Heart failure drugs

Question 1

treatment of choice post-infarct

Answer 1

beta blocker

Question 2

how does a beta blocker benefit in heart failure

Answer 2

decrease adverse effect of SNS

decreased cardiomyocyte apoptosis and cardiac remodelling

Question 3

carvediolol blocks alpha and beta receptors, how is this useful

Answer 3

alpha relaxes arteries and does not have to work as hard to eject blood
beta slows the heart and decreases force of contraction

Question 4

what does metoprolol inhibit

Answer 4

selectively blocks beta1 receptors

Question 5

in what diseases should you avoid use of a beta blocker

Answer 5

asthma
COPD
peripheral vascular disease
diabetes
physically active

Question 6

what disease states are beta blockers good for

Answer 6

hypertension 
glaucoma
arrhythmia 
MI 
angina

Question 7

define inotropes

Answer 7

agents which alter the force of contraction of the heart

Question 8

what do digoxin and dobutamine do

Answer 8

increase contractility of the heart to treat symptoms

Question 9

which rout is dobutamine given

Answer 9

IV

Question 10

cautions with dobutamine and digoxin

Answer 10

may increase heart rate and myocardial oxygen consumption and blood pressure aggravating ischemia and arrhthymias causing increased risk of mortality

Question 11

how does dobutamine increase contractility

Answer 11

stimulates beta 1 receptors

Question 12

how does digoxin increase heart contractility

Answer 12

blocks Na/KATPase causing an increased intracellular sodium concentration so less pumping out of calcium by Ca/NaATPase

Question 13

what must you monitor when using digoxin

Answer 13

potassium levels, may causehypokalemia

Question 14

which meds can increase blood levels of digoxin and result in cardaic arrhythmias

Answer 14

antibiotics

amiodarone

Question 15

what do patients with heart failure need diuretics

Answer 15

help the kidney deal wiht fluid overload of edema

Question 16

what happens in the proximal tubule

Answer 16

reabsorbs all glucose and amino acids
most of sodium
water passively follows

Question 17

what happens in the ascending loop of henle

Answer 17

impermeable to water

na/k/cl reabsorbed by transporter

Question 18

what happens in distal convoluted tubule

Answer 18

impermeable to water

na and cl reabsorbed

Question 19

what happens in collecting tubule and duct

Answer 19

reabsorb sodium and water from the urine and secrete potassium

Question 20

what are thiazides primary site of action

Answer 20

inhibit Na/Cl transporter in the distal tubule causing increased sodium excretion and decreased calcium excretion

Question 21

problems wiht thiazides

Answer 21

hypokalemia 
hyperglycemia 
increased LDL
erectile dysfunction
volume contraction 
interact with amiodarone

Question 22

uses of thiazides

Answer 22

edema and hypertension

Question 23

advantages of thiazides

Answer 23

orally active
not postural hypotension
potentiate other anti-hypertensives

Question 24

different effect on calcium in thiazide compared to loop

Answer 24

thiazide decreases urinary excretion of Ca, loop increases it

Question 25

where are loop diuretics primary site of action

Answer 25

inhibit Na/K/Cl cotransporter in the ascending loop of henle

Question 26

what electrolyte secretions of increased with loop diuretics

Answer 26

Na
Cl 
K 
Mg
Ca

Question 27

problems with loop diuretics

Answer 27

deafness and kidney damage if combined wiht aminoglycoside antibiotics
interacts with amiodarone

Question 28

uses for loop diuretics and when theyre preferred

Answer 28

edema 
hypertension 
hypercalcemia
heart failure 
preferred in renal insufficiency

Question 29

how does spironolactone work

Answer 29

aldosterone receptor antagonist that causes decreased sodium reabsorption and increased potassium excretion

Question 30

problem with spironolactone

Answer 30

may cause hyperkalemia

Question 31

spironolactone prevents cardiac remodelling associated with what

Answer 31

high levels of aldosterone in heart failure

Question 32

difference between stage A,B,C,D

Answer 32

A -no limitation of physical activity
B - slight limitation of physical activity
C - marked limitation of physical activity
D - unable to carry on any physical activity without discomfort

Question 33

first step in treating heart failure

Answer 33

manage conditions that contribute

diet, physical activity, lifestyle

Question 34

which drugs should all be used in heart failure typical at the start

Answer 34

diuretic first if they have edema
ACEi
then beta blocker once stable

Question 35

what do you use in extreme heart failure

Answer 35

inotrope