HF pharm

Question 1

What do inotropes do? List them.

Answer 1

Inotropes affect contractility.

• Dobutamine
• Milrinone
• Digoxin

Question 2

List the vasodilators.

Answer 2

Isosorbide dinirate
Sacubitirl
Hydralazine

Question 3

List the beta blockers

Answer 3

Metoprolol

Carvedilol

Question 4

List the diuretics

Answer 4

Furosemide

Question 5

List the ARBs.

Answer 5

Angiotensin Receptor Blockers.

• Losartan

Question 6

List the aldosterone receptor antagonists

Answer 6

Spironulactone

Question 7

Dobutamine

Answer 7

• beta 1 agonist
• used in acute HF
• IV, short duration
• SAE: arrythmias

Question 8

Milrinone

Answer 8

• selective reversible phosphodiesterase 3 inhibitor. cAMP degradation is blocked, leading to increased Gs, cAMP, and PKA signaling, which increases CO and results in vasodilation (decreased afterload)
• used in acute HF
• IV, short duration
• SAE: arrythmia

Question 9

Digoxin

Answer 9

• Na/K pump inhibitor which leads to increased Na in cell, which results in increased Ca storage in SR, leading to increased contractility
• used in CHF and arrhythmias
• SAE: arrhythmias, malaise, nausea, diarrhea, vision problems

Question 10

Isosorbide dinitrate

Answer 10

• increased NO results in smooth muscle relaxation which leads to vasodilation (decreased afterload)
• used in acute HF, often in combination with hydralazine
• SAE: tachycardia, hypotension

Question 11

Sacubitril

Answer 11

• Neprilysin inhibitor, leading to increased ANP stimulated vasodilation and salt/water excretion, leading to decreased afterload
• used in CHF, often in combination with valsartan
• SAE: hypotension, hyperkalemia, cough

Question 12

Hydralazine

Answer 12

• opens vascular K channels, making voltage gated Ca channels more difficult to open, leading to vascular smooth muscle relaxation, vasodilation, and decreased afterload.
• used in CHF (in combination with isosorbide dinitrate) and angina
• long duration of action
• SAE: tachycardia, hypotension, headaches

Question 13

Furosemide

Answer 13

• inhibits NKCC2 in the loop of Henle (diuretic loop)
• used for CHF edema, cirrhosis, nephrotic syndrome, HTN, hyperCa
• rapid onset
• SAE: hypokalemia, ototoxicity, dehydration

Question 14

Metoprolol

Answer 14

• beta 1 antagonist
• used in CHF (reduces mortality), HTN, angina
• SAE: bradycardia, CNS sedation, AV block

Question 15

Carvedilol

Answer 15

• alpha 1 and beta adrenergic antagonist
• used in CHF (reduces mortality), HTN, angina
• SAE: AV block, bradycardia, CNS sedation, bronchospasm

Question 16

Captopril

Answer 16

• ACE inhibitor: reduces afterload, preload, and CVS remodeling
• used in CHF and HTN
• causes a persistent dry cough (due to bradykinin metabolism)
• SAE: hyperkalemia, teratogenic

Question 17

Losartan

Answer 17

• binds Angiotension II receptor, therefore blocking any angiotensin processes. This results in decreased preload and afterload
• used in CHF and HTN
• does not cause cough (unlike Captopril)
• SAE: hyperkalemia, teratogenic

Question 18

Spironolactone

Answer 18

• aldosterone receptor antagonist, resulting in lowered TPR, afterload, and pre-load
• used in CHF, HTN, and hyperaldosteronism
• SAE: hyperkalemia and endocrine effects (gynacomastia)