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pharm exam 2 > Topic 10 Heart Failure Drugs > Flashcards

Topic 10 Heart Failure Drugs Flashcards

1
Q

Heart Failure Definitions ?

A

“Inability to effectively return all the blood volume it (the heart) receives to the critter’s circulation”
•“(The heart’s)…inability to deliver adequate oxygen to the critter’s body to maintain normal function and homeostasis”
•“The heart is unable to effectively provide
the critter’s tissues with necessary metabolites and remove metabolic wastes

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2
Q

“The heart is unable to effectively provide

the critter’s tissues with necessary metabolites and remove metabolic wastes

A

Heart Failure

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3
Q

What causes Heart Failure ?

Symptomatic definition

A

Symptomatic definition

-”A mismatch between right and left heart volume outputs”

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4
Q

What causes Heart Failure ?

Cardio-centric definition

A
  • “The heart’s impaired ability to adequately fill with &/or eject blood”
  • Which sort of implies a dual causation
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5
Q

Systolic HF - shows a decrease in what

A

Contractility and EF

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6
Q

½ of the Systolic HF patients which tend to be what demographic?

A

“younger”

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7
Q

“Batista Procedure”

A

used in Systolic HF patients

also called a reduction left ventriculoplasty

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8
Q

Diastolic HF has a decrease it what?

A

Decrease CO and Ventricular Filling

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9
Q

Diastolic HF patients tend to be what demographic?

A

Older

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10
Q

Main HF causes ? (5)

A

1) Ischemia
2) Idiopathic
3) Viral
4) Immune-mediated
5) HTN

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11
Q 
Most common (~70%?) type of HF in
America
A

Ischemic

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12
Q

Ischemic HF can contribute to what dysfunctions?

A

Can contribute to both systolic and diastolic

dysfunction

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13
Q

What amount of HF are Idopathic?

A

1/3rd ish

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14
Q

“Viral” is another term for ?

A

“idiopathic”

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15
Q

Viruses errantly (going outside the proper area) take up residence in what kind of cells?

A

myocardial cells

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16
Q

Viral HF creates what kind of cardiomyopathy?

A

Moderate/severe cardiomyopathy develops

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17
Q

Type of HF that may require valvular surgery bc of new cardiac geometry?

A

Viral HF

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18
Q

Acute myocardial infarctions (AMIs) may

expose what?

A

novel cardiac antigens affecting long-term prognosis of Immune mediated HF

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19
Q

What forces contribute to the chronic

downhill HF slide? (2)

A

Renin Angiotensin Aldosteron System

SNS and PNS

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20
Q

Why does the Heart remodel

A

Heart cells die and are replaced with

fibrotic tissues and remaining cells hypertrophy

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21
Q

What are the Goals of Therapy for HF?

A

1) Improve/alleviate critter’s symptoms
2) Slow that “downhill slide” towards transplant/VAD/death
3) Improve survival ***Increase critter’s QALYs

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22
Q

Six Classes of QALY-Improving Drugs

A

1) Positive Inotropes
2) Diuretics
3) Renin/Angiotensin Blockers
4) Primary Vasodilators
5) β-Blockers
6) Aldosterone Antagonists
7) Neprilysin Inhibitor (the future?)

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23
Q

Types of Positive Inotropes ? (3)

A
  • Cardiac Glycosides
  • Catecholamines
  • Bipyridines
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24
Q

Digitalis

A

Digoxin

Cardiac Glycosides

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25
Q

Digitalis (Digoxin) do what?

Cardiac Glycoside

A

Positive Inotrope
Negative Chronotrope
Increased Baroreceptor sensitivity

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26
Q

Digitalis (Digoxin) therapeutic window?

Cardiac Glycoside

A

Narrow therapeutic window

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27
Q

Cardiac Glycoside: Digitalis (Digoxin) side affect?

A

Arrhythmias, GI symptoms

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28
Q

Do Cardiac Glycosides [Digitalis (Digoxin)] prolong life?

A

No evidence these drugs prolong life!

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29
Q

Digitalis (Digoxin) blocks what?

A

Blocks Na⁺/K⁺-ATPase “The Sodium Pump”

So the intracellular [ ] of Na increases, which decreases the Na/Ca exchanger so decreased extrusion into the EC space

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30
Q

Catecholamines

A

Classic β-1 adrenergic receptor stimulants

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31
Q

Catecholamine, β-1 adrenergic receptor stimulants? 4

A

Epinephrine
Norepinephrine
Dopamine
Dobutamine

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32
Q

Catecholamine, β-1 adrenergic receptor stimulants are powerful what?

A

Powerful positive inotropes and chronotropes

33
Q

PREFERRED DRUG FOR CARDIAC

ARREST

A

Epinephrine (Adrenaline)

34
Q

Epinephrine

A

Adrenaline

β-1 adrenergic receptor stimulant

35
Q

Epinephrine (Adrenaline) good for what reactions?

A

Also handy for anaphylactic reactions

36
Q

A relatively non-specific catecholamine; acts

on dopaminergic receptors

A

Dopamine

37
Q

Dopamine does what ?

A

Improves cardiac function in heart failure.
Also used for renal failure and shock
Given by IV drip infusion

38
Q

Inamrinone

amrinone back in my day

A

Inocor

Bipyridine

39
Q

Milrinone

A

Primacor
-Referred to as “phosphodiesterase inhibitors”

Bipyridine

40
Q

Bipyridines Increase what?

