Murphy- heart failure drugs

Question 1

Name the Drug treatment goal of current plan toward treating HF

Answer 1

• block actions of RAAS and sympathetic NS

Question 2

What is the purpose of aldosterone receptor antagonist?

Answer 2

• antagonist of aldosterone receptor, so you block aldosterone actions and can block the renin-angiotensin system

Question 3

which drugs do the best job of controlling the neurohormonal activation contributing to HF

Answer 3

• renin angiotensin inhibitor drugs

Question 4

which drugs do the gold standard job of reducinb mortality risk in heart faiulre

Answer 4

ACE inhibitors (‘prils)

Question 5

why choose ARB for ACE inhibitor?

Answer 5

when ACE inhibitors are poorly tolerated (cough, angiodema(

Question 6

in terms of heart failure where are beta blockers acting?

Answer 6

• at the heart (failiing left ventricular muscle)

- at the kidney… blocks renin release

Question 7

main indications of Beta blockers for heart failure

Answer 7

1. stable heart failure
2. heart failure with reduced LVEF

ALWAYS USED IN COMBO WITH ACEI or ARB

Question 8

gibe adverse effects of beta blockers

Answer 8

• because of magnitude of beta receptor blockade
• if you block too much, you get decreased cardiac performance (decompensation)… bradycardia, hypoglycemia, hypotension

Question 9

purpose of diuretics for HF

Answer 9

decrease TPR… eliminate salt and water from body..

Question 10

what is effect of mortality for diuretics in HF

Answer 10

• not established… probably because it’s used as an adjuct to other drugs

Question 11

potentially adverse effects of diuretics

Answer 11

1. hypokalemia (excessive sodium loss in urine)
2. drug interactions – hypokalmia potentiates digitalis action
3. potentiates diruesis from ACEI and aldosterione receptor antagonist

Question 12

What are cardiac glycosides… whats the most common formulation

Answer 12

• digitalis glycosides

- DIGOXIN

Question 13

Mechanism of action of digoxin

Answer 13

• inhibits sodium potassium pump (keeping sodium inside the cell and keeping depolarization higher)
• indirectly raises intracellular calcium, giving stronger contraction and improving ventiruclar performance

Question 14

what exchanger is unique to cardiomyoctes?

Answer 14

• Sodium calcium exchanger… sodium goes in, calcium goes out… to get rid of contraction

Question 15

how does digoxin inhibit sodium potassium pump

Answer 15

• binds site of where potassium would bind in order to poop it into the cell for exchange with sodium

Question 16

Digoxin works on what cell directly?

Answer 16

• myocardium, thus improving the overall neurohormonal profile

Question 17

indications of Digoxin in HF

Answer 17

• when standard therapy is not sufficient
• to increase CO and organ perfusion while reducing neuro-hormonal activation
• INCREASES VAGAL TONE (bezold-jarisch baroreflex) – senses increased contractility

Question 18

describe therapeutic index and clearance of digoxin

Answer 18

• low therapeutic index… cleared by kidney’s unchanged (if you’re in renal failure, you can slow clearance and cause toxicity)]

Half life is very long… makes toxicity a problem

Question 19

what are the main side effects of digoxin in heart failure

Answer 19

• Ubiquitous drug target… causes many different side effects in different organs (because you’re targeting sodium potassium pump)
• CAUSES ARRYTHMIAS
  
  • supraventricular (excess paraasympathetic from bezold-jarisch baroflex0
• ventricular arrythmias… too high of intracellular Na+/Ca2+, as well as low extracellular potassium

Question 20

effect of digoxin on mortality

Answer 20

• no effect

Question 21

effect of caclium channel blockers on mortality

Answer 21

• no effect

Question 22

• effect of alpha 1 adrenergic receptors blockers on mortality

Answer 22

• no effect

Question 23

hydrolazine is a ____ vasodilator, while isosorbide dinitrate is a ______

Answer 23

arteriolar; venodilator

Question 24

effect of hydrolazine+isosorbide dinitrate combination on mortality for HF

Answer 24

• decreases mortality!

Question 25

WHAT IS BIDIL

Answer 25

combo therapy of hydralazine + ISDN for african americans specifically

Question 26

what are the two categories of positive inotropic agents

Answer 26

1. beta adrenergic receptora agonists (induce cAMP); epinephrine and dobutamine to activate beta adrnergic receptors
2. phosphodiesteras einhibitors (protect cAMP); milrinone (CARDIAC SELECTIVE and short term)

Question 27

when would you use positive inotropic agents most for HF

Answer 27

acute and severe