Heart Failure pharm Flashcards

1
Q

What are 8 classes of drugs used in HF?

A

1) ACEi
2) ARBs
3) ß-blockers
4) Sacubitril-Valsartan
5) Mineralocorticoid receptor antagonists
6) Hydralazine
7) Ivabradine
8) Nitrates

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2
Q

Which 4 ß-blockers are approved for HF treatment?

A

Cardio(ß1) selective:
1) Bisoprolol
2) Metoprolol XL

Non-selective:
3) Carvedilol

Mixed (3rd gen):
4) Nebivolol

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3
Q

What is the moa of Sacubitril-Valsartan?

A

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

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4
Q

When is Sacubitril-Valsartan indicated?

A

Chronic HFrEF

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5
Q

What are 5 AEs of Sacubitril-Valsartan?

A

1) Hypotension
2) Hyperkalemia
3) Renal failure
4) Cough
5) Angioedema

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6
Q

What are 5 examples of loop diuretics?

A

ET is FABulous
Ethacrynic acid
Torasemide
Furosemide
Azosemide
Bumatanide

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7
Q

What is the moa of loop diuretics?

A

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
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8
Q

How do NSAIDs affect loop diuretics?

A

Loop diuretics induce renal PG synthesis (↓ by NSAIDs)

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9
Q

Loop diuretics are (slowly/rapidly) absorbed and the diuretic response is (slow/rapid) following IV injection.

A

Rapid absorption, extremely rapid response

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10
Q

What are 4 clinical uses of loop diuretics?

A

1) Acute pulmonary edema
2) Acute hyperkalemia
3) Acute renal failure
4) Anion overdose

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11
Q

What are 4 AEs of loop diuretics?

A

1) Hypokalemic metabolic acidosis
2) Ototoxicity
3) Hyperuricemia
4) Hypomagnesemia

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12
Q

What antibiotics should be avoided with loop diuretics?

A

Aminoglycosides (ototoxicity)

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13
Q

What are 4 K+-sparing diuretics?

A

1) Spironolactone
2) Triamterene
3) Amiloride
4) Eplerenone

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14
Q

What is the moa of K+-sparing diuretics?

A

Spironolactone, Eplerenone: inhibit aldosterone receptor on principal cells of collecting duct
Triamterene, Amiloride: inhibit Na+ channel

Both eventually ↓Na/water reabsorption → ↓K+ secretion

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15
Q

Spironolactone has a (fast/slow) onset of action.

A

slow

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16
Q

Where is triamterene metabolised?

17
Q

Triamterene has a (longer/shorter) T1/2 than amiloride?

18
Q

How is amiloride excreted?

A

unchanged in urine

19
Q

What are the clinical uses of K+-sparing diuretics?

A

1) Diuretic
2) Hyperaldosteronism

20
Q

What are 2 AEs of K+-sparing diuretics?

A

1) Hyperkalemia
2) Metabolic acidosis
3) Gynecomastia (spironolactone)
4) Acute renal failure (triamterene + indomethacin)
4) Kidney stones (Triamterene)

21
Q

What is the moa of hydralazine?

A

Direct arteriole vasodilator:
- inhibit IP3-induced Ca release from SER
→ ↓ peripheral resistance
- compensatory release of E/NE → ↑venous return and CO

22
Q

What are 3 indications for hydralazine?

A

1) HFrEF (with ISDN): oral
2) essential HTN (when 1st line inadequate): oral
3) Acute severe peripartum/post-partum HTN: IV

23
Q

What is the onset and duration of IV and oral hydralazine?

A

IV: onset 5-30min, duration 2-6hrs
Oral: onset 20-30min, duration 2-4 hrs

reaches peak Pc in 2.5 hrs, T1/2 ~ 7hrs

24
Q

When is hydralazine contraindicated?

A

px with CAD
(SNS stimulation → ↑myocardial O2 Dd)

25
What are 4 AEs of Hydralazine?
1) Hydralazine-induced lupus syndrome (HILS - Arthralgia, myalgia, serositis, fever - dose dependent - can be resolved w discontinuation Baroreflex associated SNS activation: 2) Flushing 3) Hypotension 4) Tachycardia
26
What plant is digitalis derived from?
Foxglove
27
What is the moa of digitalis?
inhibits Ka/K exchanges → ↑intracellular Na → inhibit Ca2+ efflux by Ca/Na exchanger → ↑intracellular Ca → stronger systolic contraction
28
What are 3 cardiac effects of digitalis
1) Mechanical: Contractility ↑ → ↑CO → ↓SNS + ↓ AT2 → ↓Afterload + preload 2) Electrical: a) ↓QT, ST, T wave inversion b) ↑PNS → ↑PR ↓Ventricular rate 3) Toxic - ↑intracellular Ca → ↑ automaticity, extrasystoles, tachycardia, fibrillation
29
What are 2 clinical uses for digitalis?
1) Systolic dysfunction 2) Atrial fibrillation
30
What are 3 AEs of digitalis?
1) Progressive dysrhythmias: AV block, Afib, Vfib 2) GI effects: anorexia, nausea, vomiting 3) CNS: headache, fatigue, confusion, blurred vision
31
How is digitalis toxicity treated?
1) Discontinue 2) Correct K/Mg deficiency 3) Antiarrhythmics (eg. lidocaine, propanolol) 4) Digoxin Abs (FAB fragments, digibind)