Heart Meds Flashcards
ACE inhibitors
First line treatment
-used for patients with systolic heart failure
-lowers BP not heart rate
END in PRIL
“chill pril”
Decrease both preload and afterload
-blocks RAAS/aldosterone
-Helps prevent cardiovascular remodeling
-Cough
-Angioedema (swelling of tongue, face)
-hyperkalemia
Vasodilators
(Nitrates, Hydralazine)
-Decrease workload of overworked cardiac muscle
Diuretics - Loop
Entresto
(Sacubitril + Valsartan)
Sacubitril (neprilysin inhibitor) + Valsartan (ARB)
Used in systolic heart failure
Increase:
Naturetic peptides (BNP)
Bradykinin (vasodilation)
Other mediators which increase vasodilation
Side effects: Hypotension, hyperkalemia, renal failure
Can cause cough
NO NSAIDS
Beta Blockers
used for patients with heart failure with reduced ejection fraction (HFrEF)
Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenal
drugs in class: END in LOL
Carvedilol, Metoprolol Succinate & Bisoprolol
Never stop abruptly
ALWAYS check Apical heart rate (make sure not less than 60)
Adverse effects:
Hypotension,
Bronchospasm (COPD, asthma)
Exacerbation of peripheral vascular disease
Decreases catecholamine (epinephrine) stimulation
Decreases myocardial energy demands
Arrhythmia (irregular heartbeat) promotion
Nitrates
Prevention/treatment of angina pectoris and heart failure
-Arterial and venous dilator
-Decrease venous return to the heart (decrease preload and afterload)
Increases oxygen to the heart
Decreases myocardial oxygen demand
Pharmacokinetics:
Very rapidly absorbed
Tolerance develops easily, must have drug free periods
Nitrates medication details
Every 5 minutes for a max of 3 doses
If no relief, then call 911
Must stay in the original bottle and be protected by light
Must be sitting or lying when taking
Side effects:
Tingles or burns under tongue
Headache, dizziness
Watch BP before and after giving
IV Nitroglycerin
Used in the critical care setting: Acute chest pain
Myocardial infraction
Unstable angina
Must be administered in a glass bottle
Same side effects as other routes
Isosorbide
Oral nitrate
Has a drug free period in the delivery system
Works for about 18 hours
Can be short acting or a sustained release
Side effects similar to NTG
Spironolactone and Eplerenone
Are aldosterone receptor blockersused to reduce fluid retention (edema)
-caused by heart, liver or kidney problems, hypertension.
Also Mineralocorticoid receptor antagonist (MRA)
Work by reducing aldosterone effects which can cause cardiac fibrosis which leads to hypertrophy and can cause arrhythmias
Indications: Hypertension and heart failure
Can cause gynecomastia
Monitor potassium levels
Do not given in renal insufficiency
gynecomastia
Man boobs
Hydralazine + Nitrates
First drug regimen shown to improve heart failure symptoms
Combined use ofhydralazineand nitrate (isosorbide) therapy
Decreases preload and afterload by achieving both venous and arterial vasodilation
Used in patients who:
Have symptoms despite ACEI, BB, diuretic therapy
Those who can not tolerate routine therapy
Cardiac Glycosides: Digoxin
Indications:
Heart failure
Atrial fibrillation
Not first line treatment
-Increases intracellular calcium
Allows more calcium to enter the myocardial cell during depolarization;
Positive inotropic effect (increase contraction)
Increased renal perfusion with a diuretic effect
Decrease in renin release
Slowed conduction through the AV node (decrease HR)
Has a very narrow therapeutic margin
Normal level: 0.5-2.0
Desired level 0.8
Can be given oral and IV
Rapid onset and absorption
Renal excretion
ALWAYS check Apical heart rate, Monitor BUN/creatine and potassium
Toxicity:
Vision changes, Nausea/ vomiting, dizziness
Increased risk in hypokalemia
Antidote: Digibind
Caution
Pregnancy and lactation
Pediatric and geriatric patients
Renal insufficiency
