Pharmacology Heart Failure Drugs

Front 1

what is hear failure?

Back 1

heart failure is a condition with multiple causes that result in cardiac output that is inadquate to provide oxygen needed by the body

Front 2

what are the primary signs of CHF?

Back 2

tachycardia
decreased exercise tolerance
SOB
peripheral and pulmonary edema

Front 3

what is a positive inotropic effect?

Back 3

increase contractility (the force of the heart contraction)

Front 4

where does a positively inotropic drug act?

Back 4

on the heart to increase contractility

Front 5

what are the classes of drugs that are positive inotropic drugs?

Back 5

Digitalis glycosides: digoxin
Phosphodiesterase inhibitors: inamrinone, milrinone
B-adrenoceptor agonist: dobutamine/dopamine

Front 6

what is the effect of Digoxin on cardiac contractility, heart rate, preload reduction, afterload reduction, and risk of arrhthymia in treatment of CHF?

Back 6

increases contractility
decreases heart rate
Reduces afterload
reduces preload
other effects: increase parasympathetic tone and decreases sympathetic tone

Front 7

________ inhibits Na+/K+ ATPase pump in treatment of CHF

Back 7

Digoxin

Front 8

_________ increases the force of contraction and length of time of the interaction between actin and myosin filaments in the cardiac sarcomere.

Back 8

Digoxin
via increased free calcium concentration in the vicinity of contractile proteins during systole

Front 9

how long is the onset of action for Digoxin in treatment of CHF?

Back 9

1 hour

Front 10

how long is the duration of action in the treatment of CHF with Digoxin?

Back 10

24 hours

Front 11

what are the clinical effects of Digoxin in treatment of CHF?

Back 11

improves symptoms & exercise tolerance
reduces hospitalization
withdrawal of patients receiving digoxin leads to worsening heart failure

Front 12

does Digoxin decrease mortality?

Back 12

NO

Front 13

what is the hockey stick configuration of an ECG caused by?

Back 13

Digoxin causes ST segment depression in the ECG giving the hockey stick configuration

Front 14

If digoxin reduces the AV velocity what does it appear as in the ECG?

Back 14

increase the PR interval

Front 15

Digoxin shortens action potentials in the ventricular tissue, what does this appear as on an ECG?

Back 15

decreases the QT interval

Front 16

what are some common side effects of Digoxin?

Back 16

anorexia, nausea, vomitting, arrhythmias, blurred vision, chomatopsia, gynecomastia, seizures, hypokalemia induced arrhythmias

Front 17

what are common drug interactions in administration of Digoxin in CHF?

Back 17

digoxin absorption inhibited by antacids and cholestyramine

digoxin clearance reduced by dilitiazem (CCB), quinidine, verapamil (CCB)

Front 18

If your patient is on digoxin and has a diuretic induced hypokalemia what is this going to do to digoxin in the treatment of CHF?

Back 18

precipitates digoxin toxicity

Front 19

what are b1-selective agonist used for in the treatment of CHF?

Back 19

increase cardiac contractility

Front 20

what type of drug is Dobutamine? what is it used for?

Back 20

Dobutamine is a b1-selective agonist used to treat acute heart failure or heart failure that does not respond to other agents

Front 21

if heart failure does not respond to positive digoxin or other agents what is another positive inotropic drug that can be administered?

Back 21

Dobutamine and Dopamine

Front 22

why is Dopamine used in the treatment of CHF?

Back 22

it is a b-receptor agonist and is used in treatment of acute CHF or heart failure if it does not respond to treatment by other agents or Dobutamine

Front 23

What are you going to administer for treatment to a patient that has arrived in the ER with acute heart failure?

Back 23

Dobutamine administered by continuous infusion

Front 24

what is the effect of dobutamine on cardiac contractility, heart rate, preload, afterload, and risk of arrhythmia?

