Pharmacology CHF Part 1

Question 1

heart failure occurs when…

Answer 1

cardiac output is inadequate to provide oxygen needed by the body

Question 2

differentiate between HFrEF and HFpEF

Answer 2

HFrEF is SYSTOLIC FAILURE – reduced pumping and contractility of the heart (reduced ejection fraction)

HFpEF is DIASTOLIC FAILURE - not enough relaxation
(ejection fraction can normal – preserved ejection fraction - pEF)

Question 3

4 primary signs and symptoms of all types of heart failure

Answer 3

tachycardia
SOB
cardiomegaly
decreased exercise tolerance

Question 4

for a patient in CHF, why is a major symptom a fast heart rate?

Answer 4

because the heart is trying to compensate for the lack of cardiac output

Question 5

in CHF, what happens to renal blood flow and what is the body’s response?

Answer 5

decreased renal blood flow

this causes the release of renin – resulting in angiotensin II formation and sympathetic discharge

causes increased force, rate, preload, afterload, etc – in order to restore cardiac output

Question 6

name 2 classes of drugs used in acute heart failure

Answer 6

vasodilators and natriuretic peptide

Question 7

**name 3 loop diuretics

Answer 7

furosemide
torsemide
bumetanide

Question 8

where do loop diuretics work

Answer 8

in the thick ascending loop of henle

Question 9

why are loop diuretics generally preferred over thiazides for heart failure

Answer 9

loop diuretics get rid of more fluid - the congestion

Question 10

explain the MOA of loop diuretics

Answer 10

they block the sodium-potassium-chloride cotransporter in the thick ascending loop of henle

this enhances the excretion of sodium, potassium, and chloride, as well as lot of fluid

Question 11

true or false

loop diuretics increase the preload on the heart

Answer 11

FALSE - decrease – by decreasing intravascular fluid volume

Question 12

loop diuretics increase ___ and ____ delivery to the distal convoluted tubule

Answer 12

sodium and water

Question 13

true or false

thiazide diuretics have limited value in CHF and loop diuretics are preferred

Answer 13

true

more GFR is delivered to the thick ascending loop of henle, so more fluid can be excreted

Question 14

____ loss occurs more with loop diuretics than with thiazides

(what electrolyte?)

Answer 14

POTASSIUM

(can give with potassium sparing!)

Question 15

true or false

in CHF patients, diuretics do NOT improve the mortality rate

Answer 15

TRUE

just like a “patch” on the bigger issue
they need other medication

Question 16

true or false

furosemide can be used in pregnancy

Answer 16

FALSE - it cant

Question 17

furosemide depletes what 4 electrolytes

Answer 17

hypokalemia (K+)
hyponatremia (Na+)
hypomagnesemia (Mg2+)
hypochloremia (Cl-)

“ELECTROLYTE WASHOUT”

Question 18

furosemide and other loop diuretics cause metabolic alkalosis or acidosis??

Answer 18

alkalosis

Question 19

true or false

furosemide can be used in patients with hyperkalemia

Answer 19

true

Question 20

which food should NOT be given with loop diuretics like furosemide and why

Answer 20

licorice

enhances the hypokalemic effects
bc it enhances aldosterone - sodium retention and potassium loss

Question 21

loop diuretic DDI with corticosteroids

Answer 21

more potassium loss and hyperglycemia

Question 22

dofetilide interaction with loop diuretics

Answer 22

enhanced QT prolongation

Question 23

aldosterone antagonists are also known as….

Answer 23

MRA’s (mineralocorticoid receptor antagonists)

Question 24

aldosterone antagonists/mineralocorticoid receptor antagonists can be used to treat what 2 conditions

Answer 24

hypertension and CHF

Question 25

name 3 aldosterone antagonists/mineralocorticoid receptor antagonists

Answer 25

spironolactone
eplerenone
canrenone/canrenoate

Question 26

what is the name of the newer anti-aldosterone drug?
why is it beneficial?

Answer 26

eplerenone

it has less antiandrogenic and progestational effects because it is SELECTIVE for the minerolocorticoid receptor – less affinity to the steroid receptor

Question 27

____ vasodilators can be used in CHF

Answer 27

nitroso

Question 28

how are nitrates/nitroso vasodilators useful in CHF?

Answer 28

they reduce preload and arterial resistance, and also dilate the coronary artery in the heart to allow for better perfusion

HOWEVER, not normally given alone – often combined with OTHER vasodilators for better effect

Question 29

our endothelial cells are continually producing _____.

what happens if the endothelial cells are disrupted or damaged?

Answer 29

NO will not be produced as much

this isn’t good bc NO is a natural vasodilator - blood vessels too constricted

Question 30

***true or false

sodium nitroprusside is a slow acting vasodilator and does not act consistently

Answer 30

FALSE

it acts rapidly and consistently as a vasodilator

Question 31

**EXPLAIN the MOA of sodium nitroprusside

Answer 31

the drug reacts with the sulfhydryl groups in proteins (albumin) and RBCs to produce NO

NO activates guanylate cyclase, which increase production of intracellular cGMP

cGMP in turn activates protein kinase G. this activates phosphatases that inactivates myosin light chain

THIS RESULTS IN SMOOTH MUSCLE RELAXATION AND VASODILATION!!!!!!!

Question 32

*how does sodium nitroprusside have an advantage over hydralazine

Answer 32

it decreases cardiac work with NO reflex tachycardia

Question 33

*sodium nitroprusside improves ____ function in heart failure by _____

Answer 33

ventricular function by reducing the preload

Question 34

*true or false

sodium nitroprusside reduces total peripheral resistance and cardiac output (by decreasing the venous return)

Answer 34

true

Question 35

*MAJOR SE of sodium nitroprusside

Answer 35

cyanide toxicity!!!

Question 36

*name 1 sodium nitroprusside overdose treatment

Answer 36

methylene blue

Question 37

which vitamin can be used as a neutralizing agent in sodium nitroprusside toxicity (cyanide)

Answer 37

B12 (hydroxocobalamin)

Question 38

aside from methylene blue and B12, name 2 other neutralizing agents for cyanide toxicity from sodium nitroprusside overdose

Answer 38

4-dimethylaminophenol

dicobalt adetate

Question 39

**nesiritide class

Answer 39

a vasodilator

B-type NATRIURETIC PEPTIDE

Question 40

true or false

nesiritide cannot be used in CHF treatment

Answer 40

false - it can

Question 41

what does it mean that nesiritide causes “natriuresis”

Answer 41

excretion of sodium by the kidneys

Question 42

MOA nesiritide

Answer 42

increase cGMP in smooth muscle – this reduces tone of arteries and veins - VASODILATOR

also causes natriuresis

excreted naturally by the ventricles

Question 43

**true or false

hydralazine is not a vasodilator

Answer 43

FALSE - it is

Question 44

hydralazine is often used in CHF in combo with….

however, ____s are superior to hydralazine in reducing mortality from CHF

Answer 44

hydralazine + isosorbide dinitrate

ACE inhibitors superior – reverse left ventricular hypertrophy

Question 45

*class of minoxidil

Answer 45

vasodilator

Question 46

true or false

minoxidil is a prodrug

Answer 46

true

Question 47

MOA minoxidil (as a vasodilator for CHF)

MOA minoxidil (as an alopecia agent)

Answer 47

hyperpolarizes smooth muscles – thereby relaxing them

enhanced circulation around the hair follicles – they grow more. also, decreased androgen effect on them

Question 48

active form of minoxidil

Answer 48

minoxidil sulfate