HF Treatment Flashcards
Three symptomatic relief agents in HF?
- vasodilators
- diuretics
- inotropic agents
Which 4 drug classes inhibit hypertrophic growth responses in HF?
- BB’s
- ACEI’s
- AGII receptor blockers
- aldosterone antagonists
What two beta blockers are used to Tx HF?
metoprolol succinate (B1 selective), carvedilol (non-selective with multiple other functions)
What are the ACEI and ATII-receptor blockers used to Tx HF?
Lisinopril
Losartan
What are the two aldosterone antagonists used to Tx HF?
eplerenone
spironolactone
What are two balanced vasodilators?
nitroprusside and nesiritide (decreased pre-load and after load)
Two types of AE’s of hydralazine?
- genetic: hydralazine is activated by acetylation and can produce a lupus-like syndrome in SLOW acetylators
- vasodilator AE’s: typical effects, tachycardia, pounding headache
What three drug types have additive effects with hydralazine?
- anti-HTN’s
- vasodilators
- ED drugs
What are three side effects of nitroprusside?
- hypotension
- tolerance to vasodilator actions
- also potential cyanide poisoning (met to CN and thiocyanate - body can buffer this unless blood levels are increased)
What is nesiritide and how does it work?
- recombinant human B-type natriuretic peptide (hBNP)
- stimulates soluble guanylate cyclase, increases arterial and venous levels of cGMP – decreasing pre-load and after-load
Indication for nesiritide Tx?
decompensated HF like nitroprusside, except no tolerance develops
Action of digoxin?
- inhibits Na/K ATPase
- inc intracellular Na which decreases Na influx/Ca efflux via Na/Ca exchanger = inc intracellular Ca
What is digoxin used to treat as a rate control drug?
SVT by increasing PARA tone on cardiac pacemakers via enhancement of the sensitivity of baroreceptors = slowed HR
Pharmacokinetic qualities of digoxin?
- 24-48 hour half life
- variable bioavailability
- excreted unchanged by the kidney (renal disease increases likelihood of fox)
- NARROW therapeutic window = induces arrhythmias
Consequences of digoxin toxicity?
- NV
- CNS/visual disturbances
- arrhythmias
- first signs: ectopic beats, first degree AV block (then higher block, VTAC, VFIB) due to Na/K ATPase poisoning and blockage of SAN/AVN (inc PARA tone)
- calcium overload – DAD’s – VTAC, VFIB
4 drugs to Tx digoxin fox?
- K: lowers affinity of digoxin for its receptor
- Lidocaine: anti-arrhythmic (Na+ blocker)
- Atropine: dec PARA tone; M2R antagonist
- Fab fragments = digibind
In what ionic imbalance is digoxin tox enhanced?
- hypokalemia (loop, thiazide diuretics)
- inc binding affinity of digoxin to receptor
How do bile acid sequestrants affect digoxin?
decreased absorption (bind negative, lipophilic drugs)
How do amiodarone and verapamil affect digoxin metabolism? (also quinidine)
decreased renal digoxin clearance
What gas imbalance increases digoxin toxicity?
hypoxia
What 3 beta1 agonists are used to Tx HF for rapid inotropic support?
- very potent, arrhythmogenic and must be monitored
- dopamine, milrinone and dobutamine
absolute contraindication with ACEI and AT1 antagonists?
pregnant women or those planning on becoming pregnant
What is one AE specific to ACEI?
decreased breakdown of bradykinin = increased cough
4 AE’s associated with ACEI/AT1R antagonists?
- hyperkalemia (inc Na+ efflux; worse in renal insuff or when used with K+ sparing diuretics)
- angioedema
- loss of taste
- hypotension
Two indications for the K+ sparing diuretic aldosterone antagonists? Examples?
- minimize K+ loss and potentiate actions of diuretics in Tx HTN or edema
- Spironolacton and eplerenone are used to improve outcomes in HF
AE’s associated with aldosterone antagonists?
- hyperkalemia
- gynecomastia, dec libido, impotence in men; menstrual irregularities/hair growth in women (less with eplerenone, more with spironolactone)
Two AE’s associated with loop diuretic (Na/K/Cl block) furosemide?
- hypokalemia – V arrhythmias, muscle weakness, drowsiness
- ototoxicity (also amino glycoside antibiotics, cisplatin anti-cancer drug
What class of drugs can blunt the actions of loop diuretics?
NSAIDs
