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Cardio Pharm > Vasoactive Peptides- Inhibitors and HF > Flashcards

Vasoactive Peptides- Inhibitors and HF Flashcards

1
Q

-PRIL

A

ACEI

captopril
enalapril
lisinopril

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2
Q

ACEI indication

A

-PRIL

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

Acute MI
Chronic Renal disease

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3
Q

ACEI MOA

A

-PRIL

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

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4
Q

ACEI contraindications

A

-PRIL

pregnancy,bilateral renal stenosis

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5
Q

ACEI AE

A

-PRIL

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

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6
Q

-SARTAN

A

AT1 receptor blockers (ARB)

losartan
valsartan

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7
Q

ARB MOA

A

-sartan

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

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8
Q

ARB indication

A

-sartan

Primary HTN
Heart Failure

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9
Q

ARB contraindications

A

-sartan

Contraindications – pregnancy, bilateral renal stenosis

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10
Q

Endothelin Receptor Antagonists

A

-SENTAN
bosentan
ambrisentan

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11
Q

Endothelin Receptor Antagonists MOA

A

Restores balance between Eta & prostaglandins

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

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

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12
Q

Endothelin Receptor Antagonists indications

A

Pulmonary Arterial HTN

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13
Q

Endothelin Receptor Antagonists AE

A

requires liver monitoring

contraindication in pregnancy!

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14
Q

Natriuretic peptide agonists indication

A

Nesiritide

acute decompensated HF

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15
Q

Natriuretic peptide agonists MOA

A

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

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

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16
Q

Angiotensin receptor & Neprilysin inhibitor MOA

ARNI

A

Sacubitril/
valsartan

Sacubitril: activated into LBQ657, blocks Neprilysin.

Valsartan: AT1-R antagonist

Enhance ANP/BNP, Block Ang II

17
Q

ARNI indication

A

HFrEF

mortality/hospitalization in patients with HFrEF

18
Q

why do we always use sacubitril WITH valsartan?

A

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

19
Q

ARNI AE

A

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

20
Q

Diuretics: 2 types

A

K+ Sparing:
Spironolactone
Eplerenone

Non-K+ Sparing:
Furosemide
Loop
Most Potent

21
Q

diuretics MOA

A

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

22
Q

diuretics indications

A

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

23
Q

diuretics contraindications

A

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

Check renal function and plasma [K]

24
Q

Furosemide notes on usage

A

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

25
Q

Beta blockers MOA

A

-OLOL

Carvedilol blocks 1, 1, 2 + anti-oxidant/anti-proliferative properties

Metoprolol – cardioselective (1)

26
Q

-olol

A

BBlockers

Propranolol
metoprolol
Carvedilol

27
Q

BBlockers Indication

A

HFrEF

alone with ACEI, slows progression of HF

28
Q

Digoxin MOA

A 
Inhibition of Na/K ATPase
   Ca++ Accumulation
\+ Inotrope, + Chronotrope
SA node:  HR
AV node:  Conduction
                Refractory Period
29
Q

Digoxin indication

A

CHF with:

  • standard therapy, yet symptomatic
  • A fib

Does not improve mortality

30
Q

Digoxin AE

A

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

31
Q

Digoxin Interactions

A

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

32
Q

Beta receptor agonists- examples

A

dopamine

dobutamine

33
Q

Beta receptor agonists- indications

A

dopa/dobut

end stage HF

34
Q

Vasodilators- examples

A

Hydralazine (artery)
&
Isosorbide dinitrates (vein)

35
Q

vasodilators indication

A

If intolerant to ACE-inh & ARB

African Americans with NYHA III-IV, standard therapy not sufficient

36
Q

Funny channel blocker indication

A

ivabradine

Reduce hospitalization for worsening HF with:
  - stable, symptomatic CHF
  - LVEF <35% &amp; HR is >70 in 
    sinus rhythm
  -  max dose  blockers or  
    blockers are contraindicated
37
Q

Funny channel blocker MOA

A

Blocks If current in SA node

NO survival benefits

Cardio Pharm (6 decks)

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