Back 24

increases contractility
increases heart rate
decrease preload
decrease afterload
increase risk of arrhythmia

Front 25

what is the onset of action for Dobutamine?

Back 25

1 minute

Front 26

what is the duration of action of dobutamine?

Back 26

less than 10 minutes

Front 27

what is the elimination half life of dobutamine?

Back 27

2 minutes

Front 28

what are some common adverse side effects in treatment of CHF with dobutamine?

Back 28

excessive vasoconstriciton
tachyarrhythmias
hyper/hypotension

Front 29

describe the mechanism of action for Phosphodiesterase inhibitors in treatment of CHF?

Back 29

these drugs inhibit the enzymes that inactivate cAMP and cGMP
selective for PDE type III which is only found in smooth and cardiac muscle
inhibition of type III PDE results in increased cAMP concentration in the cell, causing increased cardiac muscle contracitlity and vasodilation

Front 30

Name two Phosphodiesterase inhibitors

Back 30

Inamrinone
Milrinone

Front 31

how are phosphodiesterase inhibitors used in the treatment of CHF?

Back 31

inamrinone and milrinone are used only for short term management of acute heart failure

Front 32

what are the cardiovascular effects associated with phosphodiesterase inhibitors in treating CHF?

Back 32

Milrinone and Inamrinone
increase cardiac contractility
increase heart rate
decrease preload
decrease afterload
slight risk of arrhythmia

Front 33

onset of action of inamrinone and milrinone?

Back 33

phosphodiesterase inhibitor
onset of action 3 minutes

Front 34

common adverse effects of Milrinone (phosphodiesterase inhibitor)

Back 34

arrhythmias
hypotension
nausea
vomitting
thrombocytopenia
do not mix milrinone with furosemide (loop diuretic) in an IV line because a precipitate will form

Front 35

what types of drugs without positive inotropic effects are used to treat CHF?

Back 35

Vasodilators: Angiotensin II inhibitors, Hydralizine, nitrates
Some b-adrenergic antagonist
diuretics

Front 36

how do ACE inhibitors assist in treatment of CHF?

Back 36

decrease activation of cardiac angiotensin receptors > decreases cardiac remolding & wall thinning > increases ventricular performance > decreases morbidity & mortality

Front 37

what are the adverse affects of ACE inhibitors in treatment of CHF?

Back 37

chronic cough
severe hypotension
hyperkalemia
rash
acute renal failure in patients with bilateral renal stenosis

Front 38

what are the cardiovascular effects of all of the ACEI in treating CHF?

Back 38

decrease preload
decrease afterload

Front 39

what ACEI are used in treating CHF?

Back 39

Captopril
Enalapril
Lisinopril

Front 40

what are the cardiovascular effects of ARBs in treating CHF?

Back 40

decrease preload
decrease afterload

Front 41

Candesartan, Losartan, and Valsartan are examples of what type of drug to treat CHF?

Back 41

Angiotensin II receptor blockers

Front 42

what is the CV effect of Hydralazine in treating CHF?

Back 42

Hydralazine is a vasodilator
increases heart rate reflex
decreases afterload
reduces blood pressure
risk of arrhythmia

Front 43

what type of drug is Isosorbide dinitrate?

Back 43

Nitrate drug that is broken down into NO which causes vasodilation

Front 44

what are the CV effects of Isosorbide dinitrate in treating CHF?

Back 44

reduces pulmonary congestion
increases heart rate reflex
decreases preload
decreases afterload

Front 45

what is the role of diuretics in the treatment of CHF?

Back 45

thiazide and loop diuretics increase excretion of NaCl and water
reduction in plasma volume and ventricular preload
reduction of pulmonary and peripheral edema
reduction of cardiac size and improved pumping efficiency

Front 46

what is significant about Spironolactone in the treatment of CHF?

