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Heart Failure > HF drugs > Flashcards

HF drugs Flashcards

0
Q

Which pt population is at increased risk for hyperkalemia?

A

diabetics & elderly

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1
Q

Potassium supplements should not be used with aldosterone antagonist when the serum potassium is…

A

> 3.5mEq/L

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2
Q

When should potassium levels be checked when using an aldosterone antagonist?

A
  1. 3 days after starting therapy then1 week later & at least monthly for the 1st 3 months of therapy
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3
Q

Before an aldosterone antagonist can be started, the renal clearance should be checked. what are the Ideal SCr levels for a man & woman?

A

Male: < 2.5mg/dL
female: <2mg/dL

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4
Q

Unlike ACEIs, BB & aldosterone antagonist, digoxin has no effect on what outcome?

A

Digoxin has no effect on mortality.

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5
Q

Digoxin affects this outcome of HF

A

It is ONLY for symptomatic benefit

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6
Q

What is the MOA of digoxin?

A

Digoxin inhibits the Na-K-ATPase pump which causes increased INTRAcellular calcium –> positive inotropic effects (increased contractility)

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7
Q

What happens at low doses vs. high doses of Lanoxin (digoxin)

A

Low doses: there is decreased sympathetic output w/o (+)inotropy
High doses: positive inotropic effect

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8
Q

What are the side effects of digoxin?

A

Heart: arrhhythmias, bradycardia, heart block
GI: abdominal pain, Nausea, vomiting, anorexia
neurologi: fatigue, visual disturbance, disorientation, confusion

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9
Q

What are the Therapeutic ranges for digoxin

A

HF: 0.5-1ng/ml

A. Fib: 0.8-2ng/ml

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10
Q

Digoxin is the drug of choice after failure of BB or CCB in what condition?

A

LV systolic dysfunction

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11
Q

What are the initial signs & symptoms of digoxin toxicity?

A

Nausea, comiting, diarrhea, bradycardia, dizziness, lightheadedness, fatigue

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12
Q

prolonged digoxin toxicity has symptoms of

A

vision changes (green/yello halos)
hallucinations
palpitations

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13
Q

At what levels do many pts experience digoxin toxicity

A

concentrations >2ng/ml normally, but in the elderly & pts with HYPOkalemia or HYPOmagnesemia toxicity can be seen with lower doses.

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14
Q

What medications need to be decreased by half when used in combination with digoxin?

A

Quinidine
verapamil
amiodarone

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15
Q

Which medications increase the concentration of digoxin?

A

Verapamil, Amiodarone, Quinidine
1c antiarrythmics (Propafenone, Flecanide)
Macrolides (erythromycins & clarythromycin)
Azols (itraconazole & ketoconazole)
Spironolactone
Cyclosporin

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16
Q

What medications decrease digoxin levels

A

Kaolin-pectin
Antacids, cholestryamine & colestipol (bind)
Metoclopramide

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17
Q

Digoxin is cleared significantly by the liver?

A

FALSE, digoxin is cleared mainly by the kidneys and dose adjustment in renal failure is REQUIRED

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18
Q

What is an appropriate starting dose of digoxin when used in the elderly or pts with low body mass?

A

0.125mg/day or every other day is appropriate

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19
Q

When is a loading dose of digoxin needed?

A

A loading dose of 0.25mg q2h with a max of 1.5mg is needed in the treatment of A. Fib.

NONE is needed in HF

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20
Q

A nurse has a patient on digoxin for HF & A. Fib. She knows that a dig level needs to be drawn on the pt, but is not sure when. What do you tell her?

A

Blood samples for dig levels should be drawn at least 6 hours, but preferably 12hrs AFTER the last dose of dig was given

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21
Q

The combination of hydrazine & isosorbide (BiDil) has what effect of HF outcomes

A

reduced mortality (but not more than ACEIs)

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22
Q

When can hydrazine & isosorbide (BiDil) be used in HF when

A
  1. pts that CAN’T use an ACEI or ARB due to intolerance, hypotension or renal insufficiency
  2. pts experience peristent HF symptoms despite therapy with ACEI + BB
  3. in addition to ACEI + BB + diuretic + digoxin in AF with HF
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23
Q

What are the most common side effects of hydrazine & isosorbide (BiDil)

A

HA
dizziness
GI complaints

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25
Q

When are BB indicated for use in HF

A

All STABLE pt with: a) current or hx of HF + reduced LVEF b) in combo with ACEIs & loops

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26
Q

Though BB have been shown too reduce symptoms, improve clinical outcome and decrease hospitalization & death; caution should be used when initiating & increasing dosage because BB can cause this?

A

increase in fluid retention = worsening HF when starting or increasing the dose

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27
Q

BB side effects of _____ & _____ that occur in the first weeks of therapy usually resolve

A

Fatigue & weakness

28
Q

BB cause bradycardia which leads to the other BB side effects of

A

dizziness, lightheadedness, or blurred vision

29
Q

Norvasc (amiodarone) & NDHP CCB increase these BB SE

A

bradycardiaheart blockhypotention

30
Q

Metoprolol (Torpolol-XL) & carvediliol (Coreg) are 2D6 substrates and their hepatic metabolism is inhibited by

A

Quinidinefluoxetineparoxetineother 2D6 inhibitors

31
Q

Which of the HF BB is metabolized by the Kidney & is adjustment for renal failure needed?

A

Bisoprolol & yes renal adjustment is needed

32
Q

A diabetic patient with HF is currenlty being manage with oral anti-diabetics. Which class may not be effective if the patient is on a BB?

