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Pharmacotherapy of Heart Failure - Summary Flashcards

1
Q

What medication is the first line therapy in acute DHF?

A

Furosemide

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2
Q

What class of medication is furosemide?

A

Loop diuretic

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3
Q

MOA of furosemide?

A

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

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4
Q

Adverse reactions of fursosemide?

A

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

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5
Q

MOA of HCTZ?

A

Inhibit DCT NaCl transporter

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6
Q

Adverse effects of HCTZ?

A

Hypokalemia
gout
hyperglycemia
Hyperlipidemia

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7
Q

Which diuretic has a higher risk of hypokalemia?

A

Furosemide

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8
Q

What diuretic should be avoided in patients with sulfa allergies?

A

HCTZ

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9
Q

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

A

ACEI’s

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10
Q

MOA of ACEIs?

A

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

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11
Q

What is a common side effect of lisinopril?

Why does this occur?

A

Cough

ACEI’s cause increase in levels of bradykinin.

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12
Q

Adverse reactions to ACEIs

A

Chronic dry cough

Hyperkalemia

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13
Q

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

A

Spironolactone or eplerenone

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14
Q

MOA of spironolactone and eplerenone?

A

Block aldosterone mediated remodeling

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15
Q

Adverse reactions to spironolactone/eplerenone?

A

Hyperkalemia

***Spironolactone - GYNECOMASTIA

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16
Q

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

A

ARBs - losartan or valsartan

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17
Q

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

A

ARBs

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18
Q

MOA of ARBs?

A

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

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19
Q

Adverse reactions to ARBs?

A

Hyperkalemia

20
Q

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

A

Sacubitril

21
Q

What class is sacubitril?

A

Neprilysin inhibitor

22
Q

Sacubitril should be used with what other heart failure medication?

A

ARB (valsartan)

23
Q

MOA of sacubitril?

A

Decreases BNP breakdown by neprilysin

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

24
Q

Adverse reactions to sacubitril?

A

Dizziness, hypotension, cough, hyperkalemia

25
Q

When should beta blockers be used in heart failure?

A

Started after stable on ACEI

26
Q

Name 3 beta blockers

A

metoprolol
carvedilol
bisoprolol

27
Q

MOA of B blockers?

A

Block B1 mediated remodeling

Blocks SNS activation in HFrEF

28
Q

Adverse reactions to beta blockers?

A 
Can precipitate acute heart failure
Worsen asthma - cause bronchospasm
May increase blood lipids
Sedation
Sleep disturbances
29
Q

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

30
Q

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

A

If systolic dysfunction and symptoms persist on standard treatment

31
Q

MOA of digoxin?

A

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

32
Q

Adverse reactions to digoxin?

A

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

33
Q

What factors increase risk of V tach while taking digoxin?

A

Hypokalemia or epinephrine use

34
Q

OD treatment for digoxin?

A 
If in V tach - Lidocaine
Suicidal OD (K+ high= heart block) - digoxin antibodies
35
Q

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

A

A vasodilator such as hydralazine or isosorbide dinitrate

36
Q

MOA of hydralazine?

A

Decrease afterload by opening arteriole K+ channels

37
Q

MOA of isosorbide dinitrate?

A

Decrease preload by increases cGMP levels in veins

38
Q

Adverse reactions to hydralazine ?

A

Reflex tachycardia
Orthostatic hypotension
Edema

39
Q

Adverse reactions to isosorbide dinitrate?

A

Reflex tachycardia
flushing
dizziness

40
Q

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

A 
Ionotropic agents (dobutamine, milrinone)
Vasodilators (nitroprusside, nitroglycerine)
41
Q

MOA of dobutamine and milrinone?

A

Increase contractility by B1 agonism

PDE-3 inhibitor - increasing cAMP levels to increase contractility and vasodilator action

42
Q

MOA of nitroprusside?

A

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

43
Q

MOA of nitroglycerine?

A

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

44
Q

Adverse reactions so dobutamine and milrinone?

A

Ventricular and supraventricular arrhythmias

N/V

45
Q

Adverse reactions to nitroprusside?

A

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

46
Q

Adverse reactions to nitroglycerine?

A

Tachyphylaxis with extended infusion

Cam's Cards (103 decks)

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