Heart Failure Drugs Flashcards
tx for stage A
indications:
-Vascular disease, diabetes, hypertension
ACE inhibitors
ARB
tx for stage B
Indications:
1) Recent or remote MI, asymptomatic LVD, hypertensive LVH
2) Recent or remote MI, asymptomatic LVD
1) ACE inhibitor or ARB
2) beta-blocker
tx for stage C
Indications: All pt
Ace inhibitor or ARB
Beta blocker
tx for stage C
Indication: fluid retention
Diuretics
tx Stage C
Indication: Symptomatic LVD, post-MI HF, LVD
Aldosterone antagonist
tx stage C
Indication:
Symptomatic HF, African-American race
Hydralazine and nitrates
tx stage C
indication: symptomatic HF
ARB and ACEI
tx stage C
indication: symptomatic HF, a fib
digoxin
tx stage D
indication: All patients unless contraindicated or not tolerated
ACEI or ARB
tx stage D
indication:Stable NYHA class IV
beta blocker
tx stage D
indication: fluid retention
diuretics
tx stage D
indication: Atrial fibrillation with rapid ventricular response
digoxin
tx stage D
indication: Bridge to transplantation or end of life
positive inotropes
stage A
high risk developing HF
stage B
asymptomatic HF
stage C
symptomatic HF
stage D
refractory end-stage HF
drug to increase cytosolic Ca2+
increasing myocardial contractility
Cardiac glycosides - Digitalis (digoxin)
drug to Increase myocardial cAMP
increasing myocardial contractility
Phosphodiesterase inhibitors (Amrinone, Milrinone)
drug that is an agonist at beta1 receptor
increasing myocardial contractility
beta adrenergic agonists
(Isuprel, Dobutamine, Dopamine, Epinephrine, Norepinephrine)
drug that increases beta1 receptor density
increasing myocardial contractility
B1 adrenergic antagonist
Metoprolol and Carvedilol
MOA of digoxin
Block Na/K ATPase enzyme – will not get exiting of Na out of cell and get an increase in [Na+]; calcium stops moving out of cell as well –> increase contractility
cardiac effects of digoxin
- *Positive inotropic effect
- decrease EDV and ↓ESV
- ↓ pulmonary and systemic venous pressure
- reflex ↓SANS –> (↓preload, afterload & ↓HR)
- *Direct (+) vagal effect –>
- increase vagal tone –> decrease A-V conduction
- increase PR interval (longer ERP)
- ↓APD (shorter QT)
**↑coronary flow (↓hypertrophy)
- *Proarrhythmic
- ST depression (typical hockey stick)*
T1/2 of digoxin
36-48 hrs
digoxin:
Near steady-state blood levels are achieved____ days after initiation of maintenance therapy.
7
Digoxin is excreted by the 1 and is affect by rx that chage 2
- kidney
2. RBF
SE of digoxin
- Low margin of safety
- Electrolyte disturbances (hypokalemia) & acid-base dysbalance –> susceptibility to side effects –> monitor plasma K+
- Arrhythmias
- CTZ stimulation induces anorexia, nausea, vomiting
what is digoxin often used for
HF, especially CHF with AF ( no longer 1st line therapy)
how are adverse elvations in plasma digoxin corrected
cholestyramine
digoxin immune Fab (des-IgG) [Digibind®]–
- IV –> immediate onset of action
- clinical effects also reversed
cardiovascular effects of what drug?
1) Directly stimulate myocardial contractility
2) Accelerate myocardial relaxation
3. Balanced arterial & venous dilation
- -> decrease TPR, PVR, decrease LV, RV filling pressures
Imamrinone and Milrinone (phosphodiesterase 3 inhibitors)
what is imamrinone and milrinone approved for?
short-term circulation support in advanced CHF
MOA of inamrinone and milrinone
inhibit phosphodiesterase 3
increase cAMP
how does digoxin effect mortality rate
no effect
