Heart Failure Drugs Flashcards
What is HF?
A pathological condition where the heart is unable to pump blood in sufficient amounts from ventricles to meet the body’s metabolic needs
What are the syndromes of HF
Failure of ventricle to eject blood
Fluid overload
Chamber dilation
Elevated intracardiac pressure
What are the symptoms of left sided HF? (lungs)
Pulmonary edema
Coughing
SOB
Dyspnea
What are the symptoms of right sided HF?
Systemic venous congestion
Pedal edema
JVD
Ascites
Hepatic congestion
What are the 2 primary causes of HF?
Myocardial deficiency
Increased workload
What conditions fall under myocardial deficiency and what specific categories (2)?
Inadequate contractility:
MI, CAD, Cardiomyopathy, Valvular insufficiency
Inadequate filling:
A-fib, Infection, tamponade, ischemia
What conditions fall under increased workload and what specific categories (2)?
Pressure overload:
Pulmonary and systemic HTN, Outflow obstruction
Volume overload:
Hypervolemia, congenital abnormalities, anemia, thyroid disease, infection, diabetes
Describe the 4 classes of HF
1:
No physical activity limitations
2:
Ordinary physical activity results in fatigue, dyspnea, etc.
3:
Marked limitation in physical activity
4:
Symptoms at rest or with no activity
What is the difference b/w positive inotropic, chronotropic and dromotropic?
I: Increase the force of myocardial contraction
C: Increase HR
D: Speed up cardiac conduction
What are the drugs of choice for early treatment of HF?
ACE inhibitors: Lisinopril
ARBs: Valsartan
B-blockers: Metoprolol
Positive inotropic drug: Dobutamine
T/F: Digoxin is given before these drugs
False; digoxin is given AFTER the drugs of choice
How does lisinopril help w HF, what are its ID and AE
Causes diuresis which decreases preload and the work of the heart
ID: HF, HTN, Acute MI
AE: Dry cough, hyperkalemia, decreased renal function
Why is valsartan (ARB) preferred over lisinopril (ACE i)
ARBs are less likely to cause a dry cough and hyperkalemia
How does spironolactone help w HF?
It’s a K-sparing diuretic that is shown to reduce the symptoms of HF
T/F: ARBs decrease preload and ACE i decrease afterload
False: ARBs = afterload
ACE = Preload
What are phosphodiesterase inhibitors?
Inhibit phosphodiesterase resulting in:
Intracellular increase in cAMP
Positive inotropic responses
Vasodilation
Increase in Ca for myocardial muscle contraction
What is the only available phosphodiesterase inhibitor in canada?
Milrinone
What is milrinone? (AE, forms, IE)
Only injectable
AE: Dysrhythmias, hypotension, angina, hypokalemia, tremor, thrombocytopenia
IE: Diuretics and digoxin
Name a cardiac glycosides and it’s ID
Digoxin
Used in HF and to control ventricular response to a-fib
What is the MOA of digoxin?
Increase myocardial contractility
Change electrical conduction properties of the heart
Decrease the rate of electrical conduction
Prolong the refractory period
What are the tropic effects of cardiac glycosides ?
+ve inotropic effect: Increased force and velocity of myocardial contraction
-ve chronotropic effect: Reduced HR
-ve dromotropic effect: Decreased automaticity at SA node, decreased AV nodal conduction
What are other drug effects of cardiac glycosides?
Increased stroke volume
Reduction in heart size during diastole
Decrease in venous BP and vein engorgement
Increase in coronary circulation
Decrease in exertional and paroxysmal nocturnal dyspnea, cough and cyanosis
Promotion of perfusion and diuresis
What is a consideration regarding the therapeutic window of digoxin?
Very narrow
Low K levels increase its toxicity
What is the optimal drug level of digoxin?
0.8 - 2 ng/mL
