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Pharmacology B > Lecture 4 - Heart Failure Drugs 2 > Flashcards

Lecture 4 - Heart Failure Drugs 2 Flashcards

1
Q

List examples of B-blockers

A

Metoprolol, carvedilol

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2
Q

How are B-blockers usually administered to HF patients?

A

Low doses (0.1 x) gradually increased over weeks cause some but little hemodynamic depression

  • reduces heart rate and oxygen consumption
  • cardiac output is increased after several months

*chance of irregular heart beat reduced

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3
Q

When are B-blockers most effecting in HF patients?

A

post-MI

**Mortality reduced post-MI

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4
Q

Benefits of B-blockers?

A
  • decrease adverse effects of high catecholamine levels on the heart
  • decreased cardiomyocyte apoptosis (cell death)
  • decreased cardiac remodeling (decreased mitogenic activity)

*mechanism is not completely understood but clinical benefits are clear!

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5
Q

How does Carvedilol (B blocker) work?

A
  • blocks B and alpha receptors
  • alpha blockage helps to relax (dilate) arteries
  • the heart does not have to work as hard to eject blood
  • decreases afterload
  • B adrenergic receptor blockade slows the heart and decreases force of contraction
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6
Q

How does Metoprolol (B blocker) work?

A
  • similar benefits to carvedilol

- selectively blocks B1 adrenergic receptors

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7
Q

____ is a B1 selective B blocker

A

Metoprolol

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8
Q

In what kinds of patients should you avoid/caution B blockers with?

A

-asthma, COPD, peripheral vascular disease, insulin dependent diabetes, the very physically active

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9
Q

B blockers are good if what certain other diseases are present (i.e. they will treat both the HF and the other condition)

A
  • hypertension
  • glaucoma
  • certain arrhythmia
  • myocardial infarction
  • angina
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10
Q

Carvedilol interacts with _____ and will worsen breathing problems due to narrowing of airways

A

ventolin

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11
Q

Carvedilol and Metoprolol - interact with _____ (anti-hypertensive) and may cause irregular heartbeat

A

verapamil

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12
Q

B blockers and ____ medications could cause arrhythmia

A

antiretroviral

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13
Q

B blockers and ____ are dangerous since it is has additive effects of lowering blood pressure

A

alcohol

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14
Q

What are inotropes?

A

Agents which alter the force of contraction of the heart

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15
Q

Do we want positive or negative inotropes to treat HF?

A

positive

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16
Q

List 2 positive inotropes used in HF

A

digoxin

dobutamine

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17
Q

What effects do digoxin and dobutamine have?

A
  • increase contractility of the heart
  • symptomatic relief - long-term benefit unclear
  • chronic use associated with increased mortality
18
Q

Why don’t you want to use positive inotropes (digoxin, dobutamine) long term?

A

Positive inotropes increase strain on the heart, which is unfavourable. We want to reduce strain on the heart. Don’t want to use these long-term because of the increased strain on the heart.

19
Q

Dobutamine must be given by ____

A

IV

20
Q

What does dobutamine do?

A

stimulates B1-adrenergic receptors in the heart to increase heart rate and more importantly, contractility

21
Q

Why must you carefully monitor dobutamine?

A
  • it may increase HR, myocardial oxygen, consumption and blood pressure
  • may aggravate ischema (inadequate blood supply to an organ) and provoke arrhythmias
22
Q

What does digoxin do?

A
  • increases heart contractility (increases calcium in myocardial cells)
  • blocks Na/K ATPase (intracellular calcium levels stay high)
23
Q

Why must you carefully monitor digoxin?

A
  • may increase HR, myocardial O2 consumption, BP

- may aggravate ischemia and provoke arrhythmias

24
Q

Digoxin provides symptomatic improvement: describe this

A
  • improved exercise capacity

- decreased hospitalization for heart failure

25
Q

Digoxin does not improve _____

A

mortality

26
Q

Digoxin does improve ____

A

QOL (quality of life)

27
Q

Mechanism of action for Digoxin ?

A

increases calcium release for each beat

28
Q

When on digoxin, must monitor _____ levels

A

potassium

29
Q

____ increases digoxin toxicity

A

hypokalemia

*both inhibit the Na/K ATPase

30
Q

____ use may produce hypokalemia and increase digoxin toxicity

A

diuretic

31
Q

ACEi and ARBs or B blockers may _____ K+ levels

A

increase

32
Q

What kind of diuretics do not cause hypokalemia??

A

potassium sparing diuretics (spironolactone)

*not as good at increasing sodium excretion though

33
Q

What type of drug interactions with digoxin can dangerously increase blood levels of digoxin and result in cardiac arrhythmias?

A
  • common antibiotics such as amoxicillin and erythromycin

- the anti-arrhythmic agent amiodarone

34
Q

Diuretics are discussed in this lecture, but i’ve already made flashcards on diuretics so go see those fam

A

alrighty

35
Q

Describe the treatment of heart failure

A

1) Manage conditions that contribute to heart failure
- identify and treat risk factors (hypertension, diabetes, lipids, etc)
- diet, physical activity and lifestyle changes

2) Start with ACEi or B-blocker
- lower BP and reduce stress on heart
* if ACEi not tolerated, may switch to ARB

3) Diuretic - in patients with edema
- Remove excess fluid and sodium from body

4) Extreme failure - add inotrope
- Increase contractility to alleviate heart failure symptoms

36
Q

How do you treat Stage A (High risk with no symptoms)?

A

Risk-factor reduction

Patient Education

37
Q

How do you treat Stage B (Structural heart disease, no symptoms)?

A

ACEi or ARBs in all patients

B blockers in selected patients

38
Q

How do you treat Stage C (Structural heart disease, previous or current symptoms)?

A

ACEi and B blockers in all patients

39
Q

Describe the sequence for a “typical” patient

A

1) Loop diuretic
- act to rapidly control symptoms of volume overload (edema)
- more important in overt heart failure - may not need early

2) ACEi
- once diuretic therapy optimized if needed
- start at low dose

3) B blocker
- once patient is stable on ACEi
- start at low dose

4) Inotropes
- in those that have symptoms of HF in spite of above regimen

40
Q

Read case studies at end of lecture

A

ok

Pharmacology B (21 decks)

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