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KG - Pharmacology 2 > KG - Pharm 2 Exam 2, Drugs for CHF > Flashcards

KG - Pharm 2 Exam 2, Drugs for CHF Flashcards

1
Q

drug class used to reduce preload

A

diuretic or venodilator

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2
Q

drug class used to reduce afterload

A

arteriodilator

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3
Q

drug class used to increase contractility

A

inotropic drugs

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4
Q

drug class used to reduce energy expenditure

A

Beta-adrenergic antagonist

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5
Q

digoxin - mechanism of action

A
  • inhibition Na/K/ATPase

leads to: increased Ca2+ stores, increased contractility, increased intracellular Na+

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6
Q

digoxin - cardiac effects

A
  • HR reduced/slowed

- as digitalis increases myocardial contractility, sympathetic tone will be reduced

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7
Q

digoxin - pharmacokinetics

A
  • oral

- 80% excreted by kidneys (best of glycosides)

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8
Q

digoxin - adverse effects

A
  • toxic (like all glycosides)
  • narrow safety margin
  • earliest signs toxicity = GI (N/V, diarrhea, etc)
  • CNS
  • ARRHYTHMIAS (bradycardia, vent beats, AV block, bigeminy)
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9
Q

digoxin - what should you do if intoxication occurs?

A
  • discontinue
  • oral/IV K+
  • lidocaine/phenytoin/propranolol
  • digitalis immune fab (in overdose cases)
  • NO CARDIOVERSION (except v fib)
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10
Q

digoxin - enhanced toxicity by…

A
  • decr renal clearance
  • QUINIDINE displaces digoxin from tissue binding sites
  • incr GI absorption
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11
Q

digoxin - what causes reduced toxicity?

A

decr GI absorption (ie: cholestyramine)

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12
Q

digoxin - what happens w/ hypokalemia?

A

more digitalis action

ie: w/ thiazides, loops, diarrhea

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13
Q

digoxin - what happens w/ further decr SA/AV node activity?

A

incr digoxin activity

ie: with Beta blockers

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14
Q

digoxin - what happens w/ myocardium?

A

myocardial sensitization to digoxin

NE releasing agents

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15
Q

what class of drugs are INAMRINONE & MILRINONE?

A

positive inotropic drugs, INODILATORS

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16
Q

inamrinone, milrinone - mech of action

A
  • inhibit cAMP phosphodiesterase
  • incr cAMP
  • incr Ca2+ influx (like B1 stim)
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17
Q

inamrinone, milrinone - indications/therapeutic effects

A
  • acute heart failure

incr CO

18
Q

inamrinone, milrinone - contraindications

A

long term effect = decreased survival & ARRHYTHMIAS!!!

19
Q

dopamine - low dose effects/location?

A

renal vasodilation @ D1 receptors in kidney

20
Q

dopamine - mod dose effects/location?

A

inotropic effect @ B1 receptors in heart

21
Q

dopamine - high dose effects/location?

A

vasoconstriction @ alpha receptors in vessels

22
Q

When to use dopamine?

A

SEVERE, REFRACTORY CHF

23
Q

dopamine - pharmacokinetics

A

IV

24
Q

dobutamine - mech of action

A

selective B1 agonist

25
Q

dobutamine - indications

A
  • positive inotropic, less tachycardia

- decr filling pressure, incr O2 consumption

26
Q

dobutamine - pharmacokinetics

A

IV

27
Q

diuretics - indications

A
  • decr salt, H20 retention

- decr venous pressure (decr edema, decr cardiac size)

28
Q

spironolactone, eplerenone - why do these drugs have additional benefits over other diuretics for CHF?

A
  • inhibit Aldo receptors

- REDUCED MORTALITY RATE

29
Q

which drugs reduce CHF mortality?

A
  • Aldo antagonists
  • beta blockers (beg only)
  • ARBs
  • ACE inhibitors
30
Q

what three things does angiotensin II cause that you do NOT want in CHF? (or ever..)

A
  • increased after load
  • increased preload
  • increased remodeling
31
Q

ACE inhibitors - mech of action

A

inhibits angiotensin converting enzyme (ACE), will not make ATII

32
Q

which drugs are ACE inhibitors?

A

-pril

33
Q

ARBs - mech of action

A

block angiotensin II from binding to the ATI receptor

34
Q

which drugs are ARBs?

A

-sartan

35
Q

which drugs are the backbone of CHF treatment?

A

ACE INHIBITORS

36
Q

therapy w/ ACE INHIBITORS will diminish cardiac workload by:

A
  • decr afterload (decr vasoconstriction)

- decr preload (decr aldo release)

37
Q

RAS inhibitors - adverse effects & why

A

dry cough bc reduction in bradykinin metabolism

38
Q

beta blockers (ie: Carvedilol, Metoprolol) - indications

A
  • DECR MORTALITY
  • decr renin secretion
  • decr HR
  • decr remodeling
  • up regulate B receptors
39
Q

when are beta blockers effective in CHF?

A

early stages only - dangerous in end stage bc of neg inotropic effects

40
Q

list of vasodilators?

A
  • sodium nitroprusside
  • isosorbide dinitrate
  • hydralazine
41
Q

vasodilators - how are they effective?

A

reduce:
- preload (venodilation)
- afterload (arteriolar dilation)
- or both!

also reduces damaging remodeling of heart

KG - Pharmacology 2 (10 decks)

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