Fcm- Heart Failure Pharmacology

Front 1

what are the classes of drugs used for CHF?

Back 1

diuretics
vasodilators
+ inotropes
cardiac inhibitory agents

Front 2

what is the therapeutic strategy for CHF?

Back 2

reduce the renin-angiotensin system activation

restore fluid volume

unload the myocardium

augment contractility

Front 3

what are the classes of Inotropic agents?

Back 3

cardiac glycosides
beta agonists
PDE inhibitors

Front 4

which is the only cardiac glycoside on the market?

Back 4

digoxin (lanoxin)

Front 5

what has decreased the popularity of digoxin use?

Back 5

it's toxicity as well as the advent of more effective CHF drugs

Front 6

what is the MOA for cardiac glycosides?

Back 6

inhibit the Na/K ATPase on the myocyte membrane

result: elevated intracellular NA+ which opposed the concentration gradient pulling Na+ into the cell by the Na+/Ca++ exchanger, which increases Ca++ and augments ventricular contractility

Front 7

what is another important effect of cardiac glycosides?

Back 7

parasympathomimetic action, slows conduction through AV and increases AV nodal refractory period

Front 8

what is their affect on life span?

Back 8

cardiac glycosides DO NOT prolong life

Front 9

what are the adverse rxns assoc with cardiac glycosides?

Back 9

toxicity is sig. compounded by NARROW THERAPEUTIC WINDOW.

Front 10

how should you titrate cardiac glycosides?

Back 10

upward from low dose to maintenance dose (avoid toxicity)

Front 11

what can amplify toxicity of cardiac glycosides?

Back 11

low serum K or Mg or high Ca

Front 12

how is overdose with digoxin treated?

Back 12

with digoxin antibody (digibind)

Front 13

(T/F) Dobutamine and dopamine are useful in the tx of CHRONIC HF.

Back 13

False. They are not useful due to tolerance issues, poor oral efficacy and aignificant arrhythmogenic effects.

Front 14

(T/F) Dobutamine and dopamine are useful in the tx of ACUTE HF.

Back 14

True

Front 15

what are two hemodynamic effects of Dobutamine and dopamine that contribute to their clinical efficacy?

Back 15

decrease TPR and ventricular filling pressure (preload)

Front 16

Dobutamine and dopamine are two examples of...

Back 16

Inotropic agents (Beta Agonists)

Front 17

is dobutamine a selective agonist?

Back 17

yes, it's a selective B1 agonist

Front 18

is dopamine a selective agonist?

Back 18

No, it stimulates 3 kinds of receptors (DA, Beta and Alpha adrenergic)

thus has inotropic and pressor fxn

Front 19

what are the major PDE inhibitors?

Back 19

Amrinone and milrinone

Front 20

what is the MOA of PDE inhibitors?

Back 20

increase myocyte cAMP levels and thus intracellular calcium.

they also increase cAMP and DECREASE Ca++ in smooth muscle, they cause vasodilation

Front 21

(T/F) PDE inhibitors are not to be used in CHRONIC CHF.

Back 21

True, they increase mortality and morbidity

Front 22

(T/F) PDE inhibitors are recommended during acute MI

Back 22

False

Front 23

(T/F) PDE inhibitors are frequently used

Back 23

False

Front 24

what is a possible adverse rxn of amrinone?

Back 24

thrombocytopenia

Front 25

what are some possible adverse rxns assoc with milrinone?

Back 25

ventricular arrythmias, hypotension, angina

Front 26

what is a possible significant drug interaction of Milrinone?

Back 26

precipitates when mixed with furosimide (DO NOT give in same IV sltn.)

Front 27

what is the MOA of beta adrenergic antagonists?

Back 27

although they decrease contractility, they also decrease pressure (afterload) on the myocardium ("unload the myocardium)

Front 28

what are the 4 beta adrenergic antagonists?

