Pharm #9 - Acute CHF Drugs Flashcards
(22 cards)
NITRATES (nitroglycerin/ nitroprusside)
- MOA
- Indications (2) and clinical effect
- reduce preload by causing vasodilation of venous capacitance vessels
- reduce after load
3- decrease filling pressures, decrease arterial blood pressure
NITRATES (nitroglycerin/ nitroprusside)
- adverse effects (4, 1 main)
- contraindication 1
adverse:
- hypotension
- relfex tachy
- methemglobinemia
- nitrate tolerance**
contra:
- systemic hypotension
Nisertide
- MOA
- indication 1 + Clinical effect (2)
MOA: activates vascular smooth muscle and renal BNP receptors
- raise cGMP levels in VSMC and renal epithelial cells
Indication:
- acutely decompensated CHRONIC CHF in hospitalized patients
Clinical: vasodilation (afferente arteriole) to increase GFR, induce natriuresis and vasodilation
Nisertide
- adverse effects (2)
- contra (2)
- hypotension
- ventricular arrhythmias
Contra: reduced LV filling pressures
- systemic hypotension
B- Agonists (isoproterenol, dopamine, dobutamine, NE)
- MOA
- 2 indications / 3 clinical effects
MOA:
- stimulates cardiac beta receptors to increase cAMP
- low cardiac output due to acute CHF
- cardiogenic shock
Clinical:
- increase HR
- Increase contractility
- increase CO
B- Agonists (isoproterenol, dopamine, dobutamine, NE)
- adverse effects 3
- 2 contra
- arrhythmias
- increased O2 consumption
- Angina & vasoconstriction(NE)
Contra
- ventricular arrhythmias
- severe peripheral vascular disease
Digoxin:
- MOA
- indication (2)
- clinical 2
MOA:
- partially inhibits Na/K ATPase increasing reverse mode Na/Ca exchange and increasing SR Calcium!!!
Indications:
- acute CHF
- atrial fibrillation with rapid ventricular response
Clinical:
- increased contractility
- decreased AV node conduction velocity
Digoxin:
Side effects 2 major , 2 others
contra (2)
- Arrhythmias
- heart block
anorexia, nausea/vomiting
- History of Ventricular tachycardia / ventricular fibrillation
- hypokalemia
Phosphodiesterase inhibitors (name 2)
MOA
Indication
Clinical (3)
Inamrinone
Milrinone
Moa: inhibit degradation of cAMP in cardiomyocytes –> increasing cAMP in cardiac muscle
- inhibit degradation of cGMP in vascular smooth muscle inducing vasodilation
Clinical (3)
- increased contractility
- vasodilation
- increased cardiac output
Phosphodiesterase inhibitors (name 2)
Side effects 2
Inamrinone
Milrinone
- arrhytmias
- hypotension
Nitrates
- name 3
nitroglycerin
- isosorbide dinitrate
- erythrityl tetra nitrate
Nitrates (nitroglycerin, isosorbide dinitrate, erythrityl tetranitrate)
MOA indications (3 types of \_\_\_)
MOA: reacts with cysteinyl resides in vessel wall to increase the concentration of nitric oxide in vascular smooth muscle cells
= vasodilation in capacitance vessels (veins)
Indications
- exertional angina
- variant angina
- unstable angina
Nitrates (nitroglycerin, isosorbide dinitrate, erythrityl tetranitrate)
adverse effects -4
contra 1
- orthostatic hypotension
- reflex tachycardia
- HA
- nitrate tolerance
Contra: systemic hypotension
Ca Channel blockers
- nifedipine
- nicardipine
- verapamil
- diltiazem
MOA
Indication
Block L type C achannels in VSMC and cardiac myocytes
= vasodilation and decreased contractility
Indication:
- exertional angina
- variant angina
- unstable angina
Clinical effect: prevents episodes of exercise induced vasospastic angina
Ca Channel blockers
- nifedipine
- nicardipine
- verapamil
- diltiazem
Adverse effects 4 (1 for nifedipine specifically)
Contra 3
Adverse
- bradycardia
- heart block
- CHF
- hypotension & peripheral edema
- REFLEX TACHY in NIFEDIPINE
Contraindication:
- advanced heart block
- CHF
- systemic hypotension
B - Blockers
( propranolol, nadolol, atenolol, metoprolol, carvedilol)
MOA
Indications 3
Clinical effect - 1
MOA: block B receptors in cardiac myocytes to reduce contractility
Indications:
- exertional angina
- unstable angina
- post MI prophylaxis
Clinical effect:
- prevent exercise induced myocardial ischemia
B - Blockers
( propranolol, nadolol, atenolol, metoprolol, carvedilol)
- adverse effects - ALOT
- contraindication (4)
Adverse:
- bronchospasm
- peripheral vasospasm
- bradycardia
- CHF
- Heart block
- depression/fatigue
- BLOCK INSULIN INDUCED HYPOGLYCEMIA
- impotence
Contra:
- heart block
- ACUTE CHF
- insulin dep. diabetes mellitus
- COPD
RANALAZINE
MOA (?)
Indication
MOA: inhibit fatty acid beta oxidation in cardiac myocyte mitochondria
Indication: patients with chronic stable angina unresponsive to other agents
- now approved for EXERCISE INDUCED ANGINA
RANALAZINE
- adverse effect
- contraindicated
prolong QT interval
Contra: long QT syndrome & use with other drugs that prolong QT
Ivabradine
MOA
Indication
MOA:
- block If current in SA nodal fibers
- indication: chronic stable angina
Ivabradine
- adverse 3
- contraindication 2
adverse:
- bradycardia
- heart block
- luminous phenomenon
Contra:
- sick sinus syndrome
- use with calcium channel blockers verapamil or dilitiazem
Which dog is contraindicated for use with - use with calcium channel blockers verapamil or dilitiazem
IVABRADINE
- block If current in Sa nodal fiber and prevent exercise induced MI