A

Sulfonylureas

33
Q

When are diuretics used in HF & which type is preferred?

A

Diuretics are used ONLY in pts with signs & symptoms of volume overload with loop diuretics are preferred

34
Q

Which electrolytes are depleted by loop diuretics

A

potassium (hypokalemia) &magnesium (hypmagnesemia)

35
Q

Which diuretics should be given on an empty stomach & why?

A

Lasix (furosemide) & Bumex (bumetanide) are best taken on an empty stomach because food decrease their absorption

36
Q

A pt presents to the emergency room with ADHF. their current oral medications include: Lasix(furosemide) 10mg, Prinivil(lisinopril) 5mg and Lanoxin(digoxin) 0.25mg. Which of these medication should be kept?

A

All of the medications should be kept; however PO furosemide should be switched to either IV Lasix or another loop diuretic due to decreased absorption PO lasix in ADHF.

37
Q

What is the indication for ACEIs in HF

A

ACEIs are indicated for all pt with current or past HF symptoms + reduced LVEF

38
Q

What are the positive effects/outcomes of ACEIs on HF

A

ACEIs:1. improve HF symptoms2. reduce hospitalizations & death3. slow the progression of HF

39
Q

What are the side effects of ACEIs?

A

Renal isufficinceyAngioedemaHyperkalemiaRashCoughTaste disturbancehypotention & thus dizziness

40
Q

Which ACEI, induced toxicities are increased by cyclosporine(Neoral) & tacrolimus(Prograf, Protopic)

A

nephrotoxicity & hyperkalemia

41
Q

Which ARBs are indicated for HF & when should they be used?

A

Candisartan (Atacand) & Valsartan (Diovan) are indicated for HF in pts that are intolerant to ACEIs

42
Q

When are aldosterone antagonists used in HF?

A

They are to be added to standard therapy in pts with moderate-severe HF & reduced LVEF or NYHA class 2 pts currently on BB + ACEI therapy & LVEF <35%

43
Q

What effects to aldosterone antagonists have on HF outcomes

A

They reduce the risk of death & hospitalization

44
Q

Name all vasodilators

A

Nipride (nitroprusside)
Nitro-Bid, Nitrostat (nithroglycerin)
Natrecor (nesiritide)

45
Q

What is the MOA of Natrecor (nesiritide)

A

Natecore(nesiritide) is a B-type natriuretic peptide that cases an increase in diureses as well as arterial and venous dilation

46
Q

Nipride(nitroprusside) causes dilation of?

A

arterials & ventricals

47
Q

What is the dilatory effect of Nitro-Bid/Nitrostat (nitroglycerin)

A

low doses = venous dilation &

high doses = arterial dilation

48
Q

What are the side effects specific to Nipride?

A

myocardial ischemia

cyanide & thiocyanate toxicity

49
Q

Which of the vasodilators used in ADHF has the side effect of hemodynamic effect tolerance?

A

Nitroglycerin

50
Q

Vasodilators Nipride &Nitrostate cause which SE

A

hypotension, HA & tachycardia

51
Q

A pt taking Natrecor/ nesiritide is more likely to experience hypotension, HA if they are also taking what medication for HF or HTN?

A

a diuretic

52
Q

What is the generic name for Nipride

A

Nitroprusside

53
Q

What is the generic name for Natrecor

A

nesiritide

54
Q

What are the brand names for nitroglycerin

A

Nitro-Bid & Nitrostat

55
Q

What class do Intropin/dopamine, Doburex/dobutamine & Primacor/Milrinone fall into?

A

Inotropic agents

56
Q

What is the MOA of Intropin

A

Dose dependent dopamine, Beta and alpha1 agonist

57
Q

What dose of Intropin/dopamine stimulates dopamine receptors & what effect dose it have in the body?

A

0-3mcg/kg/min stimulates dopamine = improved urine output

58
Q

What dose of Intropin/dopamine stimulates Beta receptors & what effect dose it have in the body?

A

3-10mcg/kg/min stimulates Beta1 &2 receptors = increased CO

59
Q

What dose of Intropin/dopamine stimulates alpha1 receptors & what effect dose it have in the body?

A

> 10mcg/kg/min stimulates aplha-1 receptors = increased BP

60
Q

When should dopamine be used?

A

ONLY in pts with marked systemic hypotension or cardiogenic shock

61
Q

In what type of pt would Doutrex/dobutamine NOT be of benefit?

A

Dobutamine should NOT be used to increase BP in hypotensive pts because it has only weak agonistic effects on alpha1= little BP increase.

62
Q

What is the MOA of Primacor/milrinone

A

Milrinone/Primacor inhibits Phosphodiesterase III = positive inotropic & vasodilating effects

63
Q

What is the MOA of Dobutrex/Dobutamine

A

B1 & B2 agonist with WEAK alpha1 agonist activity that causes increases in CO & vasodilates

64
Q

What are the side effects of Primacor/milrinone

A

Arrhythmias
hypotention
HA

65
Q

When is the use of milrinone/Primacor indicated

A
  1. An alternative to dopamine/Intropin & dobutamine/Dobutrex when the pt is not responding
  2. Pt currently on BB, since the inotropic effects of Primacor are via a different pathway
66
Q

Which Inotrope & vasodilator must be adjusted or monitored in renal failure?

A

Inotrope- Primacor/milrinone = adjust

Vasodilator- Natrecor/nesiritide = monitor

67
Q

When are Inotropes indicated for use?

A

ONLY in hypoperfused pts, b/c they can increase the risk of death

Heart Failure (2 decks)

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