Pharmacology CHF - Beta Blockers, (+) inotropes, ARNI

Question 1

how are beta blockers helpful in CHF?
(2 points)

Answer 1

they reduce the sympathetic tachycardia reflex (this wastes oxygen)

reduce the preload on the heart

Question 2

true or false

while loop diuretics do not improve the mortality rate for CHF patients, beta blockers DO

Answer 2

TRUE

Question 3

4 negative heart effects from too much sympathetic activation as a compensatory mechanism for CHF

what class of drugs helps to block this sympathetic activation?

Answer 3

cardiomyocyte damage/death

arrythmia

interstitial fibrosis

beta adrenergic system desensitized

beta blockers help to prevent all these things from happening by blocking excess sympathetic stimulation

Question 4

**2 advantages of carvedilol in particular in treating CHF

Answer 4

-reduces lipid peroxidation (free radical-induced)

-prevents cardiac and vascular smooth muscle mitogenesis

PLUS it has alpha and beta receptor blocking activity

Question 5

true or false

in treating CHF, a combined alpha and beta blocker is preferred

Answer 5

true - like carvedilol

Question 6

*true or false

beta blockers reduce catecholamine-induced cardiomyocyte toxicity

Answer 6

TRUE

they do this by inhibiting prolonged sympathetic discharge that is done as a reflex

Question 7

*true or false

beta blockers cannot prevent or delay myocardial contraction dysfunction

Answer 7

FALSE - they can

Question 8

*true or false

beta blockers DECREASE cardiomyocyte apoptosis

Answer 8

TRUE

Question 9

*is it possible for beta blockers to induce myocardial remodeling

Answer 9

YES

by decreasing oxidative stress on the heart

Question 10

for which CHF patients are beta blockers NOT recommended

Answer 10

with severe or new onset CHF

Question 11

beta blockers are recommended for use in CHF patients along with…

Answer 11

ACE inhibitors or ARBS

Question 12

**name 4 positive inotropes for CHF

Answer 12

digoxin
milrinone
dopamine
dobutamine

Question 13

which + inotrope for CHF is a cardiac glycoside

Answer 13

digoxin

Question 14

which + inotrope for CHF is a Phosphodiesterase inhibitor

Answer 14

milrinone

Question 15

which + inotrope for CHF is adrenergic/dopaminergic cardiac stimulant

Answer 15

dopamine and dobutamine

Question 16

differentiate between inotropes and chronotropes

what is lusitropy?

Answer 16

inotropes increase the force of contraction

chronotropes increase the RATE of the heart

lusitropy increases ventricular relaxation and filling

Question 17

digoxin can be used to treat ___ and ____ by different mechanisms

Answer 17

CHF and A fib

CHF - increases calcium availability

a fib - blocks AV node conduction to help arrhythmias

Question 18

explain how dopamine and dobutamine work

Answer 18

they interact with the B1 receptor of the heart to activate adenylyl cyclase and cause cAMP formation – which causes protein kinase activation

this in turn increases the membrane transport of calcium, which increases myocardial force of contraction – POSITIVE INOTROPES

Question 19

name 2 + inotropes that increase the contraction of the heart through binding the B1 receptor

Answer 19

dopamine and dobutamine

Question 20

***name 3 positive inotropes that are phosphodiesterase-3 inhibitors

explain their mechanism

Answer 20

xanthines
amrinone
milrinone

inhibit the breakdown of cAMP – which causes increase in protein kinase and increase in calcium – causing contraction

Question 21

**is digoxin an inotrope?

how does it work?

Answer 21

yes

increases calcium available for contraction. inhibits the sodium/potassium ATPase – this causes intracellular sodium to increase - which leads to calcium intracellular accumulation as well via the sodium/calcium exchange system

Question 22

positive inotropes are used mainly for systolic or diastolic dysfunction

Answer 22

systolic – NEED CONTRACTION

Question 23

true or false

digoxin can be used in afib to correct arrythmias

Answer 23

true

blocks AV node condution

Question 24

some ADR digoxin

Answer 24

arrythmias
hallucination
blurred vision

Question 25

why is digoxin dangerous

Answer 25

has narrow therapeutic index!

Question 26

“van gough” effect

Answer 26

visual disturbances from digoxin – halos, altered colored perceptions, photophobia

Question 27

SEVERE digoxin toxicity

Answer 27

atrial and ventricular arrythmias

Question 28

****4 NON-digitalis positive inotropes that resemble norepinephrine

Answer 28

dopamine
dobutamine
amrinone
milrinone

Question 29

true or false

amrinone and milrinone are positive inotropes

Answer 29

TRUE

PDE3 inhibitor + inotropes

Question 30

ARNI**

Answer 30

angiotensin receptor-neprilysin inhibitor

SACUBITRIL IS THE NEPRILYSIN INHIBITOR

Question 31

**WHICH DRUG IS A NATRIURETIC PEPTIDE

Answer 31

NESIRITIDE

Question 32

explain how neprilysin inhibitors (sacubitril) work in heart failure

Answer 32

they inhibit neprilsyin

neprilysin is an enzyme that BREAKS DOWN NATRIURETIC PEPTIDES!!!! we want natriuretic peptides in heart failure bc they make the kidney release excess water and sodium

Question 33

true or false

sacubitril is a prodrug

Answer 33

true

Question 34

MOA ivabradine

Answer 34

NEW DRUG

selectively inhibits the “funny channel” PACEMAKER current in the SA node – lowers HR and more blood flow through myocardium

kind of works similarly to beta blockers - reduced firing and prevent o2 wasting