Sacubitril-Valsartan, Milrinone, Nesiritide, Ivabradine, ranolazine Flashcards
What is the mechanism of action of sacubitril?
Sacubitril is a neprilysin inhibitor that increases levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), promoting natriuresis, vasodilation, and reduced preload and afterload.
Why is sacubitril combined with valsartan?
Valsartan is an angiotensin II receptor blocker (ARB) that complements sacubitril’s effects by inhibiting the renin-angiotensin system, reducing vasoconstriction and sodium retention.
How does neprilysin inhibition affect bradykinin?
Neprilysin metabolizes bradykinin, so its inhibition increases bradykinin levels, which can contribute to vasodilation but also increases the risk of angioedema.
What is the primary indication for sacubitril/valsartan (Entresto)?
Heart failure with reduced ejection fraction (HFrEF) to reduce mortality and hospitalization.
How does sacubitril/valsartan compare to ACE inhibitors in heart failure treatment?
It is preferred over ACE inhibitors in HFrEF because it reduces cardiovascular mortality and hospitalization more effectively.
Why is sacubitril/valsartan not used in acute decompensated heart failure?
It can cause hypotension and is better suited for chronic heart failure management.
Why is sacubitril contraindicated with ACE inhibitors?
The combination increases the risk of angioedema due to excessive bradykinin accumulation.
What is the required washout period when switching between sacubitril and an ACE inhibitor?
A 36-hour washout period is required to minimize the risk of angioedema.
Why should renal function be monitored with sacubitril/valsartan?
Both sacubitril and valsartan can impair renal function and increase the risk of hyperkalemia.
What are the common adverse effects of sacubitril/valsartan?
Hypotension, hyperkalemia, acute kidney injury, and angioedema.
Why does sacubitril/valsartan cause hyperkalemia?
Valsartan inhibits aldosterone release (through less AT II), reducing potassium excretion.
What is the mechanism of action of milrinone?
Milrinone is a phosphodiesterase-3 (PDE-3) inhibitor that increases cAMP, enhancing cardiac contractility and vasodilation.
When is milrinone used?
In acute decompensated heart failure when inotropic support is needed.
What are the adverse effects of milrinone?
Hypotension, arrhythmias, and increased mortality with long-term use.
What is nesiritide and how does it work?
Nesiritide is a synthetic BNP that increases cGMP in vascular smooth muscle, leading to vasodilation and natriuresis.
What are the risks associated with nesiritide?
Hypotension and renal dysfunction.
What is the mechanism of action of ivabradine?
Ivabradine inhibits the funny current (If) in the sinoatrial (SA) node, slowing heart rate without affecting contractility.
What is ivabradine used for?
HFrEF in patients with resting heart rates >70 bpm despite beta-blocker therapy.
What are the side effects of ivabradine?
Bradycardia and visual disturbances (phosphenes, transient brightness in vision).
What is the mechanism of action of ranolazine?
Ranolazine inhibits the late sodium current, reducing diastolic wall tension and myocardial oxygen consumption.
What is ranolazine used for?
Chronic stable angina refractory to other anti-anginal medications.
What is a major side effect of ranolazine?
QT interval prolongation, increasing the risk of torsades de pointes.
