Heart Failure Pharm

Question 1

Name the 5 drugs used in chronic HF?

Answer 1

• Digoxin
• ACE-I and ARB’s
• Loop diuretics
• BB
• Neprilysin inhibitor and ARB

Question 2

Name the 3 drugs used in acute HF?

Answer 2

• Vasodilators (Nitroprusside)
• Beta agonist (Dobutamine, Dopamine)
• Loop diuretics (Furosemide)

Question 3

Which 5 drugs reduce preload and after load?

Answer 3

• Vasodilators Nitroprusside
• ACE-I and ARB’s
• HCTZ
• Loop diuretics
• Hydralazine(after load) isosorbide dinitrate (preload)

Question 4

T/F Furosemide causes orthostatic hypotension

Answer 4

TRUE

Question 5

Which 4 drugs reduce mortality?

Answer 5

• HCTZ
• BB
• ACE-I and ARB’S
• Spirinolactone

Question 6

What is MOA of Neprilysin blocker?

Sacubtril-Valsartan (Entresto)

Answer 6

• Sacubtril is an enzyme that blocks neprilysin
• this mechanism keeps BNP in the blood
• BNP: vasodilator, diuretic, decreases sympathetic tone
• Valsartan is ARB

Question 7

What should you discontinue if you are going to give entresto?

Answer 7

ACE-I 36 hours before

Question 8

What is the MOA of isosorbide dinitrate?

Answer 8

• release of NO to induce vasodilation

- reduced preload and stretch

Question 9

What is a drug interaction with isosorbide dinitrate?

Answer 9

-synergistic effect with Viagra

Question 10

What are the clinical uses of isosorbide dinitrate?

Answer 10

• angina

- acute or chronic HF

Question 11

T/F Hydralazine decrease after load

Answer 11

TRUE

Question 12

What are ADE with Hydralazine isosorbide dinitrate?

Answer 12

tachycardia

• postural hypotension
• lupus like syndrome

Question 13

What is MOA of nitroprusside? What ROA?

Answer 13

powerful vasodilator that reduced preload and after load

-IV only and last a few minutes

Question 14

What is the clinical use of nitroprusside?

Answer 14

Acute decompensated HF

Question 15

What are ADE of nitroprusside?

Answer 15

cyanide toxicity

Question 16

What is MOA of Digoxin/Cardiac glycoside?

Answer 16

• blocks Na/K ATPase
• this causes Na/Ca exchanger to be activated
• Na goes and Ca come into cell
• increases contractility

Question 17

What are the clinical uses of digoxin (2)?

Answer 17

• Chronic HF

- a-fib with RVR

Question 18

What are ADE with digoxin?

Answer 18

• N/V/D

- arrhythmia

Question 19

What are the 2 beta agonists?

Answer 19

• Dobutamine Beta 1 selective

- Dopamine Beta and alpha

Question 20

What are the MOA of beta agonists?

Answer 20

-increase BP CO and contractility

Question 21

What are the clinical uses of beta agonists?

Answer 21

• acute decompensated failure

- dopamine-ADHF and shock

Question 22

What is route of administration for beta agonists?

Answer 22

IV-last a few minutes

Question 23

What is MOA of bypyridines?

Answer 23

PDE-3 inhibitor

vasodilates, increases CO

Question 24

Name 2 bypyridines?

Answer 24

Milrinone

-Iamnirone

Question 25

What is the clinical use of bypyridines?

Answer 25

ADHF

-don’t give in chronic HF-increases mortality

Question 26

What is MOA of Nesiritide ?

Answer 26

• Natriuretic peptide
• activates BNP for diuresis and vasodilation
• no longer in use

Question 27

What ADE of Natriuretic peptide (3)?

Answer 27

• mortality
• renal failure
• hypotension

Question 28

What is MOA of Ivabradine?

Answer 28

blocks If current channels

• decreases Na
• decreases SA node firing decrease HR
• allows diastolic filling time

Question 29

What is the clinical use of ivabradine?

Answer 29

• use for stable HF and bpm > 70 bpm

- don’t use in ADHF

Question 30

What are drug interactions with ivabradine?

Answer 30

CYP3A4 inhibitor-can cause toxicity

Question 31

What are ADE of ivabradine (5)?

Answer 31

• hypotension
• dizziness
• hepatic issues
• ADHF
• arrhythmia