HF Flashcards
Inotropic drugs
Digoxin
Milrinone (PDEI)
Dobutamine
Dopamine
Iondilator
Milrinone
HF med when need increase in contractility and has low BP
Dopamine
MOA of digoxin
inhibit Na/K ATPase –> increase intracellular Na –> decrease Ca export –> increased contractility and decreased HR
HR decrease in normal hearts on digoxin
baroreflex causes increases sensitivity of SA node to Ach (vagal stimulation)
HR decrease in HF hearts on digoxin
high sympathetic tone –> as digitalis increases myocardial contractility, sympathetic tone is reduced
Most common SE of digoxin
cardiac: sinus bradycardia, AV block. ectopic ventricular beats, bigeminy
Most common cause of death on digoxin
V. fib
GI effects on digoxin
lower dose
Mild arrhythmia on digoxin
give IV or oral vitamin K and lower dose
Severe arrhythmia/life threatening on digoxin
DigiFab
Decrease clearance of digoxin
quinidine amiodarone cyclosporine captopril verapamil diltiazam
Increase absorption of digoxin
omeprazole
erythromycin
Decrease absorption of digoxin
Bran
Cholestyramine
Other digoxin toxicities
vitamin K decreases
calcium increases
BB: bradycardia
CCB: dec. contractility
PDEI
milrinone
beta-1 agonist
dobutamine
used in severe refractory cases of HF
Dobutamine
Dopamine
Oral inotropic HF drug
digoxin
Drugs that reduce mortality in HF
adosterone antagonists, ACE, ARBS, BB, ARBNI
Diuretic that increases life span in HF
spironolactone
eplerenone
ACE effects
dec. afterload (dec. ATII)
Dec. preload (dec. aldosterone release)
Neprilysin
degrades natriuretic peptides, bradykinin and others
Entresto
ARNI: good at reducing mortality; dec. vasoconstrction, sodium retention and cardiac remodeling
SE of entresto
hypotension
hyperkalemia (ARB)
cough/angioedema
Contra of entresto
pregnancy
ACE
BB drugs
carvedilol
metoprolol
Effects of BB
decrease mortality dec renin secretion attenuate effects of high catecholamines up-regulate b receptors dec. HR dec. remodeling
When do you not use BB
severe, end stage HF (negative inotropic effect)
Vasodilators
Sodium nitroprusside
Isosorbide dinitrate
Hydralazine
How are vasodilators effect
reduce preload, afterload or both
dec. damaging remodeling of heart
Ivabradine MOA
block funny current in SA node, thus decreasing HR
When to use ivabradine
used when HR >70 bpm and beta blockers are at max dose or you can’t take BB
Adverse effects of ivabradine
bradycardia
conduction abnormalities: sinus arrest and heart block
Nesiritide
synthetic BNP, vasodilation and diuresis
