Heart Failure Drugs Flashcards
long term, this drug decreases myocardial fibrosis
spironolactone
eplerenone
a prodrug, rapidly metabolized to active compound that reduces Na reabsorption
spironolactone
eplerenone
spironolactone may cause hyperkalemia when combined with what drugs?
ace inhibitors
digoxin
decreases mortality in CHF even at low doses that do not diurese
spironolactone
eplerenone
side effect = gynecomastia
spironolactone
eplerenone
decreases preload and afterload
captopril
enalapril
side effect: angioedema, cough
captopril
enalapril
which of these is a prodrug: captopril or enalapril
enalapril
protects against severe cardiac remodeling
ACEIs and ARBS
toxic to fetus
ACEIs and ARBS
bilateral renal artery stenosis is a contraindication
ACEIs and ARBS
degrades ANP, BNP, CNP
Neprilysin
enhances ARBs by blocking neprilysin and AT1 receptor
ARNI
Sacubitril/Valsartan
adverse effects: hypotension, angioedema, cough
Sacubitril/valsartan
Drugs that interact with ARNIs, causing angioedema
ACE inhibitors
beta-1 selective blocker
metoprolol
decreases after load, preload, heart rate, contractility, conduction velocity
beta blockers
beta-nonspecific > alpha-1 blocker
carvedilol
abrupt discontinuation of this drug may cause severe angina/MI
carbedilol
use with caution in asthmatics
carvedilol
contraindicated in decompensated CHF
beta blockers
contraindicated in sick sinus syndrome and 2nd and 3rd degree AV block
beta blockers
ivabradine
block adrenergic stimulated adverse remodeling of myocardium
beta blockers???
if beta blockers combined with Ca channel blockers
severe hypotension
hyperpolarization-activated cyclic nucleotide gated channel blocker
(the If channel on SA node)
ivabradine
adverse effects of ivabradine
Afib
bradyarrythmias
visual disturbances
metabolized by CYPs
ivabradine
for what patient might you try ivabradine?
someone with stable, symptomatic CHF, EF <35%, HR>70, maxed out on beta-blockers
unclear mechanism that dilates arterioles and decreases afterload
hydralazine
improves morbidity and mortality in African Americans with CHF
BiDil (isosorbide denigrate + hydralazine)
prodrug releases NO, causing vasodilation
veins (decrease preload)»_space;> arteries (decrease after load)
isosorbide dinitrate
need dose free period (14 h/d) to prevent tolerance
isosorbide dinitrate
causes severe hypotension if combined with phosphodiesterase-5 inhibitors (Viagra)
isosorbide dinitrate
contraindicated in CAD
hydralazine
could enhance side effects of beta-blockers
hydralazine
PDE-3 inhibitor
milrinone (IV)
increases Ca+ to increase contractility
increases artery vasodilation to decrease afterload
milrinone (IV)
short term (<48 h) use in acute decompensated HF
milrinone
cardiac glycoside
digoxin
inhibits Na/K ATPase pump to increase intracellular Ca+ in myocytes
digoxin
increases vagal tone to decrease HR
digoxin
risk of toxicity if combined with spironolactone
digoxin
antibiotics increase bioavailability, and it has a low therapeutic index
digoxin
indications: CHF, Afib
no mortality benefit
digoxin
