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CVS pharm > heart failure medications > Flashcards

heart failure medications Flashcards

1
Q

What are the 4 beta-blockers indicated in the treatment of heart failure?

CBMN

A

Carvedilol
Bisoprolol
Metoprolol XL
Nebivolol

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2
Q

What enzyme does sacubitril inhibit?

A

Neprilysin

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3
Q

What is the MOA of sacubitril?

A

Sacubitril inhibits neprilysin, preventing the breakdown of brain natriuretic peptide (BNP). Since BNP antagonises RAAS, the prolonged BNP effects will have protective effects on the heart

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4
Q

Why is valsartan given in combination with sacubitril?

A

Neprilysin breaks down both BNP and angiotensin II

Valsartan is an ARB which helps block the effects of angiotensin II

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5
Q

What is the clinical indication for sacubitril-valsartan?

A

Heart Failure with reduced Ejection Fraction (HFrEF)

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6
Q

What are the adverse effects of sacubitril-valsartain?

A
  1. Hypotension
  2. Hyperkalemia
  3. Renal failure
  4. Cough & angioedema

Literally the same as ACEI

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7
Q

Why does sacubitril-valsartan cause cough & angioedema?

A

Sacubitril inhibits neprilysin, which breaks down bradykinin

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8
Q

Loop diuretics inhibit the luminal ________ in the ________, causing an increase in the secretion of ________ & ________.

This increases the ________ of the luminal tubular fluid, decreasing ________

A

Loop diuretics inhibit the luminal Na+/K+/2Cl- transporter in the Loop of Henle, causing an increase in the secretion of Mg2+ & Ca2+.

This increases the tonicity of the luminal tubular fluid, decreasing H2O reabsorption

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9
Q

Name the most important loop diuretic

A

Furosemide

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10
Q

What DDIs do loop diuretics have?

A

NSAIDs reduce renal PG synthesis and hence interfere with the action of loop diuretics

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11
Q

What is the duration of effect for furosemide?

A

2-3 hours; extremely rapid diuretic response following IV injection

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12
Q

What are the clinical indications for furosemide?

A
  1. Hyperkalemia
  2. Acute pulmonary edema/other edema
  3. Anion overdose
  4. Acute renal failure
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13
Q

What are the adverse effects of furosemide?

A
  1. Hypokalemic metabolic alkalosis
  2. Ototoxicity (avoid with aminoglycosides)
  3. Hyperuricemia
  4. Hypomagnesemia
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14
Q

Which class of diuretics act on the collecting tubule?

A

Potassium-sparing diuretics

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15
Q

________ & ________ block the aldosterone receptors in the collecting tubule

A

Spironolactone & eplerenone block the aldosterone receptors in the collecting duct

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16
Q

________ & ________ block the activation of the Na+ channels in the collecting tubule

A

Triamterene & amiloride block the activation of the Na+ channels in the collectube tublule

17
Q

Potassium-sparing diuretics have a faster onset of action than loop diuretics.

True/False

A

False.

Potassium-sparing diuretics have a slow onset and require several days before they can exert their full therapeutic effect

18
Q

What is the MOA of hydralazine?

A

Direct arteriole vasodilator –> reduces afterload

Induces a compensatory release of NE –> increased venous return through venous vasoconstriction + cardiac output

19
Q

What are the clinical indications for hydralazine?

A

1.HFrEF (in combination with ISDN)
2.Second-line antihypertensive
3.Acute onset post-partum htn

20
Q

What group of individuals is hydralazine contraindicated in?

A

Patients with coronary artery disease

Hydralazine stimulates sympathetic NS –> increased CO & O2 demand

21
Q

What are the 2 adverse effects associated with hydralazine?

A
  1. Flushing, hypotension, tachycardia
  2. Hydralazine-induced Lupus Syndrome (HLS)

1 - symptoms associated with baroreflex associated sympathetic activation

22
Q

Digitalis inhibit the ________, reducing the efficiency of the ________ as intracellular-[Na+] increases, leading to ________. Hence, this increases the ________ of the heart.

A

Digitalis inhibit the Na+/K+ ATPase, reducing the efficiency of the Na+/Ca2+ exchanger as intracellular-[Na+] increases, leading to less Ca2+ efflux. Hence, this increases the contractility of the heart.

23
Q

Is digitalis used in early or late-stage heart failure?

A

Late-stage

24
Q

What are the clinical indications for digitalis?

A
  1. Systolic dysfunction
  2. AFib
25
Q

What are the adverse effects of digitalis?

A
  1. Progressively more severe dysrhythmia
  2. GI effects
  3. CNS effects - headache, confusion, blurred vision
26
Q

Why do drugs that treat early-stage heart failure tend to reduce workload on the heart?

A

To preserve heart function

27
Q

What antibiotics should NOT be given with furosemide (loop diuretics)?

A

Aminoglycosides due to ototoxicity

28
Q

What is the MOA of the potassium-sparing diuretics?

A

They block aldosterone receptors/Na+ channels, preventing Na+ from being reabsorbed in the collecting duct

This increases H2O excretion by the kidney

29
Q

Which drug induces a compensatory release of NE?

A

Hydralazine

CVS pharm (6 decks)

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