gi coupled, decrease SA, AV nodal rate A2a: Gs-coupled, vasodilate
A2b: Gq-coupled, bronchoconstriction
Clinical use: Drug of Choice for PSVT Antagonist: Theophylline
Adverse effects:
Flushing, shortness of breath, burning sensation in the chest.

38
Q

What is the digoxin use for

A

Digoxin
Used in heart failure
Control ventricular rates in afib and aflutter.
Torsades de pointes
Arrhythmias caused by drugs that cause prolongation of QT intervals such as Amiodarone, quinidine, sotalol, thioridazine And Tricyclic antidepressants
Management
1.Discontinue the offending drug
2.Administer magnesium sulfate and potassium

CVS II Drugs Used in Angina Pectoris (18 decks)

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