Cardiovascular, Pharmacology Of Hf

Front 1

what is the formula for cardiac output?

Back 1

stroke volume x HR

Front 2

what is the equation for pressure?

Back 2

flow x resistance

Front 3

what is the equation for MAP?

Back 3

cardiac output x systemic vascular resistance

Front 4

is a diastolic or systolic dysfunction more common in HF?

Back 4

systolic

Front 5

systolic dysfunction as seen in HF is due to what?

Back 5

decreased cardiac contractility which in turn decreases CO and SV

afterload, preload, and HR all increase during this systolic dysfunction

Front 6

what causes the diastolic dysfunction seen with HF?

Back 6

decreased compliance of the ventricles -> decreased relaxation and filling

preload and afterload are increased, but contractility and HR are maintained, unlike systolic dysfunction

Front 7

what are the 3 things that can decrease cardiac contractility at the cellular level?

Back 7

1. Ca++ homeostasis dysregulation
2. problem with contractile proteins
3. problem with Beta-adrenergic signaling pathways

Front 8

describe the effect of disrupting Beta-adrenergic receptors would have on cardiac myocytes?

Back 8

decrease cAMP -> decrease protein kinase C -> decreased intracellular Ca++

Front 9

which drug is a cardiac glycoside used to increase cardiac contractibility?

Back 9

digoxin

Front 10

what drug is best for increasing cardiac contractibility in acute decompensated HF?

Back 10

dobutamine

Front 11

what type of drug is milrinone and what is it used for with the heart?

Back 11

it is a phosphodiesterase inhibitor which can increase cardiac contractility during HF

Front 12

what drug is good for treating congestive heart failure and can also act as an antidysrhythmic to slow ventricular tachycardia in atrial flutter/fibrillation?

Back 12

digoxin

Front 13

why is digoxin not a first line drug in most patients with HF?

Back 13

it has a narrow therapeutic window

Front 14

you patient is complaining of nausea and seeing yellow halos around lights, what drug causes the above adverse effects?

Back 14

Digoxin

Front 15

describe the mechanism of action of beta1-agonists in treatment of HF?

Back 15

increase cAMP -> increase activation of protein kinase C -> more Ca++ in sarcoplasmic reticulum -> stronger contraction

Front 16

what is the reason dobutamine is the preferable B-adrenergic agonist to use during HF?

Back 16

it has lots of Beta1 activity which increases contractility, Beta2 activity which decreases afterlaod, and much less HR effect as compared to other beta-adrenergic agonists

Front 17

why is dobutamine only used in acute decompensated HF?

Back 17

it must be given IV because its half-life is only 2.5 mins

Front 18

which is a more potent inotrope, digoxin or dobutamine?

Back 18

dobutamine

Front 19

what is the mechanism of action of milrinone?

Back 19

phosphodiesterase inhibitor that increases cAMP -> increase protein kinase C -> increases Ca++ in sarcoplasmic reticulum

Front 20

what peripheral effects does milrinone have?

Back 20

arterial/venous vasodilation leading to decrease in preload and aftertload

Front 21

in what HF setting will milrinone be used?

Back 21

acute decompensated HF

Front 22

what is one reason to precede with caution when using/considering milrinone for treatment of HF?

Back 22

may increase mortality

Front 23

what is the normal amount of Na+ that is excreted in urine?

Back 23

1%

Front 24

what is the most common type of diuretic used for HF?

Back 24

loop diuretics

Front 25

second to loop diuretics, this type of diuretic is often used in HF?

Back 25

potassium sparing

Front 26

where do loop diuretics work?

Back 26

the thick ascending limb

Front 27

where do K+ sparing diuretics work?

Back 27

the distal collecting tubules

Front 28

what is the mechanism of action of loop-diuretics?

Back 28

inhibit Na+/K+/2CL- transporter of the ascending limb -> excretion of Na+ and water

Front 29

what are the two most common loop-diuretics?

Back 29

1. furosemide (lasics) = most common
2. bumetanide

Front 30

what is the fronline therapy for HF and other edematous states?

Back 30

loop-diuretics

Front 31

what are the two most common adverse effects of loop diuretics?

Back 31

1. hypovolemia
2. hypokalemia

Front 32

what are the 3 examples of potassium sparing diuretics we have to know?

Back 32

1. spironolactone
2. amiloride and triamterene act the same way

Front 33

what is the mechanism of action of spironolactone?

Back 33

competitive antagonist of aldosterone resulting in the excretion of Na+ and water

Front 34

which is the only diuretic shown to improve survival of Class II/IV HF?

