MI/CHF Drugs Flashcards
1
Q
ACE-Is in CHF Effect/Use
A
- blocks conversion of Angiotensin I to II; venous dilation –> decreased afterload
- for pt’s with HF, EF <40% to improve symptoms/increase survival
2
Q
ACE-Is in CHF Monitoring
A
- renal function
- hyperkalemia
- hypotension
- dry cough
3
Q
ACE-Is contraindications
A
- angioedema
- pregnancy
4
Q
ACE-Is drug examples
A
Lisinopril, Enalapril, Ramipril
5
Q
ARBs in CHF effect/use
A
- blocks angiotensin II effects
- for pt’s with HF, EF <40% to improve symptoms/increase survival
- alternative to ACEs
6
Q
Considerations of ARBs
A
- no bradykinin accumilation –> no cough
- angioedema in cross-sensitivity
7
Q
ARBs monitoring
A
- renal function
- hyperkalemia
- hypotension
8
Q
ARBs drug examples
A
- losartan
- valsartan
9
Q
Angiotensin receptor neprilysin inhibitor (ARNI) in CHF effects
A
- blocks RAAS system/neprilsyin –> increases natriuretic peptides
- decreases cardiac hypertrophy and promotes diuresis
10
Q
ARNI drug/use
A
- Entresto (valsartan/sacubitril)
- used for stage C-D
- in place of ACE/ARB if persistent exacerbation
11
Q
ARNI Monitoring
A
- renal function
- hypotension
- angioedema
11
Q
ARNI contraindications
A
- do not use with ACE-I –> can cause angioedema
12
Q
Beta Blockers in CHF effect/use
A
- decrease SNS activation –> decreases HR and contractility
- asymptomatic EF <40%
- symptomatic of condition is not worsening
13
Q
Beta blockers monitoring
A
- hypotension
- worsening HF
- bradycardia
14
Q
Beta blockers contraindications
A
- symptomatic bradycardia
- severe reactive airway disease
- acute decompensation
15
Q
Beta blocker drug examples
A
- Metoprolol tartrate
- metoprolol succinate
- carvedilol, labetolol, atenolol
16
Q
Loop diuretics in CHF effect/use
A
- reduces pulmonary congestion and peripheral edema by decreasing preload
- admin based on symptoms/daily body weight
17
Q
Loop diuretics considerations
A
- maintains effect in renal dysfunction
- dietary sodium intake, NSAIDs
18
Q
Loop diuretics monitoring
A
- volume depletion –> hypotension
- electrolyte abnormalities
- ototoxicity
19
Q
Loop diuretics drugs
A
- furosemide/lasix
- bumetanide
20
Q
aldosterone antagonist effect/use
A
- blocks aldosterone receptors –> decreases preload/afterload and remodeling (potassium sparing)
- EF </= 35%; symptomatic stage C-D
21
Q
aldosterone antagonist monitoring
A
- renal function
- hyperkalemia (d/c potassium supplements)
- breast tenderness or enlargement
22
Q
aldosterone antagonist drugs
A
- spironolactone
- eplerenone
23
Q
Nitrates and Hydralazine Effect/goal
A
- increase in nitric oxide (vasodilation) & increases cardiac output/stroke volume
- symptomatic, EF </= 40%
24
Nitrates and Hydralazine monitoring
- hypotension
- avoid with phosphodiesterase inhibitor (ex. sildenafil aka Viagra)
25
Digoxin effect/use
- PO/IV
- increases intracellular sodium; reduces calcium transport out; increases contractility
- symptomatic, EF
26
monitoring digoxin
- narrow therapeutic level, high toxicity risk --> early signs: N/V, bradycardia
- monitor electrolytes (antagonistic for K+)
27
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
28
Ivabradine contraindications
- sinus node dysfunction
- not in combo with verapamil or diltiazem
- not in combo with CYP3A4 inhibitiors (ex. -azole antifungals)
29
Ivabradine AEs
- luminous phenomena
- bradycardia
- headaches
- dizziness
- blurred vision
30
Meds for acute decompensated heart failure (ADHF)
- milrinone
- amrinone
- dobutamine
*all IV
31
Milrinone/amrinone MoA
- increases inward Ca --> higher contractility
- increased vasodilation
32
Dobutamine MoA
- Beta 1 selectivity
- increased mortality; only use for short term to support BP
33
Nesiritide
- recombinant form of endogenous BNP; IV
- vasodilation, decreased venous/arterial tone; increased diuresis
- used in addition to standard ADHF care
34
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
35
SGLT2 inhibitor AEs
- hypoglycemia
- female genital mycotic infections, UTIs and increased urination
- ketoacidosis
- acute kidney injury
36
SGLT2 inhibitor drugs
- CanaGLIFLOZIN
- EmpaGLIFLOZIN
- DapaGLIFLOZIN
