Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular Module > Heart Failure Pharmaco > Flashcards

Heart Failure Pharmaco Flashcards

1
Q

What is heart failure

A

Progressive disease with gradual reduction in cardiac performance due to inadequate cardiac output to provide oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common cause of heart failure

A

Coronary artery disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Major types of heart failure

A

Systolic heart failure

diastolic heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Systolic heart failure

A

Reduced mechanical pumping action (contractility)

reduced ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diastolic heart failure

A

Stiffening and loss of adequate relaxation so reduced filling and cardiac output
reduced stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Goal of treatments

A

Reduce symptoms and slowing progression to heart failure

Manage Acute episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can you increase contractility

A

By increasing sensitivity of cardiac tissues to released calcium

Increasing storage of calcium

Increasing release of calcium from Sarcoplasmic reticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primary target of cardiac Glycosides and digoxin

A

Na/K ATPase which determines amount of extra cellular Na

Important because of NCX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Compensatory mechanisms of heart failure

A

RAAs system
Ventricular hypertrophy and remodeling
Hormones activation (NE, angiotensin II, aldosterone, vasopressin )
Pro inflammatory cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Primary symptoms of heart failure

A

Tachycardia
Decreased exercise tolerance
Shortness of breath
Cardiomegaky

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptomatic heart failure routine treatment t

A

ACE inhibitor
B blocker
Diuretics
Digoxin (to considerate for symptoms improvement )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Function of ACE inhibitors

A

Improve survival
Slow disease
Reduce hospitalization
Improve life quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can you replace ACE inhibitors with if not tolerated

A

Angiotensin II receptor blocker

hydrLazine and isosorbide dinitrate combination. Je

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Type of B blockers that can prolong survival , reduce needs for hospitalization and transplantable cause reverse modeling of LV

A

Carvedilol ,?Metoprolol (CR/XR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drugs recommended when reduced ejection fraction

A

Carvedilol and metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Is therapy with diuretics mandatory

A

No only requires when there is peripheral edema / pulmonary congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Digoxin improves survival ?

A

No just help with symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drugs should be specifically added for African American with moderate to severe symptoms and in patients who still have symptoms after ACE and ARB and b blocker

A

Hydralazine

Nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cardiac glycosides types

A

Digoxin
Digitoxin
Ouabain
Marinobufagenin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cardiac glycosides action

A 
Inhibit Na/K atpase So 
Increased cardiac contraction 
Increase CO
Increase ejection fraction 
Reduced sympathetic because better circulation 
Reduced peripheral resistance

So reduced HR
Less O2 demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Digoxin therapy indication

A

Patients with severe left ventricular systolic dysfunction after ACE and diuretic therapy

When there’s heart heart failure with atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is digoxin not indicated

A

When diastolic or right sided heart failure

When mild to moderate HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Digoxin pk

A

Very potent
narrow margin of safety
Long half life (36-40h)
Metabolized by liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Digoxin elimination