Back 34

spironolactone

Front 35

what is the mechanism of action for amiloride and triamterene?

Back 35

blocks Na+ channels in late distal tubule and collecting ducts, this inhibits K+ and H+ excretion as well

Front 36

what are adverse effects of amiloride and triamterene?

Back 36

1. hyperkalemia
2. metabolic acidosis

both result from inability to secrete K+ and H+ when the Na+ channel is blocked in the distal tubule

Front 37

how long must one be taking K+ sparing diuretics before they start to really work?

Back 37

several days

Front 38

why does giving nitroglycerine help HF?

Back 38

it is metabolized into NO which is a vasodilator (NO is primarily a venodilator at low regular doses and a arteriodilator at high doses) which depending on dosing can decrease both preload and afterload

Front 39

what is the oral form of nitroglycerin called?

Back 39

isosorbide dinitrate

Front 40

what is the most common adverse effect of nitroglycerin?

Back 40

headache, likely the result of hypotension

Front 41

what is the IV infused donor of NO?

Back 41

Sodium Nitroprusside

Front 42

which of the HF drugs can cause cyanide poisoning?

Back 42

sodium nitroprusside because the liver converts it into cyanide during its metabolism and in some individuals who have a enzyme deficiency it will not be further metabolized

Front 43

what is the most common adverse effect of sodium nitroprusside

Back 43

hypotension

Front 44

what are the 3 effects of ACEI's?

Back 44

decrease
- arteriolar vasconstriction
- NaCl reabsorbtion in the kidneys

increases antidiuretic hormone levels

Front 45

what results in a large decrease in afterload when using ACEI's?

Back 45

inhibits bradykinin metabolism resulting in a large decrease in afterload and a moderate decrease in preload

Front 46

what is the first line drug in HF that is not a loop-diuretic?

Back 46

ACEI's = Captopril

Front 47

after starting a patient on a HF drug you notice a non-productive cough that just wont go away, what drug did you give?

Back 47

ACEI probably captopril

Front 48

you notice painless oral-pharyngeal edema and know this is most likely due to which drug?

Back 48

ACEI

Front 49

what drugs would you not want to give someone who was using and ACEI for HF? (3)

Back 49

1. potassium supplements
2. NSAID -> kidney failure and hyperkalemia
3. potassium sparing diuretics (EX spironolactone -> hyperkalemia

Front 50

what drug has similar effects as ACEI except that it has no effect on bradykinin metabolism and does not cause a cough?

Back 50

angiotensin receptor blockers (ARB's)

Front 51

losartan and valsartan are the most commonly used drugs in this class?

Back 51

ARB's

Front 52

what effect does hydalazine have?

Back 52

acts as an arteriolar vasodilator

Front 53

if a patient cannot tolerate ACEI's what combination of drugs can replace ACEI therapy?

Back 53

hydalazine + a nitrate (such as isosorbide dinitrate)

Front 54

what is the most common adverse effect of hydalazine?

Back 54

hypotension

Front 55

what is the rare, but important adverse effect which both hydalazine and procainamide can cause?

Back 55

drug-induced SLE

Front 56

what are the 3 types of natriuretic peptides and where are they released from?

Back 56

1. ANP from atria
2. BNP from ventricles
3. CNP from vascular endothelial cells

Front 57

what causes the natural release of natriuretic proteins?

Back 57

increased blood volume

Front 58

what is the effect of nesiritide? (3)

Back 58

1. increased natruiresis/diuresis
2. venous and arterial dilation
3. decreased preload and afterload

Front 59

what is nesiritide?

Back 59

recombinant BNP

Front 60

how is nesiritide administered?

Back 60

continuous IV infusion for acute HF only

Front 61

what is the major concern with using nesiritide?

Back 61

renal failure

Front 62

what can be used in in chronic HF to improve myocardial re-modelling, inhibit renin release, and decrease inotrpy and chronotropy?

Back 62

beta-blockers

Front 63

what are some beta-blockers used in treating HF? (3)

Back 63

1. Carvedilol
2. Metoprolol
3. Bisoprolol

Front 64

list the order in which you would add drugs to the treatment of a person with HF?

Back 64

1. loop diuretic
2. add ACEI
3. add beta-blocker
4. add spironolactone and/or digoxin
5. add other drugs such as ARB, hydalazine, nitrate

Front 65

list all of the drugs that increase survival rate in patients with HF?(5)

Back 65

1. ACEI's
2. Beta-blockers such as carvedilol, metoprolol, bioprolol
3. Spironolactone for class III and IV
4. ARB's
5. Hyalazine + nitrate