Back 46

Spironolactone is a potassium sparing diuretic
has been shown to reduce morbidity and mortality in patients with severe CHF
administered with other therapies
increases the excretion of sodium and increases potassium retention

Front 47

what is the main effect of diuretics in the treatment of CHF?

Back 47

decreases preload
reduces edema and congestion

Front 48

name some loop diuretics that would be used in the treatment of CHF?

Back 48

Bumetanide
furosemide
torsemide

Front 49

what two potassium sparing diuretics are used with other therapies to treat CHF?

Back 49

Spironolactone
Eplerenone

Front 50

when do you administer spironolactone in the treatment of CHF?

Back 50

Severe heart failure
it is an aldosterone receptor antagonist

Front 51

what class of CHF patient have b-adrenergic antagonist been shown to be beneficial in?

Back 51

patients with class II and III heart failure

Front 52

how do b-adrenergic antagonist benefit patients with CHF?

Back 52

increase cardiac output and left ventricular ejection fraction

Front 53

Can a patient expect immediate improvement of symptoms with administration of b-adrenergic antagonist in the treatment of CHF?

Back 53

NO
it takes 2-3 months for improvement
start with low dose and gradually titrate upward

Front 54

why do you start treatment of CHF with a small dose of b-blockers?

Back 54

because to much b-blocker can kill the patient with CHF because of their negative inotropic effects

Front 55

What b-adrenoceptor antagonist are used in the treatment of CHF?

Back 55

Carvedilol
Metoprolol
bisoprolol
atenolol

Front 56

what type drug is Carvedilol?

Back 56

a- and b-adrenoceptor antagonist

Front 57

what type of drug is Metoprolol and Bisoprolol?

Back 57

B1-antagonist

Front 58

what type of drug is atenolol?

Back 58

B1-antagonist

Front 59

what is a benefit of prescribing Carvedilol to a patient with CHF?

Back 59

slows cardiac remolding

Front 60

what drugs are used in the treatment of CHF that increase cardiac output?

Back 60

Digoxin
B-receptor agonist: dobutamine/dopamine
Phosphdiesterase inhibitors: Inamrinone, milrinone

Front 61

what drugs are used in the treatment of CHF that reduce preload and congestion?

Back 61

Diuretics: spironoloactone, furosimide
Angiotensin II inhibitors:
ACEI: Captopril, Enalapril, Lisinopril
ARBs: Candesartan, Losartan, Valsartan
Hydralzaine, Isosorbide dinitrite
digoxin

Front 62

what drugs are used in treatment of CHF that reduce afterload?

Back 62

Inotropic drugs:
Inamirine, Milrinone (PDEI)
ANGII Inhibitors:
ACEI: Captopril, Enalapril, Lisinopril
ARBs: Candesartan, Losartan, Valsartan
Hydralazine
b-blockers: Carvediliol, Metprolol, Bisoprolol, Atenolol

Front 63

Drugs that reduce cardiac remolding and improve ventricular performance in the treatment of CHF?

Back 63

ANGII inhibitors:
ACEI: Captopril, Enalapril, Lisinopril
ARBs: Candesartan, Losartan, Valsartan
B-blockers: Caredilol, metoprolol, bisoprolol, atenolol
Spironolactone

Front 64

Drugs that can reduce mortality or morbidity in treatment of CHF.

Back 64

Angiotensin II inhibitors:
ACEI: Captopril, Enalapril, Lisinopril
ARBs: Candesartan, Losartan, Valsartan
B-receptor antagonist (blockers): Carvediliol, metoprolol, bisoprolol, atenolol
Spironolactone in severe HF

Front 65

why is spironolactone only administered to patients who are in severe heart failure?

Back 65

because spironolactone has been shown to increase mortality and morbidity in patients with mild and moderate CHF

Front 66

why is early stage CHF often treated with an ACEI and b-blocker?

Back 66

decrease/stop cardiac remodeling
will not have pulmonary edema
SOB is due to decreased blood flow to the lungs, not from not receiving enough oxygen