A

Intact kidney so require dose adjustment based on creatinine clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Side effects of digoxin
Ventricular tachycardia Arrythmias Anorexia Nausea ``` Vomiting Headache Fatigue Confusion Blurred vision Altered color perception ```
26
Management of digoxin toxicity
Discontinuing glycoside therapy Serum k levels K supplements
27
Factors predisposing to digitalis toxicity
``` Hypokalemia Hypervalcemia Hypomagnesemia Quinidine , verapamil, amiodarone Hypothyroidism Hypoxia Renal failure Myocarditis ```
28
Positive inotropic agents
``` Digoxin Istaroxime Bipyridines (inamrinone, Milrinone, enoximone, Levosimendan B-adrenoreceptor agonists ```
29
Istaroxime action
Increases contractility by inhibiting Na/K Atpase but also enhance sequestration of CA2+ in SR
30
When to use istaroxime
Acute HF with reduced ejection fraction
31
Bipyridines
Inamrinone Milrinone Enoximone
32
Levosimendan action
Troponin system sensitized to Ca2+ | Inhibit puosohodiesterase so vasodilation
33
Bipyridines actions
Inhibit PDE3-> vasodilation | Increase myocardial contractility
34
When are bipyridines used
IV for Acute heart failure | Severe exacerbation of chronic heart failure that do not respond to normal therapy
35
B adrenoreceptor agonist inotropic agents
Dobutamine | Dopexamine
36
Dobutamine action
Increase cardiac output and decrease ventricular filling pressure
37
Dopamin uses
Acute heart failure | raise blood pressure
38
Dopexamine
Act on B2 receptors in cardiac cells Act on peripheral dopamin receptor and increase renal perfusion
39
Dopexamine side effects
``` Angina Arrythmias Bradycardia Dyspnoea Headache MI Nausea Réversible thrombocytopenia Sweating Tachycardia Tremor ```
40
Contra indications of dopexamine
``` Aortic stenosis Hypertrophic cardiomyopathy Left ventricular outlet obstruction Phaeochromocytoma Thrombocytopenia ```
41
De rugs without inotropic effects
``` Diuretics ACE inhibitors ARBs Vasodilators Beta blockers ```
42
Diuretics
Furosemide Spironolactone Eplerenone
43
Diuretics
Furosemide
44
Are diuretics drugs of choice
Yes
45
Spironolactone and eplerone advantages
Decrease morbidity and mortality
46
What is heart failure
Progressive disease with gradual reduction in cardiac performance due to inadequate cardiac output to provide oxygen
47
Most common cause of heart failure
Coronary artery disease
48
Major types of heart failure
Systolic heart failure | diastolic heart failure
49
Systolic heart failure
Reduced mechanical pumping action (contractility) | reduced ejection fraction
50
Diastolic heart failure
Stiffening and loss of adequate relaxation so reduced filling and cardiac output reduced stroke volume
51
Goal of treatments
Reduce symptoms and slowing progression to heart failure Manage Acute episodes
52
How can you increase contractility
By increasing sensitivity of cardiac tissues to released calcium Increasing storage of calcium Increasing release of calcium from Sarcoplasmic reticulum
53
Primary target of cardiac Glycosides and digoxin
Na/K ATPase which determines amount of extra cellular Na | Important because of NCX
54
Compensatory mechanisms of heart failure
RAAs system Ventricular hypertrophy and remodeling Hormones activation (NE, angiotensin II, aldosterone, vasopressin ) Pro inflammatory cytokines
55
Primary symptoms of heart failure
Tachycardia Decreased exercise tolerance Shortness of breath Cardiomegaky
56
Symptomatic heart failure routine treatment t
ACE inhibitor B blocker Diuretics Digoxin (to considerate for symptoms improvement )
57
Function of ACE inhibitors
Improve survival Slow disease Reduce hospitalization Improve life quality
58
What can you replace ACE inhibitors with if not tolerated
Angiotensin II receptor blocker | hydrLazine and isosorbide dinitrate combination. Je
59
Type of B blockers that can prolong survival , reduce needs for hospitalization and transplantable cause reverse modeling of LV
Carvedilol ,?Metoprolol (CR/XR)
60
Drugs recommended when reduced ejection fraction
Carvedilol and metoprolol
61
Is therapy with diuretics mandatory
No only requires when there is peripheral edema / pulmonary congestion
62
Digoxin improves survival ?
No just help with symptoms
63
What drugs should be specifically added for African American with moderate to severe symptoms and in patients who still have symptoms after ACE and ARB and b blocker
Hydralazine | Nitrates
64
Cardiac glycosides types
Digoxin Digitoxin Ouabain Marinobufagenin
65
Cardiac glycosides action
``` Inhibit Na/K atpase So Increased cardiac contraction Increase CO Increase ejection fraction Reduced sympathetic because better circulation Reduced peripheral resistance ``` So reduced HR Less O2 demand
66
Digoxin therapy indication
Patients with severe left ventricular systolic dysfunction after ACE and diuretic therapy When there’s heart heart failure with atrial fibrillation
67
When is digoxin not indicated
When diastolic or right sided heart failure When mild to moderate HF
68
Digoxin pk
Very potent narrow margin of safety Long half life (36-40h) Metabolized by liver
69
Digoxin elimination
Intact kidney so require dose adjustment based on creatinine clearance
70
Side effects of digoxin
Ventricular tachycardia Arrythmias Anorexia Nausea ``` Vomiting Headache Fatigue Confusion Blurred vision Altered color perception ```
71
Management of digoxin toxicity
Discontinuing glycoside therapy Serum k levels K supplements
72
Factors predisposing to digitalis toxicity
``` Hypokalemia Hypervalcemia Hypomagnesemia Quinidine , verapamil, amiodarone Hypothyroidism Hypoxia Renal failure Myocarditis ```
73
Positive inotropic agents
``` Digoxin Istaroxime Bipyridines (inamrinone, Milrinone, enoximone, Levosimendan B-adrenoreceptor agonists ```
74
Istaroxime action
