Heart Failure Treatment 1

Question 1

Define Heart Failure

Answer 1

Pathological state when the heart is unable to pump blood (reduce stroke volume & cardiac output) at a rate that meets the requirements of tissue

Question 2

Normal conditions = dynamic relationship between

Answer 2

venous capacitance, ventricular preload, CO, afterload, peripheral resistance

Question 3

Define Acute Hemodynamic Stress

Answer 3

Sharp decrease in blood volume –> decreased cardiac output –> activation of compensatory mechanisms to support the circulation

Question 4

RAS –> BP and CO

Answer 4

Increased AngII which leads to peripheral resistance and increased sodium and water which allows recovery of BP and CO

Question 5

SNS –> BP and CO

Answer 5

Increased myocardial contractility and increased heart rate via beta 1
Increased peripheral resistance via alpha 1 and 2

Question 6

Therapy for HF involves:

Answer 6

Reduction of preload and/or afterload

Enhancement of inotropic state (contraction force)

Question 7

Vasodilators

Answer 7

ACEi

Direct vasodilators

Question 8

Positive inotropic drugs

Answer 8

Cardiac glycosides
Adrenergic/dopaminergic receptor agonists
Phosphodiesterase inhibitors

Question 9

Diuretics in HF work on

Answer 9

Vasoconstriction and sodium/water retention

- Long term effects via: decrease peripheral resistance

Question 10

Loop Diuretics are

Answer 10

Furosemide
Dumetanide
Torsemide

Question 11

Loop Diuretics MOA

Answer 11

Inhibit NKCC symporter

Act in the thick ascending limb of loop of Henle

Question 12

Loop Diuretics Main effects

Answer 12

Profound diuresis (25%) which increases urine flow
Increased excretion of Na, Cl, K, Ca and Mg

Question 13

Loop diuretics Main Adverse Effects

Answer 13

Ototoxicity
Hypokalemia
Hyperglycemia

Question 14

Thiazide diuretics main representatives

Answer 14

HCTZ (microzide)
Chlorthalidone (Hygroton)
Indapamide (Lozol)
Metolazone (zaroxolyn)

Question 15

Thiazide diuretics MOA

Answer 15

Act in the distal convoluted tubule (5% of Na reabsorption)

Inhibit Na Cl symporter

Question 16

Thiazide diuretics effects on urine flow and ion excretion

Answer 16

Moderate increase in urine flow

Increased excretion of Na, Cl and increased excretion of K

Question 17

Chronic use of thiazide diuretics

Answer 17

Decreased excretion of Ca and uric acid

Question 18

Thiazide Main Adverse Effects

Answer 18

Hypokalemia
Increased risk of gout
Hyperuricemia

Question 19

Aldosterone antagonists drugs

Answer 19

Spironolactone and eplerenone

Question 20

Aldosterone antagonists MOA

Answer 20

Aldosterone (steroid hormone) binds to receptors then are translocated to the nucleus where it binds DNA and stimulates expression of aldosterone induced proteins

Question 21

ACEi drugs

Answer 21

End in -pril

Question 22

ACEi MOA

Answer 22

Reduction of Ang II which is involved in vasoconstriction, increased peripheral resistance, decreased sodium and water, slight decrease in aldosterone secretion and decreased sympathetic tone

Question 23

Alternative MOA of ACEi

Answer 23

Increased bradykin which decreased peripheral resistance via vasodilation and Ang 1-7 which is an antagonists of Ang II and natriuresis

Question 24

ACEi side effects

Answer 24

Dry cough, angioedema

Question 25

Direct vasodilators

Answer 25

Nitroglycerin Nitroprusside (Nipride) Nesiritide (Natrecor)

Question 26

Direct vasodilators MOA

Answer 26

Nitropresside and nitroglycerin either breakdown into NO or are NO and stimulate the process

Question 27

Nitroglycerin

Answer 27

Prodrug metabolized into NO Infused IV Selective for venous capacitance vessels (reduction of left ventricular filling pressure)

Question 28

Limitations of Nitroglycerin

Answer 28

Severe headache Have to taper off Development of resistance with chronic use Long infusion + increased EtOH

Question 29

Na nitroprusside

Answer 29

Metabolized into cyanide and NO IV administered Dilates both arteries and veins so it can reduce ventricular filling pressure and peripheral restance

Question 30

Na nitroprusside Limitations

Answer 30

Hypotension Cyanide toxicity Can cause tissue hypoxia, decreased oxidative metabolism, and liver or renal toxicity

Question 31

Cyanide toxicity causes

Answer 31

Altered mental status CV instability Anion gap metabolic acidosis

Question 32

Nesiritide

Answer 32

Recombinant brain natiuretic peptide Causes vasodilation of arteries and veins, nauresis and diuresis IV administration

Question 33

Nesiritide Limitations

Answer 33

Hypotension Expensive Debatable effectiveness