MI/CHF Drugs Flashcards
ACE-Is in CHF Effect/Use
- blocks conversion of Angiotensin I to II; venous dilation –> decreased afterload
- for pt’s with HF, EF <40% to improve symptoms/increase survival
ACE-Is in CHF Monitoring
- renal function
- hyperkalemia
- hypotension
- dry cough
ACE-Is contraindications
- angioedema
- pregnancy
ACE-Is drug examples
Lisinopril, Enalapril, Ramipril
ARBs in CHF effect/use
- blocks angiotensin II effects
- for pt’s with HF, EF <40% to improve symptoms/increase survival
- alternative to ACEs
Considerations of ARBs
- no bradykinin accumilation –> no cough
- angioedema in cross-sensitivity
ARBs monitoring
- renal function
- hyperkalemia
- hypotension
ARBs drug examples
- losartan
- valsartan
Angiotensin receptor neprilysin inhibitor (ARNI) in CHF effects
- blocks RAAS system/neprilsyin –> increases natriuretic peptides
- decreases cardiac hypertrophy and promotes diuresis
ARNI drug/use
- Entresto (valsartan/sacubitril)
- used for stage C-D
- in place of ACE/ARB if persistent exacerbation
ARNI Monitoring
- renal function
- hypotension
- angioedema
ARNI contraindications
- do not use with ACE-I –> can cause angioedema
Beta Blockers in CHF effect/use
- decrease SNS activation –> decreases HR and contractility
- asymptomatic EF <40%
- symptomatic of condition is not worsening
Beta blockers monitoring
- hypotension
- worsening HF
- bradycardia
Beta blockers contraindications
- symptomatic bradycardia
- severe reactive airway disease
- acute decompensation
Beta blocker drug examples
- Metoprolol tartrate
- metoprolol succinate
- carvedilol, labetolol, atenolol
Loop diuretics in CHF effect/use
- reduces pulmonary congestion and peripheral edema by decreasing preload
- admin based on symptoms/daily body weight
Loop diuretics considerations
- maintains effect in renal dysfunction
- dietary sodium intake, NSAIDs
Loop diuretics monitoring
- volume depletion –> hypotension
- electrolyte abnormalities
- ototoxicity
Loop diuretics drugs
- furosemide/lasix
- bumetanide
aldosterone antagonist effect/use
- blocks aldosterone receptors –> decreases preload/afterload and remodeling (potassium sparing)
- EF </= 35%; symptomatic stage C-D
aldosterone antagonist monitoring
- renal function
- hyperkalemia (d/c potassium supplements)
- breast tenderness or enlargement
aldosterone antagonist drugs
- spironolactone
- eplerenone
Nitrates and Hydralazine Effect/goal
- increase in nitric oxide (vasodilation) & increases cardiac output/stroke volume
- symptomatic, EF </= 40%
Nitrates and Hydralazine monitoring
- hypotension
- avoid with phosphodiesterase inhibitor (ex. sildenafil aka Viagra)
Digoxin effect/use
- PO/IV
- increases intracellular sodium; reduces calcium transport out; increases contractility
- symptomatic, EF </= 40%
- does not reduce mortality
monitoring digoxin
- narrow therapeutic level, high toxicity risk –> early signs: N/V, bradycardia
- monitor electrolytes (antagonistic for K+)
Ivabradine class/MoA/Use
- PO
- sinoatrial node modulator
- provides HR reduction without loss of contractility
- EF <35% if BBs stop working; reduced risk of death
Ivabradine contraindications
- sinus node dysfunction
- not in combo with verapamil or diltiazem
- not in combo with CYP3A4 inhibitiors (ex. -azole antifungals)
Ivabradine AEs
- luminous phenomena
- bradycardia
- headaches
- dizziness
- blurred vision
Meds for acute decompensated heart failure (ADHF)
- milrinone
- amrinone
- dobutamine
*all IV
Milrinone/amrinone MoA
- increases inward Ca –> higher contractility
- increased vasodilation
Dobutamine MoA
- Beta 1 selectivity
- increased mortality; only use for short term to support BP
Nesiritide
- recombinant form of endogenous BNP; IV
- vasodilation, decreased venous/arterial tone; increased diuresis
- used in addition to standard ADHF care
Sodium glucose co-transporter 2 (SGLT2) inhibitor MoA/route/indications
- prevent renal reabsorption of glucose and increase urinary excretion of glucose
- PO
- used in T2DM and CHF to reduce death
SGLT2 inhibitor AEs
- hypoglycemia
- female genital mycotic infections, UTIs and increased urination
- ketoacidosis
- acute kidney injury
SGLT2 inhibitor drugs
- CanaGLIFLOZIN
- EmpaGLIFLOZIN
- DapaGLIFLOZIN
