Heart failure tx Flashcards
What cause cardiac remodeling of a failing heart? What drugs do we use to prevent cardiac remodeling and increase survival?
Increase symp activation
Aldosterone release
ACEI/ARB/spironolactone/beta blocker
What are the strategies to treat heart failure?
Decrease symp
Decrease afterload
ACEI/ARB/arteriole dilator
Decrease preload
ACEI/ARB/venodilator/diuretics (loop or thiazide)
Increase contractility with + inotropic drug
Digoxin/beta agonist
What are the 3 most common beta blockers that are used for heart failure?
Metoprolol/bisoprolol/carvedilol
What is the alternative if ACEI and ARB are not tolerable for a HF pt?
Hydralazine and nitrite
How does digoxin work as an positive inotropic drug?
Block Na/K pump—>increase intracellular Na level—>impair Na/Ca pump—>increase intracellular Ca level—>increase contractility
How does dobutamine or dopamine work as inotropic drug?
Beta 1 agonist—>Gs—>increase cAMP—>PKA—>phosphorylate Ca channel—>increase intracellular Ca level—>increase contractility
What do inmrinone and milrinone do? and what are they used for?
PDE3 inhibitor--->PDE break down cAMP--->inhibit PDE--->increase cAMP--->increase PKA--->increase phosphorylation of Ca channel--->increase Ca level--->increase contractility Acute CHF (don't use for chronic)
What are the direct and indirect affect of digoxin? and what are they for?
Direct—>increase intracellular Ca level—>increase contractility—>for HF
Indirect—>inhibit neuronal Na/K channel—>increase vagal activity—>anti-arrhythmia
Digoxin has short or long half life and what drugs can displace digoxin and increase serum digoxin level?
Long half life (2 days)
Verapamil and quinidine
What condition of the heart is digoxin most appropriately used?
CFH with supraventricular tachycardia (SVT)
What does toxic dose of digoxin cause? What can be used for that?
Fatal cardiac arrhythmia/hyperkalemia
lidocaine
What drug does digoxin interact with?
Diuretics (loop and thiazide) that cause hypokalemia—>digoxin compete with K to bind to Na/K pump—>decrease K—>digoxin binds more to Na/K—>increase toxicity
What can and can’t give for WPW syndrome?
Can give:
Block accessary pathway with class 1a and 3 of anti-arrhythmia
Can’t give:
Slow AV conduction—>beta blocker/CCB/digoxin/adenosine
What does cilostazol do? what does it contraindicated in?
PDE3 inhibitor—>for intermitten claudication
CHF
What does nesiritide used for?
type B natriuretic peptide—>increase cGMP—>vasodilation—>for acute CHF
