Pharmacology - Drugs for Heart Failure (Exam 4)

Question 1

What are the drugs used for heart failure?

Answer 1

ACE Inhibitors (commonly used)
Diuretics
Vasodilators
B blockers
Angiotensin Receptor Blockers

Digoxin (NOT commonly used)

Question 2

What is the main difference between the heart and other muscles?

Answer 2

Heart cannot rest

Question 3

Inability to pump blood at sufficient rate to meet metabolic demands of the body

Answer 3

Heart failure

Question 4

Final and most severe manifestation of nearly every form of cardiac disease including things like atherosclerosis, hypertension, MI, CAD, etc

Answer 4

Heart failure

Question 5

What are the most common causes of heart failure?

Answer 5

CAD
MI
Hypertension

Question 6

What are other causes (outside the heart) of heart failure?

Answer 6

Hemorrhage
Drug toxicity
Other diseases (ex: diabetes)

Question 7

Hypertension increases __________, which _________ the chances of pumping blood out of the ventricle

Answer 7

afterload; reduces

Question 8

What does increased afterload due to hypertension cause?

Answer 8

Heart becomes hypertrophic and dilated
Leads to heart failure

Question 9

What is the cardiac output equation?

Answer 9

CO = HR x SV

Question 10

Failing heart means you have a ________ (high/low) cardiac output

Answer 10

low

Question 11

What are the 2 types of heart failure?

Answer 11

Left sided
Right sided

Question 12

Which heart failure?

Systolic dysfunction in ~2/3 of patients due to impaired ventricular contractility and increased afterload

Diastolic dysfunction in ~1/3 of patients due to impaired ventricular filling (decreased preload)

Answer 12

Left sided

Question 13

What are the causes of right sided heart failure?

Answer 13

Left sided heart failure (mainly)
Pulmonary embolism

Question 14

What are the complications of heart failure (what can heart failure lead to if untreated)?

Answer 14

Kidney damage/failure
Heart valve problems
Arrhythmia
Liver damage

Question 15

What do drugs for heart failure target?

Answer 15

The body’s compensatory mechanisms

Question 16

BP equation

Answer 16

BP = Flow x TPR

(flow = CO)

Question 17

In heart failure, you have decreased BP and CO (flow). How can the body try to bring BP back up?

Answer 17

Increasing CO (flow) and TPR

Question 18

How does the body increase CO (flow)?

Answer 18

Increase HR, contractility, blood volume

Question 19

How does the body increase TPR?

Answer 19

Vasoconstriction

Question 20

What are the 3 neurohormonal changes in heart failure?

Answer 20

1. Increase SNS
2. Increase RAA system
3. Increase ADH (to save water!)

drugs for heart failure target these

Question 21

T/F compensatory mechanisms for heart failure are good long term

Answer 21

FALSE, they are bad long term because they cause maladaptive structural changes and decreased cardiac performance

Question 22

What do drugs for heart failure target?

Answer 22

The compensatory mechanisms:

1. SNS
2. RAA system
3. ADH

Question 23

What is the best drug for short term treatment for heart failure?

Answer 23

Dobutamine (B1 agonist)

Question 23

What is the first drug of choice to treat heart failure?

Answer 23

ACE Inhibitors

Question 24

What is the suffix for ACE inhibitors?

Answer 24

"-pril"

Question 25

Which drug is an aldosterone antagonist?

Answer 25

Spironolactone

Question 26

What is the mechanism of Spironolactone

Answer 26

K+ sparing diuretic

Question 27

What is the adverse reaction of aldosterone antagonists like Spirolactone?

Answer 27

Hyperkalemia

Question 28

What is the suffix for angiotensin receptor blockers?

Answer 28

"-sartan"

Question 29

T/F decreasing the preload in patients with heart failure is a bad thing

Answer 29

FALSE, it is a good thing because it will decrease pulmonary congestion to improve breathing

Question 30

What is the mechanism of vasodilators?

Answer 30

Decrease afterload, end diastolic volume, preload, pulmonary congestion, pulmonary edema Increase tissue perfusion

Question 31

Which drugs are vasodilators?

Answer 31

Nitrates Hydralazine

Question 32

Which drugs are nitrates?

Answer 32

Nitroglycerin Isosorbide dinitrate

Question 33

What do nitrates do? (ON EXAM)

Answer 33

Decrease preload ("venous vasodilator")

Question 34

What does Hydralazine do? (ON EXAM)

Answer 34

Decrease afterload ("arteriolar vasodilator")

Question 35

How do B blockers treat heart failure?

Answer 35

Decrease HR, contractility, and oxygen/metabolic demand

Question 36

What do B blockers increase in heart failure patients that could lead to a poor prognosis?

Answer 36

Serum catecholamine levels

Question 37

What is the suffix of B blockers?

Answer 37

"-lol"

Question 38

T/F Digoxin is not a popular choice and is rarely prescribed

Answer 38

True

Question 39

Digoxin has a very ________ (high/low) toxicity

Answer 39

high

Question 40

Digoxin increases __________ and decreases ___________

Answer 40

contractility; HR

Question 41

Digoxin ___________ (increases/decreases) the need for compensatory mechanisms

Answer 41

decreases

Question 42

What is the mechanism of Digoxin?

Answer 42

1. Decrease Na+/K+ ATPase activity 2. Increase intracellular Ca2+ 3. Increase contractility, SV, CO

Question 43

Digoxin has a ________ (high/low) therapeutic index

Answer 43

low

Question 44

What are the 2 side effects of Digoxin? (ON EXAM)

Answer 44

1. Heart block 2. Ventricular arrhythmias

Question 45

What can Digoxin cause?

Answer 45

Hypokalemia

Question 46

What are the drug interactions of Digoxin?

Answer 46

1. Digoxin + B agonist = increased automaticity, ectopic pacemaker activity, & risk of arrhythmia 2. Digoxin + B blocker = decreased HR & AV conduction velocity; increased risk of bradycardia & AV nodal block

Question 47

What happens when you take Digoxin and antibiotics?

Answer 47

Increased absorption of Digoxin from GI tract Increased potential for toxicity

Question 48

Which drug is an ADH (vasopressin) antagonist?

Answer 48

Tolvaptan

Question 49

Which drug is used to treat arrhythmias?

Answer 49

Amiodarone

Question 50

How do you treat acute pulmonary edema?

Answer 50

"LMNOP" Lasix (furosemide = diuretic) Morphine (for pain) Nitrates (vasodilator) Oxygen Position (sit up)