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20 Cards in this Set
- Front
- Back
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Effects Furosimide
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-decrease BACKWARDS failure
-decrease blood volume--> decrease pulmonary congestion -decrease preload |
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Risks w/ Furosimide
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-hypokalemia- give w/ spirinolactone or eplepenone
-difficult to get into tubule w/ low GFR--> give frequent and high doses |
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Effects of Spirinolactone and Eplerenone
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-decrease BP (unknown mechanism)
-prevents remodeling of myocardium (block aldosterone) -prevents hyokalemia w/ furosimide |
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Spirinolactone vs. Eplerenone
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-Spirinolactone partial agonist for sex hormone receptors
-Eplerenone will not have sex hormone effects |
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Enalapril
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ACE (-)
-prevent myocardial remodeling -balanced vasodilation--> decrease preload--> helps FORWARD and BACKWARD failure -lower Filtration Fraction (increase RBF more than GFR) |
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Lisinopril
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ACE (-)
-prevent myocardial remodeling -balanced vasodilation--> decrease preload--> helps FORWARD and BACKWARD failure -lower Filtration Fraction (increase RBF more than GFR) |
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Captopril
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ACE (-)
-prevent myocardial remodeling -balanced vasodilation--> decrease preload--> helps FORWARD and BACKWARD failure -lower Filtration Fraction (increase RBF more than GFR) |
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Why will Filtration Fraction fall w/ Captopril/ Lisinopril/ Enalapril?
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ACE (-)
-a higher increase of RBF compared to GFR -will decrease diuresis |
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Causes Balanced Vasodilation
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ACE (-)- Captopril/ Enalapril/ Lisinopril
-decreased preload = venodilation -decreased afterload = arteriodilation ***helps FORWARD and BACKWARD failure*** -ALSO nitrates + hydralizine in black pts. |
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Risks w/ ACE (-)
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-myocardial hypoperfusion w/ lowered diastolic pressures
-hyperkalemia and uremia w/ poor renal function |
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Nitrates + Hydralazine
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-in black pts. will help increase BALANCED VASODILATION in conjunction w/ ACE (-)
-massive increase in survival -Nitrates = venodilation -Hydralazine = antioxidant preventing NO degredation |
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Risks w/ Nitrates + Hydralazine
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-prolonged Hydralizine--> SLE-like Sx in slow-acetylators
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Carvedilol Function
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Beta-antagonists- block beta and alpha 1 and 2 rec.
-prevents damage to heart w/ chronic sympathetic tone--> initial lower EF with eventual increase EF -prevents ventricular arrythmias |
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Drug makes pt.s feel worse for months before they feel better:
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Carvedilol
-initial decrease of EF w/ evential increase EF -start on dry weight w/ dose based on lean muscle mass -work-up to highest dose tolerated |
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Blocks sympathetic tone:
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Carvediol
-pts. feel worse for months before better -dose-dependant effects---> work up to highest tolerated -final increase in EF + prevents ventricular arrythmias -prolongs diastole |
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Prolong diastole in Diastolic HF pts.
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Carvediol
(blocks sympathetic tone- beta and alpha receptors) -eventual increase in EF -prolongs diastolic function -prevents ventricular arrythmias |
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Digoxin MOA
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Digoxin [=] Na/ K- ATPase (bind to Arg residue--> prevents action)
-Na/ Ca exchanger cannot work--> increased cytoplasmic Ca2++ -sarcolemmal increase in Ca-uptake--> INCREASED CONTRACTILITY -ALSO increases VAGAL TONE/ decrease sympathetic tone |
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Digoxin Effects
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-increase contractility
-increase vagal tone -decrease sympathetic tone |
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Digoxin Risks
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-narrow theraputic window
-hypokalemia and hypomagnesia will increase toxicity (beware when using furosimide) -premature ventricular contractions (in diastole) -abnormal yellow-green vision -Spirinolactone prevents clearance |
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HF Digoxin interactions
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-hypokalemia and magnesia will increase toxicity (helps bond to Asp residues--> common w/ furosemide)
-Spirinolactone will decrease clearance |
