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Pharmacology > Unit 4-Heart Failure/Inotropic agents > Flashcards

Unit 4-Heart Failure/Inotropic agents Flashcards

1
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Drug class

A

ACE inhibitor

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2
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Mechanism

A

Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)

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3
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Uses

A

1st-line for CHF; inhibit LV remodeling post-MI

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4
Q

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)

Side effects

A

Dry cough, angioedema, hyperkalemia, hypotension

Short-acting; contraindicated in pregnancy, renal artery stenosis, hyperkalemia, and prior angioedema (no ARB allowed, either); caution in renal failure

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5
Q

Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)

Drug class

A

Angiotensin Receptor Blocker (ARB)

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6
Q

Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)

Mechanism

A

Blocks type 1 angiotensin II receptors (stimulates vascular smooth muscle contraction, dilates arteries and veins, promotes renal excretion of Na and water, inhibits cardiac & vascular remodeling)

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7
Q

Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)

Uses

A

Used in place of an ACEI when cough is an issue

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8
Q

Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)

Side effects

A

Angioedema, hyperkalemia, hypotension

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9
Q

Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)

Drug class

A

β-blockers

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10
Q

Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)

Mechanism

A

Blocks high circulating levels of catecholamines

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11
Q

Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)

Uses

A

Dramatically decreases mortality in CHF patients

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12
Q

Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)

Side effects

A

Should be started at very low dose and slowly ratchet up; do not stop suddenly

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13
Q

Diuretics

Mechanism

A

Decrease volume and preload

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14
Q

Diuretics

Uses

A

Improve arterial distensibility; reduce preload

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15
Q

Diuretics

Side effects

A

Volume contraction, electrolyte depletion; causes neurohormonal activation

Contraindication in hypovolemic patients

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16
Q

Spironolactone (Aldactone), Eplerenone (Inspra)

Drug class

A

Aldosterone antagonist

17
Q

Spironolactone (Aldactone), Eplerenone (Inspra)

Mechanism

A

Block alodesterone action; inhibits sodium reabsorption in distal tubule

18
Q

Spironolactone (Aldactone), Eplerenone (Inspra)

Uses

A

Add-on for Class III & IV CHF

19
Q

Spironolactone (Aldactone), Eplerenone (Inspra)

Side effects

A

Hyperkalemia, metabolic acidosis,gynecomastia,peptic ulcers

20
Q

Digoxin

Drug class

A

Cardiac glycoside

21
Q

Digoxin

Mechanism

A

Inhibits Na/K/ATPase (increases contractility d/t more Ca); increases vagal activity to heart (reduces SA firing rate, conduction through AV node)

22
Q

Digoxin

Uses

A

Improves LV function, decreases neurohormonal activation, increases vagal tone, normalizes arterial baroreceptors; decreases hospitalizations in CHF (no mortality benefit)

23
Q

Digoxin

Side effects

A

Very narrow therapeutic-toxic window (mostly arrhythmias)

Eliminated in kidneys, so dose according to renal function

24
Q

Dobutamine

Drug class

A

β1 receptor agonist

25
Q

Dobutamine

Mechanism

A

Positive inotrope and chronotrope

26
Q

Dobutamine

Uses

A

Acutely decompensated patients (about half will die after 6 months)

27
Q

Dobutamine

Side effects

A

Quick acting, but can develop tachyphylaxis after 48 hours

No NE release; given IV

28
Q

Milrinone

Drug class

A

Phosphodiesterase IIIa inhibitor

29
Q

Milrinone

Mechanism

A

Inhibits cAMP breakdown

30
Q

Milrinone

Uses

A

Acute setting of heart failure; short-term only

31
Q

Milrinone

Side effects

A

Increased hypotensive and atrial arrhythmia events acutely. 2 month mortality nearly 50% higher than placebo

Given IV, depends on renal clearance, no tolerance after 72 hours

Pharmacology (26 decks)

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