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48 Cards in this Set

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  • Back
what drugs are used in management of stable heart failure?
Diuretics (furosemide (Lasix)
Vasodilators (Catopril (Capoten), amlodipine (Norvasc)
Positive Ionotropes- Digitalis glycosides like digoxin (lanoxin)
Beta blockers - metoprolol (Lopressor), nadolol (Corgard), atenolol (Tenormin), carvedilol (Coreg)
aspirin and other anticoagulants like heparin or Coumadin (Warfarin Sodium)
What is a diuretics used to treat stable heart failure? What effects do they have on the heart?
Furosemide (Lasix)
Increases excretion of sodium, Chloride and water
decreases preload which in turn increases CO
What are some vasodilators used to treat stable heart failure?
Catopril (Capoten), amlodipine (Norvasc)
How do drugs like captopril (Capoten) work in the treatment of stable heart failure?
ACE inhibitor - They inhibit angiotensin converting enzyme...no RAAS compensation
*causes vasodilation and decreased endothelial dysfuntion
*Useful in heart failure, tachycardia, MI, hypertension, diabetes, and chronic kidney disease.
What are some positive ionotropes that are used to manage stable heart failure?
digoxin (Lanoxin)
What are some beta blockers that are used to treat stable heart failure?
metoprolol (Lopressor),
nadolol (Corgard),
atenolol (Tenormin)
carvedilol (Coreg)
why are loop diuretics used in stable heart failure?
They are used at lowest effective dose in stable heart failure to avoid side effects (electrolyte abnormalities, systemic alkylosis, and dehydration)
why are other diuretics sometimes combined with furosemide diuretics in tx of stable heart failure?
to increase diuretic activity of lasix, combat diuretic resistance due to hypertorphy of ascending loop of henle
What electolyte abnormalities can be seen with thiazide diuretics?
hypokalemia, hypomagensemia, hyponatremia
metabolic alkalosis
increase Ca reabsorption
why are thaizide diuretics sometimes used in heart failure tx.
to potentiate the diuretic effect of furosemide
adverse effects of thiazide diuretics
dehydration and hypovolemia, electolyte imbalance, hyperglycemia and hypersenstivity reactions in patients allergic to sulfonamides, dehydration and lectorlyte abnormalites are more common when combined.
Drugs that are considered potassium sparring diuretics are
spironolactone, triameterene, amiloride
How do K+ sparing diuretics cause diursis?
competitive inhibition with aldosterone binding to receptors
adverse effects of potassium sparring diuretics?
K+ and H+ retention= hyperkalemia + acidosis
potential for adverse reproduction affects
what diuretic used in heart failure is most likely to cause dehydration and electrolyte abnormalities?
loop diuretics- furosemide
ACE inhibitors include what drugs?
Enalopril, Catopril (Capoten)
How do ACE inhibitors cause vasodilation?
they decrease Angiotensin II levels (angiotensin is a vasoconstrictor)
They also increase bradykinin levels which is a vasodilator (ACE breaks down bradykinin)
What are renal effects of ACE inhibitors?
decrease water rentention because of angiotensin and aldosterone inhibition
What is the benefit of decreased angiotensin and aldosterone in heart failue other than vasodilation and less water retention?
less sympathetic and vasopressin release (angiotensin II increaes the activity of these systems)
Aldosterone and angiotensin blockade may prevent direct toxicity to myocardium (this may be one of the biggest benefits in heart failure given it is a weak vasodilator)
When are ACE inhibitors used in heart failure?
Used in stable heart failure (shown to reduce morbidity and mortality)
would not be a very effective vasodilator in emergency heart failure and most need to be given orally
a loop diuretic and ACE inhibitors are very common drugs in tx of heart failure (baseline drugs in heart failure)
why might ACE inhibitors drugs helpful in heart failure?
because of hemodynamic effects (decreased resistance) but maybe more importantly b/c of decreased levels of angiotensin and aldosterone which can be toxic to the heart when chronically elevated
what are other uses of ACE inhibitors?
hypertension (decrease hypertension via vasodilation) and to decrease protein loss in protein losing nephropathies (less protein loss b/c they can lower intraglobmerular pressure)
What are the adverse effects of ACE inhibitors?
-Excessive vasodilation can drop blood pressure
- renal enzyme elevations due to excessive vasodilation or decreaed efferent arterial dialtion. Efferent arteriol vasodilation can decrease glomerular filtration pressure and therefore decrease glomerular filtration. In particular if starting out at a low or normal glomerular pressure.
- GI upset (more likely with catopril)
- Increased K+ due to aldosterone inhibition
-blood dysrazias, proteinuria and skin rash with catopril
-cough reported in people
What other vasodilators can be used in stable heart failure?
Amlodopine (Ca channel blocker than mainly causes vasodilation)
- can decrease afterload via vasodilation excessive doses will decrease blood pressure and blood flow just like other vasodilator
- Angiotensin II antagonist (also used for hypertension and may be beneficial in angiotensin blockade but remains to be seen if beneficial in heart failure)
-Renin blockers have also been developed for use in heart failure.