Increases contractility by inhibiting Na/K Atpase but also enhance sequestration of CA2+ in SR
75
When to use istaroxime
Acute HF with reduced ejection fraction
76
Bipyridines
Inamrinone Milrinone Enoximone
77
Levosimendan action
Troponin system sensitized to Ca2+ | Inhibit puosohodiesterase so vasodilation
78
Bipyridines actions
Inhibit PDE3-> vasodilation | Increase myocardial contractility
79
When are bipyridines used
IV for Acute heart failure | Severe exacerbation of chronic heart failure that do not respond to normal therapy
80
B adrenoreceptor agonist inotropic agents
Dobutamine | Dopexamine
81
Dobutamine action
Increase cardiac output and decrease ventricular filling pressure
82
Dopamin uses
Acute heart failure | raise blood pressure
83
Dopexamine
Act on B2 receptors in cardiac cells Act on peripheral dopamin receptor and increase renal perfusion
84
Dopexamine side effects
``` Angina Arrythmias Bradycardia Dyspnoea Headache MI Nausea Réversible thrombocytopenia Sweating Tachycardia Tremor ```
85
Contra indications of dopexamine
``` Aortic stenosis Hypertrophic cardiomyopathy Left ventricular outlet obstruction Phaeochromocytoma Thrombocytopenia ```
86
De rugs without inotropic effects
``` Diuretics ACE inhibitors ARBs Vasodilators Beta blockers ```
87
Are diuretics drugs of choice
Yes
88
Diuretics action in heart failure
Reduce venous pressure | Reduce ventricular preload
89
Spironolactone and eplerone advantages
Decrease morbidity and mortality
90
ACE inhibitors
Captopril
91
ACE inhibitors actions
Versatile drugs that reduce peripheral resistance Reduce afterload Reduce salt and water retention -> reduce preload Decreased angiotensin reduces sympathetic activity by decreasing NE release Decrease long term remodeling of heart and vessels
92
ARB examples
Losartan | Candensartan
93
ARBs actions
Same action as ACE but limited | Only used when no tolerance for ACE
94
Can you use aliskiren, a renin inhibitor normally used for hypertension?
Yes
95
Actions of vasodilators
Reduce preload by venodilstion Reduced afterload (arteriolar dilation ) Reduce damaging remodeling of heart
96
Vasodilators examples
Hydralazine Isosorbide dinitrate Bosentan Tezosentan
97
Natriuretic peptide
Nesiritide
98
Natriuretic action
Increase cGMP in smooth muscles and reduce venous and arteriolar tone Cause diuresis
99
When can you use natriuretic peptide
Only in acute cardiac failure
100
Common adverse effect of vasodilators
Excessive hypotension (main one ) Renal damage Deaths
101
What is a useful diagnosis or prognostic test
Measurement of plasma BNP Atrial natriuretic peptide and urodilatin produced in kidney. Carperitide and ularitide used as analogs of endogenous peptides
102
Bosentan Tezosentan actions
Competitive inhibitors of endothelin | Not really working on humans
103
What is bosentan approved for
Pulmonary hypertension
104
Bosentan adverse effects
Teratogenic and hepatotoxic effects
105
B blockers used in
Chronic heart failure
106
Good b blocker
Bisoprolol Carvedilol Metoprolol Nebivolol
107
Mechanism of b blockers
Attenuate action of high concentration catecholamines Up regulate b receptors Decrease heart rate Reduce remodeling of heart by inhibiting mitogenic activity of catecholamines
108
Chronic heart failure stages
Stage À Stage B Stage C Stage D
109
Stage À
High risk but no signs or symptoms of heart failure
110
Stage b
Evidence of heart failure but no symptoms of heart failure
111
Stage c
Structural heart disease Symptoms of failure Symptoms responsive to therapy ohhh
112
Stage D
Heart failure even after normal therapy | Special interventions like resynchronization therapy and transplant needed
113
Stage C différent classes
Class I class II Class III Class IV
114
Stage C class I
No limitation to ordinary activities | Symptoms only with greater than ordinary exercise
115
Stage C class II
Slight limitation of activities Fatigue Palpitations with normal physical activity
116
Stage C class III
No symptom at rest but fatigue and shortness of breath , tachycardia occur with less than ordinary activity
117
Stage C class IV
Symptoms even at rest
118
Stage À management
``` Treat : obesity Hypertension Diabetes Hyperlipidemia ```
119
Stage B management
ACEI ARBs B blocker Diuretics
120
Stage C class II or III
``` ACEI ARBs B blocker Diuretics Aldosterone antagonist Digoxin CRT hydralazine / Nitrate ```
121
Stage D Class IV
Transplant | LVAD
122
Management of chronic heart failure
Sodium removal especially if edema - diuretics( thiazides if mild but mostly loop) , salt reduction in diet hypokalemia treated by Potassium supplementsor ACEI or potassium sparing diuretic (spironolactone , eplerone) Spironolactone and eplerone in moderate and severe heart failure to reduce morbidity and mortality ACEI as first agent of left ventricular dysfunction but no edema ARBs if not possible to use ACEI Long acting nitrates (venous dilators) if there’s high filling pressure with dyspnea (pulmonary congestion ) Hydralazine (arteriolar dilation ) if there’s fatigue due to LV output B blockers to raise ejection fraction, slow heart rate , reduce symptoms
123
Acute heart failure causes
Generally in chronic heart failure Due to exertion , emotion, excess salt , not taking medications, fever anemia etc MI
124
Management of emergency MI
Emergency revascularisation with coronary angioplasty and a stent or thromblytic agent
125
Acute failure management
IV treatment in general for faster action Diuretics - furosemide + inotropic agents - Dopamine or dobutamine or levosimendan when severe hypotension If acute decompression - vasodilators like nitropusside, nutroglycerine, nesiritide Vasopressin antagonist like conivaptan for hyponatremia

Cardiovascular Module (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions