Unit 4-Heart Failure/Inotropic agents Flashcards
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Drug class
ACE inhibitor
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Mechanism
Blocks endothelial ACE from converting angiotensin I to angiotensin II (potent vasoconstrictor); as a side effect, also prevents breakdown of bradykinin (potent vasodilator)
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Uses
1st-line for CHF; inhibit LV remodeling post-MI
Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace), Quinapril (Accupril), Fosinopril (Monopril)
Side effects
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
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Drug class
Angiotensin Receptor Blocker (ARB)
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Mechanism
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)
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Uses
Used in place of an ACEI when cough is an issue
Losartan (Cozar), Irbesartan (Avapro), Valsartan (Diavan), Candisartan (Atacand), Olmesartan (Benecar), Telmisartan (Micardis)
Side effects
Angioedema, hyperkalemia, hypotension
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Drug class
β-blockers
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Mechanism
Blocks high circulating levels of catecholamines
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Uses
Dramatically decreases mortality in CHF patients
Bisoprolol (Zebeta), Carvedilol (Coreg), sustained release Metoprolol (Lopressor)
Side effects
Should be started at very low dose and slowly ratchet up; do not stop suddenly
Diuretics
Mechanism
Decrease volume and preload
Diuretics
Uses
Improve arterial distensibility; reduce preload
Diuretics
Side effects
Volume contraction, electrolyte depletion; causes neurohormonal activation
Contraindication in hypovolemic patients
Spironolactone (Aldactone), Eplerenone (Inspra)
Drug class
Aldosterone antagonist
Spironolactone (Aldactone), Eplerenone (Inspra)
Mechanism
Block alodesterone action; inhibits sodium reabsorption in distal tubule
Spironolactone (Aldactone), Eplerenone (Inspra)
Uses
Add-on for Class III & IV CHF
Spironolactone (Aldactone), Eplerenone (Inspra)
Side effects
Hyperkalemia, metabolic acidosis,gynecomastia,peptic ulcers
Digoxin
Drug class
Cardiac glycoside
Digoxin
Mechanism
Inhibits Na/K/ATPase (increases contractility d/t more Ca); increases vagal activity to heart (reduces SA firing rate, conduction through AV node)
Digoxin
Uses
Improves LV function, decreases neurohormonal activation, increases vagal tone, normalizes arterial baroreceptors; decreases hospitalizations in CHF (no mortality benefit)
Digoxin
Side effects
Very narrow therapeutic-toxic window (mostly arrhythmias)
Eliminated in kidneys, so dose according to renal function
Dobutamine
Drug class
β1 receptor agonist
Dobutamine
Mechanism
Positive inotrope and chronotrope
Dobutamine
Uses
Acutely decompensated patients (about half will die after 6 months)
Dobutamine
Side effects
Quick acting, but can develop tachyphylaxis after 48 hours
No NE release; given IV
Milrinone
Drug class
Phosphodiesterase IIIa inhibitor
Milrinone
Mechanism
Inhibits cAMP breakdown
Milrinone
Uses
Acute setting of heart failure; short-term only
Milrinone
Side effects
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