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CVS πŸ«€ > W3, 9 HF Treatment (pharma) > Flashcards

W3, 9 HF Treatment (pharma) Flashcards

1
Q

What is Heart failure (HF) or (CHF)?

A

It’s abserious condition in which the heart is not pumping enough blood around the body efficiently

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2
Q

A complication of HF?

A

When the heart is weakened by heart failure, blood and fluid can back up into the lungs, and fluid builds up in different tissues.

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3
Q

Cardiovascular Consequences of Heart Failure (slide)

A
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4
Q

Objectives in treatment of CHF

A
  • To reduce congestion (oedema)
  • To improve cardiac contractility
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5
Q

Classes of Drugs Used in Treatment of CHF (slide)

A
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6
Q

Pharmacologically active compounds extracted from foxglove plants (also called Digitalis) are ..?

A

Cardiac glycosides

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7
Q

What drug is the prototype cardiac glycoside?

A

Digoxin

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8
Q

Digoxin route of administration & excretion?

A
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9
Q

Mechanism of action of digoxin?

A
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10
Q

Adverse Reactions to Digitalis Glycosides

A
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11
Q

What drug is Beta-1 Adrenoceptor Agonists ?

A

Dobutamine

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12
Q

moa of Dobutamine

A

Activate cardiac beta-1 receptors β€”> inc cAMP β€”> elevated intracellular Ca2+ β€”> positive inotropic effect β€”> inc CO

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13
Q

What drug is Phosphodiesterase (PDE) inhibitor?

A

Amrinone

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14
Q

Moa of Amrinone

A
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15
Q

Diuretics (examples of drugs + MOA)

A
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16
Q

What drug Relaxes vascular smooth muscle by supplying nitric oxide? Name the drug class or category & drug name.

A

Direct Vasodilators & Venodilators (Nitrovasodilators) eg: Hydralazine

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17
Q

-

A
  • Reduce preload by producing venodilation (reduce VR)
  • Reduce afterload by arteriolar dilation (decrease PVR)
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18
Q

HF leads to (activation or inhibition) of the renin-angiotensin- aldosterone system?

A

Activation

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19
Q

Renin release due to ….?

A

increased sympathetic stimulation
and activation of beta-1 receptors in the kidneys

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20
Q

What is ACE enzyme

A
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21
Q

High levels of Ang II have detrimental effects on the cardiac muscle
Ψ΄Ω†Ωˆ Ψ§Ω‡Ω…ΨŸ

A

High levels of Ang II have detrimental effects on the cardiac muscle, causing remodeling, fibrosis and inflammatory changes.

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22
Q

What drug is Angiotensin-Converting Enzyme Inhibitor?

A

Captopril

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23
Q

MOA of Captopril?

A

ACEIs prevent the conversion of Angiotensin I to Angiotensin II.

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24
Q

Adverse effects to ACEIs?

A

Postural hypotension, hyperkalemia
persistent dry cough (Due to accumulation of bradykinin)

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25
Q

Effects of ACEI (slide)

A
26
Q

Angiotensin II Receptor Blockers (ARBs)
A. 2 Drug examples?
B. MOA

A

A. Losartan, valsartan
B. Antagonists at Angiotensin II type 1 receptor (block effect of ang II obtained from ACE- dependent and - independent pathways

27
Q

ARBs > ACEI or ACEI > ARBs and why?

A
  • ARBs have the advantage of more complete blockade of Angiotensin II action, because ACEIs inhibit only one enzyme β€œ
    responsible for production of Angiotensin II.
  • ARBs do not affect bradykinin levels.
28
Q

Route of administration of Losartan

A
  • ARBs are orally active compounds
  • Losartan undergoes extensive first-pass hepatic metabolism.
29
Q

Beta Blockers MOA (slide)

A
30
Q

Types of beta blockers
A.
B.

A
  • Beta-1 selective adrenoceptor antagonists (e.g. Metoprolol, Atenolol)
  • Combined Alpha-1 and Beta Blockers (e.g. Carvedilol).
31
Q

What is Metoprolol?

A

Beta 1 antagonist that reduces the mortality of patients with heart failure

32
Q

What drugs are Aldosterone Receptor Antagonists ?

A

Eplerenone, Spironolactone

33
Q

A non- selective aldosterone receptor antagonist.

A

Spironolactone

34
Q

Selectively binds to the mineralocorticoid receptor, blocking
the binding of aldosterone, inhibiting sodium reabsorption.

A

Eplerenone

35
Q

MOA of Spironolactone?

A
  • Reduces Na+ reabsorption
  • Prevents salt retention, myocardial hypertrophy and hypokalemia.
36
Q

Which aldosterone receptor antagonist has Less hormonal side effects?

A

Eplerenone

37
Q

Adverse effects of Eplerenone include

A

hyperkalemia

38
Q

How do Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) act?

A

consists of angiotensin receptor blocker valsartan and neprilysin inhibitor (blocks both RAAS & augment natriuretic peptides)
-drug name =n LCZ696 ,, not on drug list -

39
Q

What drug is Currently indicated in USA for treatment of hypertension, and
for first-line treatment of heart failure secondary to
myocardial infarction?

A

Eplerenone

40
Q

What drugs Decrease and block the effect of some symptoms caused by release of catecholamines?

A

Beta blockers

41
Q

Contraindicated in pregnancy.

A

ARBs & ACEI

42
Q

Can cause hyperkalemia, gynecomastia & testicular atrophy.

A

Spironolactone

43
Q

Long term therapy with this drug can benefit patients who had a recent myocardial infarction (protects heart)

A

ACEIs

44
Q

toxicity of this drug can be worsened by hypokalemia

A

Digoxin

45
Q

What drug Activate cardiac beta-1 receptors ?

A

Dobutamine

46
Q

Mcq: What should be monitored when administering digoxin?
A. Potassium
B. Calcium
C. Sodium
D. Chloride

A

A. Potassium

47
Q

Mcq: What drug should be carefully monitored as it has a narrow therapeutic index?

A

Digoxin

48
Q

Mcq: What is the mechanism of action of amrinone?

A

Phosphodiesterase inhibitor

49
Q

Mcq: Which of the following is a selective angiotensin II antagonist?

A

Losartan

50
Q

Mcq: Which drug has less hormonal effects because it’s band specifically to aldosterone receptor?
A. Eplerenone
B. Spironolactone

A

A. Eplerenone

51
Q

Mcq: What is the mechanism of action of digoxin?

A

A. increase intracellular calcium

52
Q

mcq: which drug causes dry cough?

A

A. Captopril (ACEI)

53
Q

Mcq: Which of the following inhibits Na/K ATPase and is used for the management of congestive heart failure?
A. Hydralazine
B. Digoxin

A

B. Digoxin

54
Q

Mcq: Indicated to prevent the deterioration of the left ventricular function after myocardial infraction
A. Angiotensin converting enzyme inhibitor
B. Nitrate
C. Secondary prevention

A

A. Angiotensin converting enzyme inhibitor

55
Q

Mcq: Selectively binds to mineralocorticoid receptors

A

A. Eplerenone

56
Q

Mcq: which one describe the mechanism of dobutamine?
A. activation of aldosterone receptor
B. inhibition of ACE
C. activation of B1 receptor
D. release of nitric oxide

A

C. activation of B1 receptor

57
Q

Mcq: What is the effect of co-administering digoxin and thiazide diuretics?
A. Increases the toxicity of digoxin
B. Reduces the absorption of digoxin
C. Reduce vagal activity of digoxin

A

A. Increases the toxicity of digoxin

58
Q

Mcq: A patient has a cardiovascular disease and he is being treated for it, after a while he Develops bilateral angioedema. Which of the following drugs is likely to cause this presentation?
A. Diuretics
B. Digoxin
C. Angiotensin converting enzyme inhibitors
D. Hydralazine Answer: C

A

ACEI

59
Q

Mcq: A patient with heart failure you gave him a drug & he comes to you with irritated throat and cough
A. ACEI
B. BB
C. Diuretic
D. Digoxin

A

A. ACEI

60
Q

Mcq: Which of the following is true regarding RAAS in HF?
A. Using angiotensin 2 receptor blocker decreases aldosterone
B. Aldosterone causes diuresis
C. It must be blocked in HF with reduced EF

A

C. It must be blocked in HF with reduced EF

61
Q

Mcq: Patient being treated for HF comes with enlarged swollen breast, what is the cause of this side effect?
A. Digoxin
B. ARB
C. Aldosterone blocker
D. BB

A

C. Aldosterone blocker

62
Q

Drug List for Treatment of CHF

A

CVS πŸ«€ (31 decks)

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