What are some positive inotropes used in heart failure?
DIgoxin/digitalis glycosides
Digitalis glycosides include what drugs?
digitoxin, digoxin
What are the hemodynamic effects of digioxin in heart failure?
increased heart contractility
Decreased heart rate
increased contractility may improve cardiac output resulting in a reflex vasodilation and therefore decrease in peripherial vascular resistance
How do digitalis glycosides decrease heart rate?
increase contractility which enhances SV and CO
Uses of Digoxin/digitalis glycosides?
Heart Failure
Used to tx heart failure due to systolic heart failure because it will increase contractility
Decreased heart rate may also help as an increase in heart rate will increase myocardial oxygen demand resulting in myocaridal injury due to an oxygen deficit
used to slow heart rate in tachyarrhythmias. May be used as an emergency drug in arrhythmia situation.
In what types of heart disease is Digoxin/digitalis glycosides contraindicated?
in cases of diastolic failure associated with cardiac hypertrophy. In these cases systolic function is not a problem. May not be useful in valvular regurge (increased contractility may worsen regurge) but some feel decreased heart rate may make it useful in these cases
What are some adverse effects of Digoxin/digitalis glycosides?
GI upset
arrhythmias (tachyarrythmias and bradyarrhythmias)
CNS depression, disorientation, and delerium
very narrow therapeutic margin
adverse effects are common with this drug requiring drug levels be monitored
what electrolyte and other abnormalities may increase digitalis toxicity and chances of arrthymias? which electrolyte abnormality is common with combined therapy?
hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia
also hypothyroidism, hyperthyrodism, hypoxemia
remember that many patients on loop diuretics are hypokalemic as a side effect of the loop diuretics (often heart failure patients are on both these drugs)
how is digitalis toxicity monitored for and treated?
monitor drug levels and check for clinical signs
to tx withdrawl drug, give antirrhythmic for arrhythmias, sometimes digibind and AB is given to bind digitalis glycosides
What is the advantage of pimobendam over other drugs such as amirinone or milrinone?
it is a phsophodiesterase inhibitor like these drugs but is also senstitzed the myofibrils to CA. Therefore contractility is increased with less Ca in the cell. This is good because excess Ca in myocardial cells can be toxic cause arrhythmias, increase cardiac work load and oxygen consumption. It also allows it to work in times of acidosis unlike other inodilators
Why are negative ionotropes used in stable heart failure?
the block the sympathetic system and RAAS.
They help improve heart function by increasing contractility which enhances stroke volume and cardiac output. Digoxin inhibitor.
Why are BETA blockers not used in emergency heart failure?
in emergency heart failure these drugs would take to long to work. Could potentially decompensate the patient by decreasing heart rate and contractility.
What beta blockers are beta 1 specific and which act on Beta 1 and BETA 2
metopolol (Lopressor) and atenolol (Tenormin) beta I specific
nadolol (Corgard), are not beta specific
caervedolol (Coreg) work on beta 1, beta 2 and alpha
side effects of beta blockers include?
sudden withdrawal can cause tachycardia, sinus bradycardia, and decreased contracility, hypoglycemia, bronchospasm, hyperkalemia, GI side effects, sedation
What are the effects of ACE inhibitors on the heart?
Block the conversion of Angiotensin I to Angiotensin II (lungs), which causes vasodilation. This blocking acts as a diuretic to get rid of fluid, decrease the afterload, and increase cardiac output.
Nitrates have what effect on the heart?
Nitrates such as Nitroglycerine (Tridil) promote peripheral vasodilation, which decrease preload and afterload, Coronary artery vasodiolator.
What effect does opioid analgesics have on the heart? What is the name of an opioid analgesic?
Morphine sulfate.
Functions as an analgesic and a sedative
Acts as a vasodilator to reduce preload
What effect does warfarin (Coumadin) have on the heart?
Interferes with hepatic synthesis of Vitamin K dependent clotting factors.....alternative for patients that cannot tolerate aspirin.
What effect does aspirin have on the heart?
Inhibits cyclooxygenase which blocks a platelet activator.
Name two anticoagulant/antiplatelet agents?
Aspirin and Warfarin (Coumadin)
What are the effects of a B Beta Blocker on the heart?
Inhibit sympathetic stimulation of the heart
Reduces the heart rate
Reduces contractility and BP
Decreases afterload
Name two B-Adrenergic blockers?
Atenolol (Tenormin)
Carvedilol (Coreg)
Metoprolol (Lopressor)
Nadolol (Corgard)
What is a B - Blocker used for?
Low dose is used to suppress tachycardia and prevent ventricular dilation due to overcompensation by the sympathetic nervous system.
Name two Calcium channel blockers and how they effect the heart?
Amlodipine (Norvasc) and Nifedipine (Procardia)
Prevent calcium from entering into vascular smooth muscle and cardiac cells.
coronary and peripheral vasodilation
reduces HR, contractility, and BP