A

⬆️ intracellular levels of cAMP =
⬆️intracellular levels of Ca⁺⁺ =
⬆️myocardial contractility

41
Q

longer-term use of Bipyridines can result in?

A

results in significantly higher mortality than that seen in untreated patients

42
Q

Bipyridines are only used in what patients?

A

ONLY used in short-term (acute) HF patients

such as patients struggling to come off bypass

43
Q

First-line D.O.C.’s for heart failure?

A

Diuretics

particularly furosemide/lasix

44
Q

Ideal for those nasty “symptoms of excessive

venous pressure”

A

Diuretics

45
Q

Diuretics affect BP how?

A

Decrease plasma volume sooo
-Decrease afterload and blood pressure
-Decrease preload as well as edema
Net affect is to decrease the heart’s workload and resulting myO₂cardial demand

46
Q

Renin-Angiotensin Converting Enzyme Blockers (Angiotensin-Converting Enzyme Inhibitors) are what drugs?

A

prils

47
Q

Renin-Angiotensin Converting Enzyme Blockers (Angiotensin-Converting Enzyme Inhibitors) - how do they work on BP

A

⬇️venous tone which in turn SVR.

* ⬇️preload & afterload

48
Q

D.O.C. at all stages of HF, particularly in patients with low EF

A

Renin-Angiotensin Converting Enzyme Blockers (Angiotensin-Converting Enzyme Inhibitors)

49
Q

Initiation of ACE-Inhibitor Rx after what event is widely considered a standard of care?

A

after AMIs

50
Q

Losartan

A

Cozaar

ARB

51
Q

Losartan (Cozaar) is used as a replacement for what in intolerant patients?

A

ACE-Inhibitors

52
Q

What may be used with ACE-Inhibitors in decompensating patients?

A

Losartan (Cozaar)

53
Q

Dilation = ⬇️preload due to what?

A

⬇️preload due to ⬆️venous capacitance

54
Q

Dilation = does what SVR and afterload?

A

⬇️SVR and ⬇️afterload

55
Q

Frequently D.O.C. venous dilators for acute CHF episodes?

A

Nitrates

56
Q

Hydralazine

A

Apresoline

57
Q

Isosorbide dihy….

A

Isordil

58
Q

Critters intolerant of ACE-Inhibitors and Angiotensin Blockers &/or β-Blockers frequently respond to what two drugs?

A

Hydralazine (Apresoline) &/or Isosorbide (Isordil)

59
Q

β-Blockers contribute to what ? 2 things

A 
Block chronic (and deadly) SNS stimulation
which contributes to cardiomyocyte apoptosis and mitogenic remodeling
60
Q

Negative chronotrope do what to my0₂cardial needs?

A

⬇️my0₂cardial needs

61
Q

β-Blockers are what kind of chonotrope?

A

Negative chronotrope =⬇️my0₂cardial needs

62
Q

Metoprolol

A

(Lopressor, Toprol-XL)

β-Blocker

63
Q

Carvedilol

A

(Coreg)

β-Blocker

64
Q

Metoprolol (Lopressor) and Carvedilol (coreg) have been show to improve

A

long-term HF survivability

65
Q

What drugs are NOT for acute HF?

A

β-Blockers

Metoprolol (lopressor) and Carvedilol (Coreg)

66
Q

Spironolactone

A

(Aldactone)

-is a direct aldosterone antagonist (β-Blockers)

67
Q

Aldactone

A

Spironolactone,

a direct aldosterone antagonist (β-Blockers)

68
Q

Aldosterone Antagonists

Spironlactone (Aldactone) & Eplerenone (Inspra) help prevent what?

A

These help prevent salt~fluid retention, myocardial hypertrophy, and K⁺ (why?)
*Improve long-term (long-term is relative when you have an EF~20%!) mortality post-MI

69
Q

Eplerenone

A

(Inspra) is a competitive aldosterone antagonist

70
Q

Inspra

A

Eplerenone is a competitive aldosterone

71
Q

LCZ696

A

An experimental drug combo showing great
promise
A 50/50 mix of Valsartan and Sacubitril

72
Q

Sacubitril is metabolized into a what?

A

neprilysin inhibitor

73
Q

ACC/AHA Stage: A

is what NYHA Class?

A

Prefailure

74
Q

ACC/AHA Stage: B

is what NYHA Class?

A

I (symptoms w/severe exercise)

75
Q

ACC/AHA Stage: C

is what NYHA Class?

A

II/III (symptoms w/marked or mild exercise)

76
Q

ACC/AHA Stage: D

is what NYHA Class?

A

IV (severe symptoms at rest)

77
Q

Morphine and its relatives are used in acute heart failure to reduce what?

A

Classically used in acute heart failure to reduce preload, heart rate, and afterload.
•NO evidence it helps; substantial evidence it produces worse long-term outcomes

78
Q

Morphine and its relatives used in Chronic Heart Failure treatment does what?

A

Lowers respiratory rate which decreases cardiac workload
–Decreases preload and afterload (some…a good reason to say why you’re giving morphine…)
–EASES ANXIETY!

pharm exam 2 (9 decks)

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