Pharmacotherapy of Heart Failure - Summary

Question 1

What medication is the first line therapy in acute DHF?

Answer 1

Furosemide

Question 2

What class of medication is furosemide?

Answer 2

Loop diuretic

Question 3

MOA of furosemide?

Answer 3

Inhibits loop Na-K-2Cl transporter causing decreased preload.

Question 4

Adverse reactions of fursosemide?

Answer 4

Hypokalemia - metabolic acidosis
Gout
Hypomagnesia, hypocalcemia
Ototoxicity w/ ethacrynic acid

Question 5

MOA of HCTZ?

Answer 5

Inhibit DCT NaCl transporter

Question 6

Adverse effects of HCTZ?

Answer 6

Hypokalemia
gout
hyperglycemia
Hyperlipidemia

Question 7

Which diuretic has a higher risk of hypokalemia?

Answer 7

Furosemide

Question 8

What diuretic should be avoided in patients with sulfa allergies?

Answer 8

HCTZ

Question 9

What class of medications is the 1st line initial treatment of heart failure?

Answer 9

ACEI’s

Question 10

MOA of ACEIs?

Answer 10

Blocks aldosterone release from kidney.
Vasodilation decreases preload and afterload.
This blocks ANG II mediated remodeling

Question 11

What is a common side effect of lisinopril?

Why does this occur?

Answer 11

Cough

ACEI’s cause increase in levels of bradykinin.

Question 12

Adverse reactions to ACEIs

Answer 12

Chronic dry cough

Hyperkalemia

Question 13

What medications could you add to a patient whose CHF symptoms persist on an ACEI and B blocker?

Answer 13

Spironolactone or eplerenone

Question 14

MOA of spironolactone and eplerenone?

Answer 14

Block aldosterone mediated remodeling

Question 15

Adverse reactions to spironolactone/eplerenone?

Answer 15

Hyperkalemia

***Spironolactone - GYNECOMASTIA

Question 16

What medication is used for patients with CHF and ACEI intolerance?

Answer 16

ARBs - losartan or valsartan

Question 17

What has more of a complete block of ANG II, ACEIs or ARBs?

Answer 17

ARBs

Question 18

MOA of ARBs?

Answer 18

Block aldosterone release from kidney.
Vasodilation decreases preload and afterload.
Blocks ANG II mediated remodeling.

Question 19

Adverse reactions to ARBs?

Answer 19

Hyperkalemia

Question 20

What medication is an option as a first line heart failure med, but is very expensive?

Answer 20

Sacubitril

Question 21

What class is sacubitril?

Answer 21

Neprilysin inhibitor

Question 22

Sacubitril should be used with what other heart failure medication?

Answer 22

ARB (valsartan)

Question 23

MOA of sacubitril?

Answer 23

Decreases BNP breakdown by neprilysin

Increases BNP, which decreases SNS activity, which decreases BP and decreases aldosterone mediated remodeling

Question 24

Adverse reactions to sacubitril?

Answer 24

Dizziness, hypotension, cough, hyperkalemia

Question 25

When should beta blockers be used in heart failure?

Answer 25

Started after stable on ACEI

Question 26

Name 3 beta blockers

Answer 26

metoprolol carvedilol bisoprolol

Question 27

MOA of B blockers?

Answer 27

Block B1 mediated remodeling | Blocks SNS activation in HFrEF

Question 28

Adverse reactions to beta blockers?

Answer 28

``` Can precipitate acute heart failure Worsen asthma - cause bronchospasm May increase blood lipids Sedation Sleep disturbances ```

Question 29

What medication is 1st line in patients with heart failure and A-fib

Answer 29

Digoxin

Question 30

When is digoxin indicated in patients with heart failure without a fib?

Answer 30

If systolic dysfunction and symptoms persist on standard treatment

Question 31

MOA of digoxin?

Answer 31

Decreases Na-K-ATPase which increases contractility by increases intracellular calcium. Increases PNS which decreases HR. Desensitizes baroreceptor response which decreases SNS activity.

Question 32

Adverse reactions to digoxin?

Answer 32

Common: N/V, anorexia, diarrhea Cardiac: Bradycardia, tachyarrhythmias (PVCs, V Tach),

Question 33

What factors increase risk of V tach while taking digoxin?

Answer 33

Hypokalemia or epinephrine use

Question 34

OD treatment for digoxin?

Answer 34

``` If in V tach - Lidocaine Suicidal OD (K+ high= heart block) - digoxin antibodies ```

Question 35

A black patient with heart failure is being treated with an ACEI and beta blocker, but symptoms are persisting. What medication should you add?

Answer 35

A vasodilator such as hydralazine or isosorbide dinitrate

Question 36

MOA of hydralazine?

Answer 36

Decrease afterload by opening arteriole K+ channels

Question 37

MOA of isosorbide dinitrate?

Answer 37

Decrease preload by increases cGMP levels in veins

Question 38

Adverse reactions to hydralazine ?

Answer 38

Reflex tachycardia Orthostatic hypotension Edema

Question 39

Adverse reactions to isosorbide dinitrate?

Answer 39

Reflex tachycardia flushing dizziness

Question 40

What two classes of meds should be considered in acute decompensated heart failure?

Answer 40

``` Ionotropic agents (dobutamine, milrinone) Vasodilators (nitroprusside, nitroglycerine) ```

Question 41

MOA of dobutamine and milrinone?

Answer 41

Increase contractility by B1 agonism | PDE-3 inhibitor - increasing cAMP levels to increase contractility and vasodilator action

Question 42

MOA of nitroprusside?

Answer 42

It is converted to NO is arterioles AND veins to decrease preload and afterload, to decrea.se BP

Question 43

MOA of nitroglycerine?

Answer 43

Increase cGMP levels in VEINS, causing venodilation and decreased preload.

Question 44

Adverse reactions so dobutamine and milrinone?

Answer 44

Ventricular and supraventricular arrhythmias | N/V

Question 45

Adverse reactions to nitroprusside?

Answer 45

hypotension, thiocyanate build-up -> weakness, nausea, muscle spasms. Cyanide accumulation -> acidosis, hypotension, death

Question 46

Adverse reactions to nitroglycerine?

Answer 46

Tachyphylaxis with extended infusion