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Pharm CPR > Heart Failure Drugs > Flashcards

Heart Failure Drugs Flashcards

1
Q

HFpEF leads to 4 things:

A
  1. Poor tolerance of Afib because no atrial contraction, this drops filling
  2. Poor tolerance of tachycardia because cannot fill
  3. Worsened by increased MAP
  4. “Flash” PE LIFETHREATENING and increases LA pressure
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2
Q

Eccentric hypertrophy is associated with

A

volume overload

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3
Q

Concentric hypertrophy is associated with

A

pressure overload

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4
Q

What is the general treatment option for treating heart failure?

A
  1. Remove and correct cause
  2. Prevent deterioration of cardiac function through drugs
  3. Control CHF state through diet, exercise, diuretics, vasodilators and digoxin
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5
Q

Less AII leads to:

A
  1. Less vasoconstriction leading to less afterload
  2. Less aldosterone secretion and less sodium/water retention to drop preload
  3. Less cell proliferation and remodeling
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6
Q

What are the two longer half life ACE inhibitors?

A

Benazepril and Lisinopril

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7
Q

Captopril is used to treat (3)

A
  1. HTN (add thiazide or loop diuretic if need more lowering)
  2. HFreEF
  3. Diabetic nephropathy
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8
Q

The the three adverse reactions of captopril:

A
  1. Angioedema
  2. Cough
  3. Fetal toxicity
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9
Q

What two drugs cause fetal toxicity?

A

Losartan and Captopril

Lose a Captain - losing a father

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10
Q

This ARB does not need activation

A

Valsartan - not a prodrug, excreted in feces as unchanged

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11
Q

This ARB has irreversible binding

A

Candesartan

Candy is irreversible

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12
Q

If ACEi don’t work for HF we use this drug

A

ARB

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13
Q

Patient has LV systolic failure. When would we want to avoid giving this drug?

A

Give ARB/ACEi UNLESS:

  1. Not tolerated (cough, angioedema)
  2. Pregnant (fetal toxicity)
  3. Hypotensive
  4. Serum creatinine > 3 mg/dL
  5. Hyperkalemia
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14
Q

This drug is used to reduce risk of CV death and hospitalization in patients with Class II-IV chronic heart failure with reduced EF

A

Valsartan/Sacubitril (which inhibits neprilysin)

Adverse effect: angioedema

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15
Q

This drug used for recent hx of MI or ACS and reduced EF, or HFrEF to prevent symptomatic HF

A

Carvedilol

Caveat: ONLY STABLE PATIENTS

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16
Q

MOA Carvedilol

A

Prevent downregulation of B1 adrenergic receptors to keep heart responsive to sympathetic stimulation during heart failure and drop renin secretion and limit remodeling

C is unique because it’s an inverse agonist

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17
Q

This drug should be given with ACEi to all patients with LV systolic dysfunction caused by MI to reduce mortality

A

B blockers

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18
Q

What is the warning of B blockers?

A

Don’t abruptly withdraw, gradually taper

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19
Q

When should we administer B blockers

A

LVEF < 40%, all patients with symptomatic CHF

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20
Q

What are your contraindications for B blockers?

A

Bronchospastic disease or heart block or bradycardia

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21
Q

If B blockers are contraindicated or are simply not working in HF, what do we give?

A

Ivabradine - This drug is given to patients with stable, symptomatic chronic heart failure with LVEF < 35%

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22
Q

What is the MOA of Ivabradine?

A

Prolong diastole and slows HR through inhibition of the hyperpolarization activated HCN Channels

23
Q

This drug reduces fibrosis in HFrEF and post-MI HF

A

Spironolactone

24
Q

What is a “better” post-MI treatment?

A

Eplerenone

25
Q

This drug is similar to furosemide but has more predictable oral absorption

A

Bumetanide

26
Q

This drug is similar to furosemide with longer t1/2, better oral absorption, works better in heart failure

A

Torsemide

27
Q

What can make K+ loss worse in loop diuretics?

A

Digoxin use

28
Q

What drug can make hearing loss worse in diuretics?

A

Gentamicin

29
Q

Protocol to relieve congestion’?