Back 28

labetalol (only Rx for HTN)
carvedilol
metoprolol
bisoprolol

Front 29

what are two vasodilators often used for acute severe HF?

Back 29

nitroprusside and nitroglycerin

Front 30

what is the MOA of nitrovasodilators?

Back 30

dilate both venous and arterial vessels decreasing pressure and unloading the myocardium

results in reduced cardiac size

Front 31

what is nesiritide?

Back 31

Recombinant brain natriuetic peptide (BNP) is a potent vasodilator with natriureticproperties. Given i.v. for acute HF

newest of it's class. use is controversial.

Front 32

which three drugs are indicated for HF induced by acute MI in the presence of HTN?

Back 32

nitroprusside
nitrates
hydralizine

Front 33

when are diuretics useful?

Back 33

in management of CHF and acute HF particularly when pulmonary congestion is severe.

Front 34

what are the 4 diuretics?

Back 34

hydroclorothiazide
furosemide
sprionolactone
eplerenone

Front 35

when is furosemide particularly useful?

Back 35

in the presence of severe pulmonary congestion, it is particularly fast and effective

Front 36

which drugs are sufficient for mild chronic failure?

Back 36

thiazides

Front 37

which two drugs have been show to have significant long term benefits in CHF?

Back 37

spironolactone and eplerenone (K+ sparing diuretics, aldosterone antagonist)

Front 38

what is the MOA of renin-angiotensin blockers?

Back 38

block the effects of Ang II at two sites:
1. formation (ACE inhibitors- block both tissue and circulation ACE)
2. Ang II receptor (ARBs)

leads to: reduced Na+ retention

Front 39

why is blocking tissue ACE important?

Back 39

prevents cardiac remodeling (reduced compliance) that accompanies CHF.

Front 40

Which side effect do ACE inhibitors have that ARBs do not?

Back 40

cough

Front 41

(T/F) ACE inhibitors are considered first line drugs for HF

Back 41

true. they are first line along w/ diuretics

Front 42

List the ACE inhibitors

Back 42

"pril" drugs:

Captopril
Enalopril
Lisinopril
Quinopril
Ramipril
Fosinopril

Front 43

which beta blockers are Rx for post MI?

Back 43

timolol
cervedilol
metoprolol

Front 44

which beta blockers are Rx for CHF?

Back 44

cervedilol
metoprolol
bisprolol

Front 45

which beta blockers are Rx for HTN?

Back 45

all of them except esmolol (prescribed for neither HTN, nor post MI nor CHF)

Front 46

which drugs are the cornerstone of both acute and chronic HF?

Back 46

ACEi and ARBs. should be given early and indefinitely. prolong long term survival

Front 47

when are diuretics typically used?

Back 47

in conjunction with ACEi

Front 48

how are beta blockers typically given?

Back 48

in conjunction with ACEi and diuretics

Front 49

what is digoxins primary role?

Back 49

add on therapy to ACEi and diuretics

quality of life enhancement in moderate to advanced HF

Front 50

when should furosemide IV be given?

Back 50

moderate to severe ACUTE congestive HF.

reduces intravascular volume, preload and afterload

Front 51

when are inotropic agents used?

Back 51

SHORT term therapy in severe congestive HF in pts with DECREASED CONTRACTILITY.

Front 52

which drugs are the tx of choice in pts with CAD and HTN w/ moderate to severe CHF?

Back 52

organic nitrates

Front 53

what is Sodium nitroprusside?

Back 53

drug for acute cardiac failure assoc. with a hypertensive crisis

Front 54

(T/F) Beta blockers are CONTRAindicated in ACUTE HF

Back 54

TRUE

Front 55

what is the strategy in management of acute HF?

Back 55

relieve pulmonary edema - loop diuretic
• inotropic support - β agonists, PDE-Is
• unload the myocardium, i.e., pre- and after-load (vasodilators)

Front 56

(T/F) Statins reduce CHF

Back 56

TRUE