Heart Failure pharm Flashcards
What are 8 classes of drugs used in HF?
1) ACEi
2) ARBs
3) ß-blockers
4) Sacubitril-Valsartan
5) Mineralocorticoid receptor antagonists
6) Hydralazine
7) Ivabradine
8) Nitrates
Which 4 ß-blockers are approved for HF treatment?
Cardio(ß1) selective:
1) Bisoprolol
2) Metoprolol XL
Non-selective:
3) Carvedilol
Mixed (3rd gen):
4) Nebivolol
What is the moa of Sacubitril-Valsartan?
Sacubitril is a neprilysin inhibitor (so prevents break down of natriuretics)
but neprilysin ↑AT2 so Valsartan added to prevent -ve effects of AT2 as a ARB
When is Sacubitril-Valsartan indicated?
Chronic HFrEF
What are 5 AEs of Sacubitril-Valsartan?
1) Hypotension
2) Hyperkalemia
3) Renal failure
4) Cough
5) Angioedema
What are 5 examples of loop diuretics?
ET is FABulous
Ethacrynic acid
Torasemide
Furosemide
Azosemide
Bumatanide
What is the moa of loop diuretics?
Inhibit luminal Na/K/Cl transporter in thick ascending limb of LoH
→ excess intracellular K+
→ K+ back diffusion
→ ↑Mg2+ and Ca2+ excretion
- furosemide also ↑renal blood flow
How do NSAIDs affect loop diuretics?
Loop diuretics induce renal PG synthesis (↓ by NSAIDs)
Loop diuretics are (slowly/rapidly) absorbed and the diuretic response is (slow/rapid) following IV injection.
Rapid absorption, extremely rapid response
What are 4 clinical uses of loop diuretics?
1) Acute pulmonary edema
2) Acute hyperkalemia
3) Acute renal failure
4) Anion overdose
What are 4 AEs of loop diuretics?
1) Hypokalemic metabolic acidosis
2) Ototoxicity
3) Hyperuricemia
4) Hypomagnesemia
What antibiotics should be avoided with loop diuretics?
Aminoglycosides (ototoxicity)
What are 4 K+-sparing diuretics?
1) Spironolactone
2) Triamterene
3) Amiloride
4) Eplerenone
What is the moa of K+-sparing diuretics?
Spironolactone, Eplerenone: inhibit aldosterone receptor on principal cells of collecting duct
Triamterene, Amiloride: inhibit Na+ channel
Both eventually ↓Na/water reabsorption → ↓K+ secretion
Spironolactone has a (fast/slow) onset of action.
slow