A
  1. Loop diuretic first
  2. K+ sparing diuretic if needed
  3. Thiazide added last for more diuresis
30
Q

What is the difference between furosemide and thiazides?

A

Furosemide actually works if you have low GFR, thiazides don’t

31
Q

What is metolazone used for?

A

Long acting thiazide diuretic used for adjunct diuretics in CHF (cardiologist favorite)

32
Q

What are causes of diuretic failure in HF treatment?

A
  1. Nonadherence to medical regimen
  2. Decreased GFR or decreased renal perfusion
  3. NSAIDs b/c antagonize diuretic effects
  4. Renal pathology
  5. Impaired diuretic absorption
33
Q

What is the first ever drug made for one racial group?

A

Hydralazine to dilate arteries and decrease afterload

African Americans

34
Q

This drug is used for treatment or prevention of angina pectoris OR acute decompensated heart failure esp. if acute MI involved

A

Nitroglycerin

35
Q

This drug is used for moderate to severe hypertension but not iNITIAL treatment for hypertension

A

Hydralazine

36
Q

What vascular structure is hydralazine used for?

A

Arterioles

37
Q

Is Digoxin safe in pregnancy?

A

yes SVT patients have long taken it

38
Q

What do we use digoxin for?

A
  1. To control CHF state in patients with chronic atrial fibrillation AND increase MI contractility in heart failure peds and adult patients
39
Q

Does digoxin need a loading dose?

A

Yes

40
Q

How does digoxin cause a positive inotropic reaction?

A

Blocks Na+/K+ ATPase pump which makes Na+ stay in cell and brings in more Ca2+ to increase contraction

41
Q

What are the electrophysiological effects of digoxin?

A

Uncouple atria from ventricles and make regular cardiomyocytes more twitchy and prone to arrhythmias

42
Q

Explain on an EKG reading what therapeutic digitalis looks like vs. toxic

A

Therapeutic: scooped ST segment
Toxic: (AV block) AV dissociation and lack of relationship between P and QRS … also bigeminy (ectopic ventricular beats)

43
Q

What must be normal before giving digoxin?

A

HR

44
Q

What is the BIGGEST contraindication to digoxin?

A

Diuretics = can cause hypokalemia that leads to increased digoxin binding and increased digoxin toxicity

45
Q

What is the strategy to treat HFrEF?

A
  1. ACEi or ARBs or ARNI
46
Q

What are the diagnostics for ADHF?

A
  1. Obtain ECG
  2. Obtain portable chest radiography
  3. Obtain CBC, troponin, electrolytes, BUN/creatinine, LFT, BNP if uncertain
  4. Besides ECG maybe?
47
Q

How do we monitor ADHF?

A 
Place in seated position
Continuous Oxygen and pulse ox monitoring
Continuous cardiac monitoring
2 IV lines
Monitor urine output
48
Q

What therapy do we initiate with ADHF?

A

Diuretics

49
Q

We treat ADHF with loop diuretics and vasodilators UNLESS

A

Hypotensive, then we just give loop diuretics

50
Q

Assume you have symptomatic hypotension with end-organ dysfunction despite adequate filling pressure… what do we give as a short term rescue?

A

Sympathomimetics: dobutamine (B1) and dopamine (B1, A)

Please discontinue carvedilol because it blocks A receptors (esp. if severe decompensation, we can continue if no hypotension)

51
Q

This is a bridge therapy drug in patients that await heart transplant or mechanical circulatory support

Palliative therapy in ADHF

Cardiogenic shock

A

IV admin of Dobutamine in the hospital

52
Q

This is used as inotropic therapy for patients unresponsive to other acute heart failure therapies like dobutamine

A

Milrinone

53
Q

This drug is used as an adjunct in the treatment of shock and cardiac decompensation

A

Dopamine

54
Q

What drugs do we want to AVOID in heart failure?

A
  1. Class 1 antiarrhythmics because negative inotropic and cause arrhythmia
  2. CCB = suppress contractility
  3. NSAIDs impair renal salt and water excretion to make HF worse

Pharm CPR (9 decks)

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