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Unit 2 Pharm II > L14: HF > Flashcards

L14: HF Flashcards

1
Q

Why DO diseased hearts see an increase in CO with digitalis

A

PVR is already maxed out (sympathetic tone), can’t increase more to counteract contractility

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2
Q

Don’t give beta blockers with

A

dobutamine

dopamine

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3
Q

At any point if a patient shows signs of digoxin intoxication

A

discontinue
IF moderate to severe, give K+
IF severe, give Digitalis Immune Fab

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4
Q

4 drugs that are positive inotropes (increase contractility)

A

Digoxin
Dobutamine
Dopamine
Milrinone

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5
Q

Why is contractility decreased in HF

A

myocardial muscle fibers are stretched too far as ventricles become dilated

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6
Q

Main side effect that occurs with ACE inhibitors but not ARBs?

A

Dry cough due to increased bradykinin

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7
Q

Milrinone is given short term due to

A

Risk of arrhythmias

IV only

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8
Q

why DON’T normal hearts see an increase in CO with digitalis?

A

Increased PVR counteracts the increased contractility

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9
Q

Reduce preload with

A

venodilators

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10
Q

Earliest signs of digoxin toxicity?

A

GI effects - even at low doses

Disappear after discontinuation

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11
Q

Sacubitril/valsartan contraindication

A

pregnancy

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12
Q

Cardioversion treatment is for

A

vfib caused by severe digitalis intoxication

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13
Q

Reduce afterload with

A

arteriodilators

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14
Q

ACE-I contraindication

A

Pregnancy

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15
Q

Milirinone indications

A

palliative care for acute HF or severe exacerbation of chronic HF
IV only

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16
Q

Bigemy

A

induced by digitalis, treated with K+

17
Q

Drugs to increase contractility

A

Inotropic drugs

18
Q

Digoxin MOA

A

Inhibition of membrane sodium pump (Na/K ATPase) leading to cardiac effects:

  • Increased intracellular Na+
  • Increased intracellular Ca2+ leads to increased SR Ca2+ stores
  • Increased actin-myosin interaction by intracellular Ca2+
19
Q

most common cause of digitalis death

A

vfib

20
Q

All glycosides are

A

toxic

digoxin is a cardiac glycoside

21
Q

Most heart failure is

A

left ventricular dysfunction

22
Q

Beta blockers in late heart failure… (Carvedilol, Metoprolol)

A

DANGER: negative inotropic effet

23
Q

Digoxin can be displaced from tissue binding sites (increased toxicity) by

A

Quinidine (careful if your patient has HF and arrhythmias!)

24
Q

Most common and dangerous side effects of Digoxin?

A

Arrhythmias: sinus bradycardia, ectopic ventricular beats, AV block, and BIGEMINY

25
Q

Things that decrease digitalis toxicity/effects

A
  1. Decreased GI absorption: cholestyramine, bran

2. Calcium Channel Blockers→ decreased contractility→ contraindicated in heart failure

26
Q

Beta blockers in early heart failure… (Carvedilol, Metoprolol)

A

decrease mortality

27
Q

What is the most important role of the neprilysin inhibitor in the Sacubitril/Valsartan combo?

A

Reduced sodium retention

Also: reduced vasoconstriction and cardiac remodeling

28
Q

Sodium nitroprusside effects

A

venous and arteriodilator

MOSTLY VEINS

29
Q

Hydralazine effects

A

vasodilation by NO

30
Q

Preload increases because

A

Increased sympathetic and RAAS activity —> Increased venous return —> Increased blood volume and venous tone

31
Q

When to use Ivabradin

A

It decreases HR when beta blockers can’t/won’t

32
Q

Afterload increases because

A

Increased sympathetic and RAAS activity —> increased peripheral resistance via arterial constriction

33
Q

Drugs to reduce contractility

A

B blockers

34
Q

Main side effects of Sacubitril/Valsartan?

A

Hypotension
Hyperkalemia (from the ARB)
COUGH and ANGIOEDEMA (increased bradykin)

35
Q

Diuretics to decrease mortality

A

spironolactone
eplerenone
aldosterone inhibition is beneficial

36
Q

Things that increase digitalis toxicity

A
  1. Decreased renal clearance or volume of distribution: quinidine, amiodarone, captopril, verapamil, diltiazem, cyclosporine
  2. Quinidine displaces digoxin from tissue binding sites
  3. Increased digoxin GI absorption: erythromycin, omeprazole
  4. Hypokalemia: thiazide/loop diuretics, diarrhea
  5. Decreased SA/AV node activity: beta blockers
  6. Myocardial sensitization to digoxin: NE releasing agents
37
Q

Monitor ______ when on digoxin therapy

A

PERFORM REGULAR EKGS, MEASURE K+ and DIGITALIS

38
Q

Isosorbide dinitrate is a…

A

precursor of nitric acid

Unit 2 Pharm II (13 decks)

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