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Specialized Pharmacology MN650 > Heart Failure Drugs > Flashcards

Heart Failure Drugs Flashcards

1
Q

LV heart failure is also known as?

A

a. HF with reduced ejection fraction (HFrEF)

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2
Q

Diastolic heart failure is also known?

A

a. HR with preserved LV ejection fraction (HFpEF)

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3
Q

What drugs are recommended for use in the treatment of HF?

A

a. Diuretics
b. RAAS inhibitors
c. B-blockers
d. Digoxin

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4
Q

What are the most common causes of LV heart failure?

A

a. CAD

b. HTN

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5
Q

Signs/symptoms of LV heart failure?

A

a. SOB
b. Orthopnea
c. Elevated PAWP
d. Fatigue
e. Pulmonary congestion
f. Cough (white/pink phlegm)
g. tachypnea
h. LE edema
i. Cyanosis
j. tachycardia

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6
Q

Signs/symptoms of right heart failure?

A

a. Fatigue
b. Inc peripheral venous pressures
c. Ascites
d. Splenohepatomegaly
e. JVD
f. Weight gain
g. Dependent edema
h. tachycardia

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7
Q

What is orthopnea?

A

Dyspnea when lying down

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8
Q

What are the pathological changes that occur with HF?

A

a. Ventricular remodeling
b. Cardiac fibrosis
c. Myocyte death

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9
Q

What are the compensatory/adaptive changes that occur during heart failure?

A

a. Cardiac dilation
b. Increased sympathetic tone
c. H2O retention/volume expansion

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10
Q

Why does heart failure result in water retention?

A

a. Have reduced GFR r/t decreased renal blood flow

b. Activation of RAAS

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11
Q

What hormones are released from heart d/t stretching of the atria/ventricles?

A

ANP and BNP

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12
Q

What are the adverse effects related to the compensatory mechanism seen in HF?

A

a. Reduced vent filling r/t increased HR
b. Reduced CO r/t arterial constriction/high pressures
c. Pulmonary/peripheral edema r/t H2O retention/high venous pressures
d. Hepatomegaly r/t H2O retention/high venous pressures

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13
Q

What is the actual cause of death in a patient with HF?

A

Excessive cardiac dilation and edema

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14
Q

What are the two classification systems for HF?

A

a. New York Heart Association (NYHA)
b. American College of Cardiology/American Heart
Association (ACC/AHA)

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15
Q

What is the criteria for an NYHA Class I HF?

A

a. No limitation

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16
Q

What is the criteria for an NYHA Class II HF?

A

a. Slight limitation of physical activity

b. Moderate activities produce symptoms

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17
Q

What is the criteria for an NYHA Class III HF?

A

a. Marked limitations

b. Minimal activity produces symptoms

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18
Q

What is the criteria for an NYHA Class IV HF?

A

Symptoms occur at rest

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19
Q

What is the criteria for ACC/AHA Stage A HF?

A

a. High risk of HF

b. No structural disease or symptoms

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20
Q

What is the criteria for ACC/AHA Stage HF?

A

Structural heart disease, no symptoms

21
Q

What is the criteria for ACC/AHA Stage C HF?

A

Structural heart disease with current or prior symptoms

22
Q

What is the criteria for ACC/AHA Stage D HF?

A

Refractory HF requiring specialized interventions

23
Q

Why are loop diuretics preferred in the tx of severe HF?

A

a. they mobilize large volumes of water

b. work even with low GFR

24
Q

Spironolactone and Triamterene are what class of drug?

A

Potassium sparring diuretics

25
Q

Eplerenone is what class of drug?

A

Aldosterone antagonist

26
Q

Captopril is what class of drug?

A

ACEi

27
Q

What are adverse effects of ACEi drugs?

A

a. Hypotension
b. Hyperkalemia
c. Intractable cough
d. Angioedema

28
Q

Losartan is what class of drug?

A

ARB

29
Q

Valsartan is what class of drug?

A

ARB

30
Q

Ramipril is what class of drug?

A

ACEi

31
Q

What are the negative effects of aldosterone?

A 
Promotes:
• myocardial remodeling
• Myocardial fibrosis
• Activation of SNS
• Suppresses NE uptake in the heart
• Vascular fibrosis
• Baroreceptor dysfunction
32
Q

What medication(s) is given with an ACEi or ARB in treatment of HF?

A

a. Aldosterone antagonist

b. Need periodic monitoring of potassium

33
Q

Which B-blocker(s) improve outcome in HF patients?

A

a. Carvedilol
b. Bisoprolol
c. SR metopolol

34
Q

Carvedilol brand name?

A

Coreg

35
Q

Digoxin is what class of drug?

A

a. Cardiac glycoside

b. Positive inotrope

36
Q

Digoxin brand name?

A

Lanoxin

37
Q

What is Digoxin’s MOA?

A

a. Inhibits Na-K-adenosine triphosphatase pumps (Na,K,ATPase)
b. Causes intracellular Na retention, which inhibits Ca out/Na in exchange

38
Q

How does potassium interact with digoxin?

A

a. K competes with digoxin for binding on Na,K,ATPase
b. Low potassium = increased dig effect
c. High potassium = reduced dig effects

39
Q

Explain the cardiac action potential cycle movement of ions?

A

a. During AP: Ca/Na in, K out

b. After: exchange of Ca for Na (Ca out/Na in); exchange of Na for K (Na out/K in) Na,K,ATPase pump

40
Q

What effect does digoxin have on the kidneys?

A

Suppresses renin release

41
Q

How does digoxin reduce sympathetic tone/activity?

A

By inhibiting Na,K,ATPase in the vagal afferent nerve fibers

42
Q

What are the adverse effects of digoxin?

A

a. Dysrhythmias
b. Anorexia
c. N/V
d. fatigue
e. Blurred vision
f. Seeing yellow
g. Halos around dark objects

43
Q

What drugs can increase digoxin levels?

A

a. Quinidine
b. Amiodarone
c. Verapamil

44
Q

How is digoxin excreted?

A

By the kidneys

45
Q

What is digoxin’s half-life?

A

1.5 days

46
Q

What is digoxin time of onset and peak?

A

a. PO: 30 min – 2 hrs

b. Peak: 4-6 hrs

47
Q

Digoxin levels about __ng/mL offer no additional benefit but do increase risk of toxicity?

A

1ng/mL

48
Q

Which drug is specifically for the treatment of HF in African Americans?

A

Isosorbide dinitrate/hydralazine

Specialized Pharmacology MN650 (28 decks)

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