Drugs Used In Heart Failure

Front 1

compensatory changes in response to heart failure?

Back 1

SNS activation
renin-angiotensin system activation
hypertrophy

Front 2

detrimental effects of compensatory changes in response to heart failure?

Back 2

SNS: worsen heart failure;
renin-angiotensin: volume overload and difficulty breathing;
hypertrophy: bad remodeling

Front 3

ACEI use in chronic heart failure?

Back 3

decrease symptoms
increase survival

Front 4

diuretics use in chronic heart failure?

Back 4

decrease congestive symptoms by decreasing preload;
effect on survival not known

Front 5

beta blockers use in chronic heart failure?

Back 5

+ other therapy decrease hospitalization and mortality;
may worsen HF initially with improvements may take months

Front 6

mechanism of how beta blockers help in heart failure?

Back 6

interrupt the SNS stimulation to slow disease progression

Front 7

rationale for spironolactone use in heart failure?

Back 7

aldosterone has negative effects on heart;
decreased hospitalization and mortality

Front 8

combination that was shown to increase survival in blacks?

Back 8

hydralazine and ISDN

Front 9

pharmacologic treatment of heart failure?

Back 9

ACEI
diuretics
beta blockers
spironolactone
cardiac glycosides
ARBs
hydralazine + ISDN
eplerenone

Front 10

use of eplerenone for heart failure?

Back 10

approve for HF following acute MI in certain cases

Front 11

additional drugs (parenteral) used in HF?

Back 11

sodium nitroprusside
dobutamine
dopamine
milrinone
nesiritide

Front 12

main uses of cardiac glycosides?

Back 12

heart failure
certain arrhythmias (atrial fib)

Front 13

only cardiac glycoside available in US?

Back 13

digoxin

Front 14

cardiac glycosides aka?

Back 14

digitalis

Front 15

mechanism of cardiac glycosides increased contractility?

Back 15

inhibition of sarcolemmal Na,K-ATPase leading to decreased transmembrane transport of Na and K, increased intracellular Na decreases Na-Ca exchange so there is less Ca available at level of contractile proteins

Front 16

actions of cardiac glycosides?

Back 16

increased contractility
vagal stimulation
decreased SNS activity

Front 17

conduction velocity corresponds to which phase of AP?

Back 17

slope of phase 0

Front 18

automaticity relates to which phase of AP?

Back 18

slope phase 4

Front 19

important action of cardiac glycosides that for treatment of supraventricular tachyarrhythmias, such as atrial fib?

Back 19

vagal stimulation to slow conduction through the AV node

Front 20

cardiac glycosides effects on electrophysiology of heart?

Back 20

direct and indirect
effect depends on type of cardiac cell
beneficial effect in atrial fib (decreased ventricular rate)
arrhythmias and heart block possible at toxic concentrations

Front 21

elimination of digoxin and consequence?

Back 21

2/3 eliminated unchanged in urine so clearance reduced in renal insufficiency and necessary to reduce dose

Front 22

adverse effects of digitalis?

Back 22

cardiac toxicity
GI (anorexia, n/v, diarrhea)
CNS (blurred vision, abnormal color vision, confusion, etc)

Front 23

red flags for digoxin toxicity?

Back 23

GI symptoms of anorexia, nausea and vomiting, or diarrhea

Front 24

what population are adverse CNS effects with digoxin seen and what are they?

Back 24

elderly:
blurred vision
abnormal color vision
confusion
other mental disturbances

Front 25

treatment for digoxin toxicity?

Back 25

stop drug
serum K management
arrhythmia and heart block management
ovine digoxin immune fab

Front 26

electrolyte disturbances increasing risk of digitalis toxicity?

Back 26

hypokalemia
hypercalcemia
hypomagnesemia

Front 27

thiazide or loop diuretic + digoxin interaction?

Back 27

hypokalemia

Front 28

digoxin + quinidine interaction?

Back 28

increased plasma digoxin concentration

Front 29

digoxin + verapamil or amiodarone interaction?

Back 29

increased plasma digoxin concentration

Front 30

digoxin + antacids, kaolin-pectin, cholestyramine interaction?

Back 30

decreased plasma digoxin concentration due to decreased absorption

Front 31

dobutamine actions?

Back 31

β1 agonist: increase CO with less reflex tachycardia than occurs with nonselective β agonists

Front 32

possible adverse effects with dobutamine?

Back 32

excessive increase in heart rate
arrhythmias

Front 33

milrinone mechanism?

Back 33

inhibits phosphodiesterase 3 --> increase cAMP --> increased contractility and vasodilation

Front 34

milrinone effects in patients with HF?

Back 34

decreased PWP
decreased peripheral resistance
increased CO

Front 35

milrinone indications?

Back 35

only IV for acute heart failure or severe exacerbation of chronic heart failure

Front 36

nesiritide?

Back 36

recombinant human B-type natriuretic peptide; hBNP

Front 37

nesiritide mechanism?

Back 37

action on guanylate cyclase receptor --> increased cGMP --> smooth muscle relaxation

Front 38

adverse effects of nesiritide?

Back 38

hypotension
renal damage and death

Front 39

indications for nesiritide?

Back 39

use in certain patients with acute decompensated heart failure

Front 40

effects of nesiritide?

Back 40

decreased PWP and dyspnea