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Cardiology > HF Treatment > Flashcards

HF Treatment Flashcards

1
Q

Three symptomatic relief agents in HF?

A
  • vasodilators
  • diuretics
    • inotropic agents
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2
Q

Which 4 drug classes inhibit hypertrophic growth responses in HF?

A
  • BB’s
  • ACEI’s
  • AGII receptor blockers
  • aldosterone antagonists
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3
Q

What two beta blockers are used to Tx HF?

A

metoprolol succinate (B1 selective), carvedilol (non-selective with multiple other functions)

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4
Q

What are the ACEI and ATII-receptor blockers used to Tx HF?

A

Lisinopril

Losartan

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5
Q

What are the two aldosterone antagonists used to Tx HF?

A

eplerenone

spironolactone

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6
Q

What are two balanced vasodilators?

A

nitroprusside and nesiritide (decreased pre-load and after load)

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7
Q

Two types of AE’s of hydralazine?

A
  • genetic: hydralazine is activated by acetylation and can produce a lupus-like syndrome in SLOW acetylators
  • vasodilator AE’s: typical effects, tachycardia, pounding headache
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8
Q

What three drug types have additive effects with hydralazine?

A
  • anti-HTN’s
  • vasodilators
  • ED drugs
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9
Q

What are three side effects of nitroprusside?

A
  • hypotension
  • tolerance to vasodilator actions
  • also potential cyanide poisoning (met to CN and thiocyanate - body can buffer this unless blood levels are increased)
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10
Q

What is nesiritide and how does it work?

A
  • recombinant human B-type natriuretic peptide (hBNP)
  • stimulates soluble guanylate cyclase, increases arterial and venous levels of cGMP – decreasing pre-load and after-load
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11
Q

Indication for nesiritide Tx?

A

decompensated HF like nitroprusside, except no tolerance develops

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12
Q

Action of digoxin?

A
  • inhibits Na/K ATPase

- inc intracellular Na which decreases Na influx/Ca efflux via Na/Ca exchanger = inc intracellular Ca

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13
Q

What is digoxin used to treat as a rate control drug?

A

SVT by increasing PARA tone on cardiac pacemakers via enhancement of the sensitivity of baroreceptors = slowed HR

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14
Q

Pharmacokinetic qualities of digoxin?

A
  • 24-48 hour half life
  • variable bioavailability
  • excreted unchanged by the kidney (renal disease increases likelihood of fox)
  • NARROW therapeutic window = induces arrhythmias
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15
Q

Consequences of digoxin toxicity?

A
  • 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
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16
Q

4 drugs to Tx digoxin fox?

A
  • K: lowers affinity of digoxin for its receptor
  • Lidocaine: anti-arrhythmic (Na+ blocker)
  • Atropine: dec PARA tone; M2R antagonist
  • Fab fragments = digibind
17
Q

In what ionic imbalance is digoxin tox enhanced?

A
  • hypokalemia (loop, thiazide diuretics)

- inc binding affinity of digoxin to receptor

18
Q

How do bile acid sequestrants affect digoxin?

A

decreased absorption (bind negative, lipophilic drugs)

19
Q

How do amiodarone and verapamil affect digoxin metabolism? (also quinidine)

A

decreased renal digoxin clearance

20
Q

What gas imbalance increases digoxin toxicity?

A

hypoxia

21
Q

What 3 beta1 agonists are used to Tx HF for rapid inotropic support?

A
  • very potent, arrhythmogenic and must be monitored

- dopamine, milrinone and dobutamine

22
Q

absolute contraindication with ACEI and AT1 antagonists?

A

pregnant women or those planning on becoming pregnant

23
Q

What is one AE specific to ACEI?

A

decreased breakdown of bradykinin = increased cough

24
Q

4 AE’s associated with ACEI/AT1R antagonists?

A
  • hyperkalemia (inc Na+ efflux; worse in renal insuff or when used with K+ sparing diuretics)
  • angioedema
  • loss of taste
  • hypotension
25
Q

Two indications for the K+ sparing diuretic aldosterone antagonists? Examples?

A
  • minimize K+ loss and potentiate actions of diuretics in Tx HTN or edema
  • Spironolacton and eplerenone are used to improve outcomes in HF
26
Q

AE’s associated with aldosterone antagonists?

A
  • hyperkalemia
  • gynecomastia, dec libido, impotence in men; menstrual irregularities/hair growth in women (less with eplerenone, more with spironolactone)
27
Q

Two AE’s associated with loop diuretic (Na/K/Cl block) furosemide?

A
  • hypokalemia – V arrhythmias, muscle weakness, drowsiness

- ototoxicity (also amino glycoside antibiotics, cisplatin anti-cancer drug

28
Q

What class of drugs can blunt the actions of loop diuretics?

A

NSAIDs

Cardiology (6 decks)

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