Heart Failure Medication

Question 1

markers for cardiac injury

Answer 1

BNP
troponin T
troponin I
CK-MB
C-reactive protein
TNF alpha

Question 2

Systolic Heart Failure - HFrEF

Answer 2

weakened pump
blood backs up and overloads heart
LVEF < 40%

Question 3

diastolic heart failure - HFpEF

Answer 3

stiff or scarred relaxation
wont allow enough blood to fill the heart before it squeezes
LVEF > 50%

Question 4

Acute decompensated heart failure
causes, results?

Answer 4

• most common cause: LV or diastolic dysfunction
• increase in ventricular filling presssure

Question 5

Inotropic agents for acute events
(MOA, results, excreted)

Answer 5

cardiac glycosides (digoxin)
- inhibit phosphorylated alpha subunit residing in Na/KATPase channel
leads to contraction due to CA buildup
results in decreased drug action of digoxin
it is excreted via renal route

Question 6

AE of digoxin (maintainence)

Answer 6

• Maintainance is < 1 ng/ml
• coadmin with Ca could result in malignant arrhythmia

Question 7

Inotropes with vascular effects:
Dopamine (MOA)

Answer 7

• at low doses -> induces vasorelaxation bc of D2 receptors inhibit NE
• at moderate doses -> stim. B1 receptors increase cardiac contract and NE release
• at high doses -> stim. a receptor causing vasoconstriction

Question 8

Dobutamine MOA

Answer 8

non-specific beta receptor agonist
- stimu. beta1 receptor resulting in increased contractility
- beta2 receptor results in vasodilation

Question 9

Dobutamine adverse effects

Answer 9

tolerance may develop so add PDE3 inhibitor

Question 10

PDE inhibitors (MOA)

Answer 10

inamrinone (PDE3) and sildenafil (PDE5)
- raise cellular cAMP levels
- positive inotropic effect with decreased resistance in both arteries and veins

Question 11

PDE3 inhibitor (AE)

Answer 11

Inamrinone
- short term therapy
- can develop thrombocytopenia

Question 12

PDE5 inhibitor

Answer 12

Sildenafil
- effective for ventricular systolic failure due to pulmonary artery hypertension

Question 13

AE of MR antagonists (K+ sparing diuretics)

Answer 13

men develop gynecomastia substitute with eplerenone
can develop hyperkalemia which can be corrected with Ca or glucose and insulin

Question 14

Diuretic Resistance

Answer 14

Plasmin and Prostasin
CAP1 cleaves gamma subunit of ENaC and activates ENaC channel

Question 15

NSAIDs and diuretics

Answer 15

• prostaglandins enhance renal perfusion via RAAS
  -NSAIDs decrease the renal perfusion and increase diuretic efficacy

Question 16

Hydralazine is a ______ thus reducing both ____

Answer 16

arterial dilator; preload and afterload
- causes a decrease in release of Ca from intracellular pools by inhibiting IP3 pathway decreasing contraction

Question 17

Organic nitrate primarily acts as a ____ thus reducing both

Answer 17

venous dilator; preload and afterload

Question 18

Systemic positive effects of nitrates

Answer 18

• reduce preload
  -decrease incidence of MI and heart failure
• increase cGMP levels inside platelets resulting in prevention of platelet aggregation

Question 19

Entresto combines

Answer 19

Sacubitril/Valsartan
- promotes simultaneous inhibition of Neprilysin and AT1R

Question 20

Sacubitrilat (active form) is a

Answer 20

neprilysin inhibitor

Question 21

Neprilysin is known to inhibit

Answer 21

endogenous natriuretic peptides (ANP, BNP) and also breakdown Ang II

Question 22

ANP and BNP have

Answer 22

antihypertensive and diuretic properties by inhibiting cyclic nucleotide-gated channel mediated Na+ uptake

Question 23

beta blockers are initiated at _____ doses and _____

Answer 23

very low; titrated upwards

Question 24

Ivabradine (MOA)

Answer 24

direct inhibition of Na+ entry (funny current) through HCN channels in SA node

Question 25

Ivabradine is recommended for

Answer 25

HFrEF patients with stable angina with heart rate = or > 70