Vasoactive Peptides- Inhibitors and HF

Question 1

-PRIL

Answer 1

ACEI

captopril
enalapril
lisinopril

Question 2

ACEI indication

Answer 2

-PRIL

Primary HTN (1st line)
Heart Failure (HFrEF)
  -1st Line, all stages-- REDUCES MORTALITY

Acute MI
Chronic Renal disease

Question 3

ACEI MOA

Answer 3

-PRIL

Bind ACE [bradykinin]
Prevent angiotensin I conversion
Preload/Afterload
Ventricular Remodeling

Question 4

ACEI contraindications

Answer 4

-PRIL

pregnancy,bilateral renal stenosis

Question 5

ACEI AE

Answer 5

-PRIL

Cough (if this bothers patient, consider switching to an AT1 Receptor Blocker)

Question 6

-SARTAN

Answer 6

AT1 receptor blockers (ARB)

losartan
valsartan

Question 7

ARB MOA

Answer 7

-sartan

Prevent Angiotensin II activity
*no effect on [bradykinin]
Preload/Afterload
Ventricular Remodeling

Question 8

ARB indication

Answer 8

-sartan

Primary HTN
Heart Failure

Question 9

ARB contraindications

Answer 9

-sartan

Contraindications – pregnancy, bilateral renal stenosis

Question 10

Endothelin Receptor Antagonists

Answer 10

-SENTAN
bosentan
ambrisentan

Question 11

Endothelin Receptor Antagonists MOA

Answer 11

Restores balance between Eta & prostaglandins

Endothelin Actions: vasoconstriction, + inotrope/chronotrope, vascular/myocardial hypertrophy, bronchoconstriction

Eta/prostaglandins Contraction & proliferation
AE: hypotension/edema, palpitations,

Question 12

Endothelin Receptor Antagonists indications

Answer 12

Pulmonary Arterial HTN

Question 13

Endothelin Receptor Antagonists AE

Answer 13

requires liver monitoring

contraindication in pregnancy!

Question 14

Natriuretic peptide agonists indication

Answer 14

Nesiritide

acute decompensated HF

Question 15

Natriuretic peptide agonists MOA

Answer 15

ANP/BNP metabolism inhibitor
Recombinant human BNP
Preload & Afterload (vasodilation)

Natriuretic Peptide function: Vasodilation, suppress RAAS ( vasoconstrictors), GFR, renin release

Question 16

Angiotensin receptor & Neprilysin inhibitor MOA

ARNI

Answer 16

Sacubitril/
valsartan

Sacubitril: activated into LBQ657, blocks Neprilysin.

Valsartan: AT1-R antagonist

Enhance ANP/BNP, Block Ang II

Question 17

ARNI indication

Answer 17

HFrEF

mortality/hospitalization in patients with HFrEF

Question 18

why do we always use sacubitril WITH valsartan?

Answer 18

Neprilysin degrades ANP/BNP & angiotensin II
*Neprilysin inhibition… angiotensin II

NYHA Class II or III & able to tolerate ACE-I or ARB

Valsartan: must be added to block Angiotensin II’s effects. [Angiotensin

Question 19

ARNI AE

Answer 19

AE: Hypotension, hyperkalemia, renal impairment, hx angioedema, coadministration with RAAS inhibitors

Question 20

Diuretics: 2 types

Answer 20

K+ Sparing:
Spironolactone
Eplerenone

Non-K+ Sparing:
Furosemide
Loop
Most Potent

Question 21

diuretics MOA

Answer 21

Eplerenon – selective aldosterone R antagonist

Spironolactone – non-selective aldosterone R antagonist

Renal: Na+/H2O reabsorption, K+/H+ excretion
CV: Prevent Cardiac fibrosis, NO, vascular growth/remodeling
Blood: platelet aggegation

Question 22

diuretics indications

Answer 22

Symptom relief from HF

Low Dose:
*NYHA classes II-IV, EF <35% despite recommend ACE-inhibitor/ blocker treatment

Reduces morbidity/ mortality post acute MI with <40% EF and…
HF symptoms present OR
Hx of diabetes

Question 23

diuretics contraindications

Answer 23

Contraindications: Renal insufficiency, serum [K+] > 5.0, Do not combine with other K+-sparing diuretics

Check renal function and plasma [K]

Question 24

Furosemide notes on usage

Answer 24

Furosemide:
*Relieve pulmonary & peripheral congestion/edema
*1st Choice for rapid relief of congestive symptoms
*May be combined with ACE-inh & blocker
AE: Hypokalemia, alkalosis
*Start at low dose to avoid electrolyte imbalance

Question 25

Beta blockers MOA

Answer 25

-OLOL Carvedilol blocks 1, 1, 2 + anti-oxidant/anti-proliferative properties Metoprolol – cardioselective (1)

Question 26

-olol

Answer 26

BBlockers Propranolol metoprolol Carvedilol

Question 27

BBlockers Indication

Answer 27

HFrEF alone with ACEI, slows progression of HF

Question 28

Digoxin MOA

Answer 28

``` Inhibition of Na/K ATPase Ca++ Accumulation + Inotrope, + Chronotrope SA node: HR AV node: Conduction Refractory Period ```

Question 29

Digoxin indication

Answer 29

 CHF with: - standard therapy, yet symptomatic - A fib Does not improve mortality

Question 30

Digoxin AE

Answer 30

AE: arrhythmias, vision changes, anorexia/nausea/vomiting/diarrhea

Question 31

Digoxin Interactions

Answer 31

Diuretics electrolyte imbalances CCB (non-dihydropyridines) dec renal clearance & AV conduction blockers dec HR & AV conduction

Question 32

Beta receptor agonists- examples

Answer 32

dopamine dobutamine

Question 33

Beta receptor agonists- indications

Answer 33

dopa/dobut end stage HF

Question 34

Vasodilators- examples

Answer 34

Hydralazine (artery) & Isosorbide dinitrates (vein)

Question 35

vasodilators indication

Answer 35

If intolerant to ACE-inh & ARB African Americans with NYHA III-IV, standard therapy not sufficient

Question 36

Funny channel blocker indication

Answer 36

ivabradine ``` Reduce hospitalization for worsening HF with: - stable, symptomatic CHF - LVEF <35% & HR is >70 in sinus rhythm - max dose blockers or blockers are contraindicated ```

Question 37

Funny channel blocker MOA

Answer 37

Blocks If current in SA node NO survival benefits