HF

Question 1

What are the 4 beta-blockers indicated in the treatment of heart failure?## FootnoteCBMN

Answer 1

CarvedilolBisoprololMetoprolol XLNebivolol

Question 2

What enzyme does sacubitril inhibit?

Answer 2

Neprilysin

Question 3

What is the MOA of sacubitril?

Answer 3

Sacubitril inhibits neprilysin, preventing the breakdown of brain natriuretic peptide (BNP). Since BNP antagonises RAAS, the prolonged BNP effects will have protective effects on the heart

Question 4

Why is valsartan given in combination with sacubitril?

Answer 4

Neprilysin breaks down both BNP and angiotensin IIValsartan is an ARB which helps block the effects of angiotensin II

Question 5

What is the clinical indication for sacubitril-valsartan?

Answer 5

Heart Failure with reduced Ejection Fraction (HFrEF)

Question 6

What are the adverse effects of sacubitril-valsartain?

Answer 6

1. Hypotension2. Hyperkalemia3. Renal failure4. Cough & angioedema## FootnoteLiterally the same as ACEI

Question 7

Why does sacubitril-valsartan cause cough & angioedema?

Answer 7

Sacubitril inhibits neprilysin, which breaks down bradykinin

Question 8

Loop diuretics inhibit the luminal ________ in the ________, causing an increase in the excretion of ________ & ________.This increases the ________ of the luminal tubular fluid, decreasing ________

Answer 8

Loop diuretics inhibit the luminal Na+/K+/2Cl- transporter in the Loop of Henle, causing an increase in the excretion of Mg2+ & Ca2+.This increases the tonicity of the luminal tubular fluid, decreasing H2O reabsorption

Question 9

Name the most important loop diuretic

Answer 9

Furosemide

Question 10

What DDIs do loop diuretics have?

Answer 10

NSAIDs reduce renal PG synthesis and hence interfere with the action of loop diuretics

Question 11

What is the duration of effect for furosemide?

Answer 11

2-3 hours; extremely rapid diuretic response following IV injection

Question 12

What are the clinical indications for furosemide?

Answer 12

1. Hyperkalemia2. Acute pulmonary edema/other edema3. Anion overdose4. Acute renal failure

Question 13

What are the adverse effects of furosemide?

Answer 13

1. Hypokalemic metabolic alkalosis2. Ototoxicity (avoid with aminoglycosides)3. Hyperuricemia4. Hypomagnesemia

Question 14

Which class of diuretics act on the collecting tubule?

Answer 14

Potassium-sparing diuretics

Question 15

________ & ________ block the aldosterone receptors in the collecting tubule

Answer 15

Spironolactone & eplerenone block the aldosterone receptors in the collecting duct

Question 16

________ & ________ block the activation of the Na+ channels in the collecting tubule

Answer 16

Triamterene & amiloride block the activation of the Na+ channels in the collectube tublule

Question 17

Potassium-sparing diuretics have a faster onset of action than loop diuretics.True/False

Answer 17

False.Potassium-sparing diuretics have a slow onset and require several days before they can exert their full therapeutic effect

Question 18

What is the MOA of hydralazine?

Answer 18

Direct arteriole vasodilator –> reduces afterloadInduces a compensatory release of NE –> increased venous return through venous vasoconstriction + cardiac output

Question 19

What are the clinical indications for hydralazine?

Answer 19

1.HFrEF (in combination with ISDN)2.Second-line antihypertensive3.Acute onset post-partum htn

Question 20

What group of individuals is hydralazine contraindicated in?

Answer 20

Patients with coronary artery disease## FootnoteHydralazine stimulates sympathetic NS –> increased CO & O2 demand

Question 21

What are the adverse effects associated with hydralazine?

Answer 21

1. Flushing, hypotension, tachycardia2. Hydralazine-induced Lupus Syndrome (HLS)## Footnote1 - symptoms associated with baroreflex associated sympathetic activation

Question 22

Digitalis inhibit the ________, reducing the efficiency of the ________ as intracellular-[Na+] increases, leading to ________. Hence, this increases the ________ of the heart.

Answer 22

Digitalis inhibit the Na+/K+ ATPase, reducing the efficiency of the Na+/Ca2+ exchanger as intracellular-[Na+] increases, leading to less Ca2+ efflux. Hence, this increases the contractility of the heart.

Question 23

Is digitalis used in early or late-stage heart failure?

Answer 23

Late-stage

Question 24

What are the clinical indications for digitalis?

Answer 24

1. Systolic dysfunction2. AFib

Question 25

What are the adverse effects of digitalis?

Answer 25

1. Progressively more severe dysrhythmia2. GI effects3. CNS effects - headache, confusion, blurred vision

Question 26

Why do drugs that treat early-stage heart failure tend to reduce workload on the heart?

Answer 26

To preserve heart function

Question 27

What antibiotics should NOT be given with furosemide (loop diuretics)?

Answer 27

Aminoglycosides due to ototoxicity

Question 28

What is the MOA of the potassium-sparing diuretics?

Answer 28

They block aldosterone receptors/Na+ channels, preventing Na+ from being reabsorbed in the collecting ductThis increases H2O excretion by the kidney

Question 29

Which drug induces a compensatory release of NE?

Answer 29

Hydralazine