Heart Failure Drugs Flashcards
LV heart failure is also known as?
a. HF with reduced ejection fraction (HFrEF)
Diastolic heart failure is also known?
a. HR with preserved LV ejection fraction (HFpEF)
What drugs are recommended for use in the treatment of HF?
a. Diuretics
b. RAAS inhibitors
c. B-blockers
d. Digoxin
What are the most common causes of LV heart failure?
a. CAD
b. HTN
Signs/symptoms of LV heart failure?
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
Signs/symptoms of right heart failure?
a. Fatigue
b. Inc peripheral venous pressures
c. Ascites
d. Splenohepatomegaly
e. JVD
f. Weight gain
g. Dependent edema
h. tachycardia
What is orthopnea?
Dyspnea when lying down
What are the pathological changes that occur with HF?
a. Ventricular remodeling
b. Cardiac fibrosis
c. Myocyte death
What are the compensatory/adaptive changes that occur during heart failure?
a. Cardiac dilation
b. Increased sympathetic tone
c. H2O retention/volume expansion
Why does heart failure result in water retention?
a. Have reduced GFR r/t decreased renal blood flow
b. Activation of RAAS
What hormones are released from heart d/t stretching of the atria/ventricles?
ANP and BNP
What are the adverse effects related to the compensatory mechanism seen in HF?
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
What is the actual cause of death in a patient with HF?
Excessive cardiac dilation and edema
What are the two classification systems for HF?
a. New York Heart Association (NYHA)
b. American College of Cardiology/American Heart
Association (ACC/AHA)
What is the criteria for an NYHA Class I HF?
a. No limitation
What is the criteria for an NYHA Class II HF?
a. Slight limitation of physical activity
b. Moderate activities produce symptoms
What is the criteria for an NYHA Class III HF?
a. Marked limitations
b. Minimal activity produces symptoms
What is the criteria for an NYHA Class IV HF?
Symptoms occur at rest
What is the criteria for ACC/AHA Stage A HF?
a. High risk of HF
b. No structural disease or symptoms
What is the criteria for ACC/AHA Stage HF?
Structural heart disease, no symptoms
What is the criteria for ACC/AHA Stage C HF?
Structural heart disease with current or prior symptoms
What is the criteria for ACC/AHA Stage D HF?
Refractory HF requiring specialized interventions
Why are loop diuretics preferred in the tx of severe HF?
a. they mobilize large volumes of water
b. work even with low GFR
Spironolactone and Triamterene are what class of drug?
Potassium sparring diuretics
Eplerenone is what class of drug?
Aldosterone antagonist
Captopril is what class of drug?
ACEi
What are adverse effects of ACEi drugs?
a. Hypotension
b. Hyperkalemia
c. Intractable cough
d. Angioedema
Losartan is what class of drug?
ARB
Valsartan is what class of drug?
ARB
Ramipril is what class of drug?
ACEi
What are the negative effects of aldosterone?
Promotes: • myocardial remodeling • Myocardial fibrosis • Activation of SNS • Suppresses NE uptake in the heart • Vascular fibrosis • Baroreceptor dysfunction
What medication(s) is given with an ACEi or ARB in treatment of HF?
a. Aldosterone antagonist
b. Need periodic monitoring of potassium
Which B-blocker(s) improve outcome in HF patients?
a. Carvedilol
b. Bisoprolol
c. SR metopolol
Carvedilol brand name?
Coreg
Digoxin is what class of drug?
a. Cardiac glycoside
b. Positive inotrope
Digoxin brand name?
Lanoxin
What is Digoxin’s MOA?
a. Inhibits Na-K-adenosine triphosphatase pumps (Na,K,ATPase)
b. Causes intracellular Na retention, which inhibits Ca out/Na in exchange
How does potassium interact with digoxin?
a. K competes with digoxin for binding on Na,K,ATPase
b. Low potassium = increased dig effect
c. High potassium = reduced dig effects
Explain the cardiac action potential cycle movement of ions?
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
What effect does digoxin have on the kidneys?
Suppresses renin release
How does digoxin reduce sympathetic tone/activity?
By inhibiting Na,K,ATPase in the vagal afferent nerve fibers
What are the adverse effects of digoxin?
a. Dysrhythmias
b. Anorexia
c. N/V
d. fatigue
e. Blurred vision
f. Seeing yellow
g. Halos around dark objects
What drugs can increase digoxin levels?
a. Quinidine
b. Amiodarone
c. Verapamil
How is digoxin excreted?
By the kidneys
What is digoxin’s half-life?
1.5 days
What is digoxin time of onset and peak?
a. PO: 30 min – 2 hrs
b. Peak: 4-6 hrs
Digoxin levels about __ng/mL offer no additional benefit but do increase risk of toxicity?
1ng/mL
Which drug is specifically for the treatment of HF in African Americans?
Isosorbide dinitrate/hydralazine
