MI/CHF Drugs

Question 1

ACE-Is in CHF Effect/Use

Answer 1

• blocks conversion of Angiotensin I to II; venous dilation –> decreased afterload
• for pt’s with HF, EF <40% to improve symptoms/increase survival

Question 2

ACE-Is in CHF Monitoring

Answer 2

• renal function
• hyperkalemia
• hypotension
• dry cough

Question 3

ACE-Is contraindications

Answer 3

• angioedema
• pregnancy

Question 4

ACE-Is drug examples

Answer 4

Lisinopril, Enalapril, Ramipril

Question 5

ARBs in CHF effect/use

Answer 5

• blocks angiotensin II effects
• for pt’s with HF, EF <40% to improve symptoms/increase survival
• alternative to ACEs

Question 6

Considerations of ARBs

Answer 6

• no bradykinin accumilation –> no cough
• angioedema in cross-sensitivity

Question 7

ARBs monitoring

Answer 7

• renal function
• hyperkalemia
• hypotension

Question 8

ARBs drug examples

Answer 8

• losartan
• valsartan

Question 9

Angiotensin receptor neprilysin inhibitor (ARNI) in CHF effects

Answer 9

• blocks RAAS system/neprilsyin –> increases natriuretic peptides
• decreases cardiac hypertrophy and promotes diuresis

Question 10

ARNI drug/use

Answer 10

• Entresto (valsartan/sacubitril)
• used for stage C-D
• in place of ACE/ARB if persistent exacerbation

Question 11

ARNI Monitoring

Answer 11

• renal function
• hypotension
• angioedema

Question 11

ARNI contraindications

Answer 11

• do not use with ACE-I –> can cause angioedema

Question 12

Beta Blockers in CHF effect/use

Answer 12

• decrease SNS activation –> decreases HR and contractility
• asymptomatic EF <40%
• symptomatic of condition is not worsening

Question 13

Beta blockers monitoring

Answer 13

• hypotension
• worsening HF
• bradycardia

Question 14

Beta blockers contraindications

Answer 14

• symptomatic bradycardia
• severe reactive airway disease
• acute decompensation

Question 15

Beta blocker drug examples

Answer 15

• Metoprolol tartrate
• metoprolol succinate
• carvedilol, labetolol, atenolol

Question 16

Loop diuretics in CHF effect/use

Answer 16

• reduces pulmonary congestion and peripheral edema by decreasing preload
• admin based on symptoms/daily body weight

Question 17

Loop diuretics considerations

Answer 17

• maintains effect in renal dysfunction
• dietary sodium intake, NSAIDs

Question 18

Loop diuretics monitoring

Answer 18

• volume depletion –> hypotension
• electrolyte abnormalities
• ototoxicity

Question 19

Loop diuretics drugs

Answer 19

• furosemide/lasix
• bumetanide

Question 20

aldosterone antagonist effect/use

Answer 20

• blocks aldosterone receptors –> decreases preload/afterload and remodeling (potassium sparing)
• EF </= 35%; symptomatic stage C-D

Question 21

aldosterone antagonist monitoring

Answer 21

• renal function
• hyperkalemia (d/c potassium supplements)
• breast tenderness or enlargement

Question 22

aldosterone antagonist drugs

Answer 22

• spironolactone
• eplerenone

Question 23

Nitrates and Hydralazine Effect/goal

Answer 23

• increase in nitric oxide (vasodilation) & increases cardiac output/stroke volume
• symptomatic, EF </= 40%

Question 24

Nitrates and Hydralazine monitoring

Answer 24

• hypotension
• avoid with phosphodiesterase inhibitor (ex. sildenafil aka Viagra)

Question 25

Digoxin effect/use

Answer 25

• PO/IV
• increases intracellular sodium; reduces calcium transport out; increases contractility
• symptomatic, EF </= 40%
• does not reduce mortality

Question 26

monitoring digoxin

Answer 26

• narrow therapeutic level, high toxicity risk –> early signs: N/V, bradycardia
• monitor electrolytes (antagonistic for K+)

Question 27

Ivabradine class/MoA/Use

Answer 27

• PO
• sinoatrial node modulator
• provides HR reduction without loss of contractility
• EF <35% if BBs stop working; reduced risk of death

Question 28

Ivabradine contraindications

Answer 28

• sinus node dysfunction
• not in combo with verapamil or diltiazem
• not in combo with CYP3A4 inhibitiors (ex. -azole antifungals)

Question 29

Ivabradine AEs

Answer 29

• luminous phenomena
• bradycardia
• headaches
• dizziness
• blurred vision

Question 30

Meds for acute decompensated heart failure (ADHF)

Answer 30

• milrinone
• amrinone
• dobutamine

*all IV

Question 31

Milrinone/amrinone MoA

Answer 31

• increases inward Ca –> higher contractility
• increased vasodilation

Question 32

Dobutamine MoA

Answer 32

• Beta 1 selectivity
• increased mortality; only use for short term to support BP

Question 33

Nesiritide

Answer 33

• recombinant form of endogenous BNP; IV
• vasodilation, decreased venous/arterial tone; increased diuresis
• used in addition to standard ADHF care

Question 34

Sodium glucose co-transporter 2 (SGLT2) inhibitor MoA/route/indications

Answer 34

• prevent renal reabsorption of glucose and increase urinary excretion of glucose
• PO
• used in T2DM and CHF to reduce death

Question 35

SGLT2 inhibitor AEs

Answer 35

• hypoglycemia
• female genital mycotic infections, UTIs and increased urination
• ketoacidosis
• acute kidney injury

Question 36

SGLT2 inhibitor drugs

Answer 36

• CanaGLIFLOZIN
• EmpaGLIFLOZIN
• DapaGLIFLOZIN