Heart Failure Drugs

Question 1

therapeutic strategies for CHF?

Answer 1

1. remove retained salt and water with diuretics
2. reduce afterload and salt and water retention with ACE-Is
3. reduce excessive sympathetic stimulation with Beta Blockers
4. reduce preload or afterload with vasodilators
5. directly augment depressed cardiac contractility with positive inotropic drugs

Question 2

acute heart failure treatment

Answer 2

loop diuretic + prompt acting positive inotropes (beta agonists or PDE inhibitors) + vasodilators

Question 3

chronic heart failure treatment

Answer 3

diuretics (loops + spironolactone) + ACE-I + Beta blocker (if tolerated)
digitalis if with prominent systolic dysfunction

Question 4

cardiac glycoside
inhibits Na/K ATPase: increases intracellular Ca, increasing cardiac contractility
used for heart failure, nodal arrhythmias
side effect: NARROW THERAPEUTIC INDEX, ARRHYTHMIAS, VISUAL CHANGES

Answer 4

Digoxin
Digitoxin

also has reduced clearance with quinidine
arrhythmogenesis increased by hypokalemia, hypomagnesemia, hypercalcemia

Question 5

what drugs have narrow thereapeutic index?

Answer 5

Warfarin
Aminoglycosides
Lithium
Amphotericin B
Carbamazepine
Phenobarbital
Phenytoin
Vancomycin
Theophylline
Digoxin

Question 6

digitalis toxicity is increased by what states?

Answer 6

hypokalemia, hypomagnesemia, hypercalcemia

Question 7

treatment of digitalis toxicity

Answer 7

1. CORRECT POTASSIUM/MAGNESIUM DEFICIENT
2. ANTI-ARRHYTHMIC DRUGS: LIDOCAINE (Phenytoin as alternative)
3. DIGOXIN ANTIBODIES (Fab fragments; digibind)

Question 8

first line therapy for both systolic and diastolic failure

Answer 8

diuretics

Question 9

diuretic that immediately reduces pulmonary congestion and severe edema associated with acute heart failure

Answer 9

furosemide

Question 10

diuretics with significant long-term benefits and can reduce mortality in heart failure

Answer 10

spironolactone and eplerenone

Question 11

first line drugs for chronic heart failure

reduce morbidity and mortality in chronic heart failure

Answer 11

angiotensin antagonists

reduce aldosterone secretion, salt and water retention, and vascular resistance

Question 12

beta1-selective sympathomimetics apt for acute heart failure, but NOT appropriate for chronic heart failure due to tolerance, lack of oral efficacy, and significant arrhythmogenic effects

Answer 12

Dobutamine (b1 selective) and dopamine

Question 13

reduce progression of CHRONIC heart failure

Answer 13

beta blockers

carvedilol, labetalol, bisoprolol, nebivolol, metoprolol

Question 14

increase cAMP by inhibiting its breakdown by phosphodiesterase
increase intracellular Ca, vasodilation
should NOT be used in chronic failure because they increase morbidity and mortality

Answer 14

Phosphodiesterase inhibitors

Inamrinone, Milrinone

Question 15

drug for acute severe failure with congestion

dramatically effective in CHF due to increased afterload

Answer 15

Nitroprusside or Nitroglycerin

Question 16

shown to reduce mortality in African-Americans

Answer 16

hydralazine + ISDN

Question 17

used for acute decompensated failure
increases cGMP
BNP analog
HIGHLY NEPHROTOXIC

Answer 17

nesiritide

Question 18

drugs that improve survival in cases of heart failure

Answer 18

ACE inhibitors
Beta Blockers
Aldosterone Antagonists (K+ sparing diuretics)