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Cardiovascular module > Pharmacology: Katzung Drugs used in heart failure > Flashcards

Pharmacology: Katzung Drugs used in heart failure Flashcards

1
Q

Why are diuretics used to treat hear failure?

A

Because they reduce fluid retention and blood volume.

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2
Q

Which diuretics are commonly used in heart failure?

A

Furosemide, Hydrochlorothiazide, Spirinolactone.

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3
Q

What is the MOA of furosemide?

A

Furosemide inhibits the Na/K/2Cl transporter in the TALH. This creates a powerful diuretic action. It also has a vasodilating effect on the pulmonary vessels.

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4
Q

What are the clinical applications for furosemide?

A

(1) Acute/chronic heart failure
(2) acute pulmonary edema
(3) other edematous conditions
(4) hypercalcemia

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5
Q

What adverse effects are associated with furosemide?

A

(1) Ototoxicity
(2) hypovolemia
(3) hypokalemia
(4) hypocalcemia

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6
Q

What is the MOA for hydrochlorothiazide?

A

Hydrochlorothiazide inhibits the Na/Cl transporter in the distal tubule. This reduces preload and edema by a modest diuretic action.

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7
Q

What are the clinical applications for Hydrochlorothiazide?

A

(1) Mild chronic heart failure
(2) Chronic renal stones
(3) Nephrogenic diabetes insipidus
(4) Hypertension

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8
Q

What are the adverse effects associated with hydrochlorothiazide?

A

(1) hypokalemia
(2) Hyponatremia
(3) metabolic alkalosis

(4) hyperglycemia
(5) Hyperlipidemia
(6) hyperuricemia
(7) hypercalcemia.

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9
Q

What is the MOA of spirinolactone?

A

Spirinolactone is an antagonist of the Aldosterone receptor in the kidney. Causes diuresis be preventing up regulation of Na channels for Na reabsorption.

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10
Q

What angiotensin inhibitors are used to treat heart failure?

A

Captopril, Benazepril, enalapril,

Losartan, Candesartan,

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11
Q

Why are angiotensin inhibitors used to treat hear failure?

A

They reduce afterload, salt, and water retention.

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12
Q

What is the MOA of ACE inhibitors like captopril?

A

Captopril and other ACE inhibitors block angiotensin converting enzyme thus preventing the conversion of Angiotensin I to angiotensin II. Decrease in angiotensin II decreases vascular tone and aldosterone secretion.

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13
Q

What are the clinical applications for the ACE inhibitors?

A

(1) Heart failure
(2) Hypertension
(3) Diabetes

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14
Q

What are the adverse effects associated with the ACE inhibitors?

A

CAPTOPRIL

Cough
Angioedema
contraindicated in Pregnancy
metalic Taste
hypOtension
Potassium increased
Rash
Increased renin
Lower angiotensin II
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15
Q

Why are positive inotropic agents used to treat heart failure?

A

Positive inotropic agents are used to treat heart failure when is particularly severe and an increase in cardiac output is necessary to maintain perfusion

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16
Q

What positive inotropic agents are used to treat heart failure?

A

Digoxin (cardiac glycoside)

dobutamine (sympathomimetic)

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17
Q

What is the MOA of Digoxin?

A

Digoxin inhibits the Na+/K+ ATPase. This increases intracellular Na+ which decreases Ca expulsion. Increase intracellular Ca causes increased cardiac contractility.

18
Q

What are the clinical applications for digoxin?

A

(1) heart failure

(2) Nodal arrythmias

19
Q

What are the adverse effects associated with digoxin?

A

(1) Arrythmogenic!!!
(2) Nausea/vomiting
(3) diarrhea
(4) visual changes (rare)

20
Q

What is the MOA of dobutamine?

A

Dobutamine is a beta 1 selective sympathomimetic the increases cAMP and thus increases the force of contraction.

21
Q

What are the clinical applications for dobutamine?

A

(1) Acute heart failure

22
Q

What are the adverse effects associated with dobutamine?

A

Arrythmias.

23
Q

Why are beta blockers used to treat Heart failure?

A

beta blockers are used to treat heart failure because they decrease excess sympathetic stimulation.

24
Q

Which beta blockers are used to treat heart failure?

A

Carvedilol
Metoprolol
bisoprolol

25
Q

What is the mechanism of action for Carvedilol, metoprolol, and bisoprolol?

A

They are beta receptor blockers, however, their effect on heart failure is poorly understood. It is possible that they decrease remodeling.

26
Q

Why are vasodilators used to treat heart failure?

A

Vasodilators reduce preload and afterload.

27
Q

Which vasodilators are used to treat heart failure?

A

Nitroprusside
Hydralazine + isosorbide dinitrate
Nesiritide

28
Q

What is the MOA of Nitroprusside?

A

Nitroprusside causes massive powerful vasodilation which reduces preload and after load.

29
Q

What are the clinical applications for Nitroprusside?

A

Acute severe decompensated heart failure

30
Q

What are the adverse effects associated with Nitroprusside?

A

(1) Excessive hypotenison

(2) thioscyanate and cyanide toxicity

31
Q

What is the MOA of Hydralazine and isosorbide dinitrate in the treatment of heart failure?

A

The MOA is poorly understood

32
Q

What are the clinical applications for Hydralazine and isosorbide dinitrate in the treatment of heart failure?

A

Hydralazine and isosorbide dinitrate are used for the treatment of chronic heart failure in African Americans.

33
Q

What adverse effects are associated with the use of Hydralazine and isosorbide dinitrate?

A

(1) headache

(2) Tachycardia

34
Q

What is the MOA of Nesiritide in the treatment of heart failure?

A

Nesiritide is an atrial peptide vasodilator and diuretic.

35
Q

What are the clinical uses for Nesiritide?

A

Acute severe decompensated heart failure

36
Q

What adverse effects are associated with nesiritide?

A

(1) renal damage

(2) hypotension.

37
Q

How is digoxin eliminated?

A

60% renal excretion

40% hepatic metabolism

38
Q

What interactions are important to consider with digitalis therapy?

A

(1) Quinidine reduces digoxin clearance
(2) Digitalis toxicity is increased by hypokalemia, hypomagnesemia, and hypercalcemia therefore care should be taken with loop and thiazide diuretics.

39
Q

What are the three steps to treating digitalis intoxication?

A

(1) correction of potassium or magnesium deficiency
(2) Antiarrythmic drugs (lidocaine or phenytoin)
(3) Digoxin antibodies

40
Q

To what class of drugs do inamrinone, milrinone, and theophylline belong to?

A

They are Phosphodiesterase inhibitors

41
Q

What is the MOA of inamrinone, milrinone, and theophylline?

A

They inhibit phosphodiesterase which decreases the breakdown of cAMP. The result in increased cardiac intracellular Ca.

Cardiovascular module (11 decks)

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