Pharm-HF

Question 1

Drugs used to slow the progression of HF:

Answer 1

1. RAAS blockers
   - ACEI, ARB, aldosterone receptor blockers
2. Beta blockers
3. Neprilysin inhibitors
4. Vasodilators

Question 2

Drugs used to relieve HF symptoms

Answer 2

1. Diuretics
2. Inotropic drugs
   - cardiac glycosides, sympathomimetics, PDE3 inhibitors
3. Funny channel blockers

Question 3

___ are the first line tx for chronic HF

Answer 3

ACEI

Question 4

Main side effects of ACEI

Answer 4

Dry cough
Hyperkalemia
Hypotension

Question 5

Contraindications of ACEI

Answer 5

Pregnancy

Bilateral renal a. stenosis

Question 6

ARBS are used when __

Answer 6

Patients cannot tolerate ACEI

Question 7

___ is a selective aldosterone receptor antagonist

___ is nonselective

Answer 7

Eplerenone

Spironolactone

Question 8

MOA

Aldosterone receptor antagonists

Answer 8

Block aldosterone receptors and therefore increase secretion of Na and H2O and reduce K loss

Question 9

Adverse effects of aldosterone receptor antagonists

Answer 9

Gynecomastia

Hyperkalemia

Question 10

Neprilysin inhibitors in combo with ARB enhance the action of ___ and suppress the effects of ___

Answer 10

Natriuretic peptide

Ang II

Question 11

Uses of neprilysin inhibitors

Answer 11

NYHA class II or III HFrEF

Question 12

Three adrenergic receptor antagonists have been shown to be effective in reducing risk of death in pts with chronic HFrEF

Answer 12

Bisoprolol (B1)
Metoprolol (B1)
Carvedilol (a1, B1, B2)

Question 13

Vasodilators used for HF

Side effects?

Answer 13

Hydralazine
Isosorbide dinitrate

*headache, flushing, tach, hypotension

Question 14

Contraindications for vasodilators

Answer 14

Co-admin of nitrates with PDE inhibitors such as sildenafil due to risk of added hypotension

Question 15

Use ___ for all pts with evidence of or prior hx of fluid retention

Answer 15

Diuretics

Question 16

___ are the only drugs that can adequately control the fluid retention of HF

Answer 16

Diuretics

Question 17

Loop diuretics
Example
Route

Answer 17

Furosemide

Orally and IV

Question 18

Cardiac effects of digoxin

Answer 18

\+ inotropic by inhibiting Na/K ATPase 
\+ chronotropic 
Renal-induced diuresis 
Vasoconstriction
Increases GI motility

Question 19

Digoxin is recommended for patients who:

Answer 19

1. Remain symptomatic after ACEI , ARB, beta blocker, aldosterone blocker, and diuretic
2. A fib

Question 20

Major things that interact with digoxin

Answer 20

Diuretics
Beta blockers
Ca channel blockers

Question 21

Treatment of digoxin toxicity

Answer 21

K supplement
Mg for deficiency
Antiarrhythmics/atropine for symptoms
Digoxin antibody/digibind

Question 22

Other inotropic agents

Answer 22

• PDE Inhibitors (bipyridines): inamrinone, milrinone

- Beta agonists : Dopamine, Dobutamine