Spring 2011 Hf Drugs Patient Management Final

Front 1

In heart failure CHF
which drugs can be used to
affect cardiac output?

Class 1ct
Rx 3ct

H+

Back 1

Inotropic drugs:

Digitalis
B-Adrenoceptor Agonists (?)
Phosphodiesterase Inhibitors (ED E-Dys-Inhibitors) (?)

Hint 1

D
BAA (Dobutamine)
PI (Milrinone)

Front 2

In heart failure
which drugs can be used to affect congestion?

8ct
H+

Back 2

Ace inhibitors
Aldosterone antagonists
ARBS
Beta Blockers
Diuretics
Hydralazine
Nitrates
Vasodilators

Hint 2

A
A antagonists
A
B
D
H
N
V

Front 3

In heart failure
which class of drugs can be used to affect cardiac remodeling?

2ct

Back 3

Ace inhibitors
Beta Blockers

slow or reverse cardiac remodeling

Name them:
Ace inhibitors?
Beta Blockers?

Hint 3

Ace inhibitors:
Enalapril & Lisinopril:
(angiotensin-converting enzyme) Inhibitors

Beta Blockers :
Carvedilol \ Metoprolol XL

Front 4

Modest inotrope effect caused by an increase in intracellular calcium
(increase force of contraction)


Produces a negative chronotropic effect of contraction
(decreased rate) of contraction

Produces a negative dromotropic effect
(a decrease in the conduction velocity).

Back 4

Digoxin

Front 5

Causes an increase in parasympathetic tone
which decreases conduction and
AV node conduction velocity and
increasing AV node refractory period

This drug is MOST HELPFUL in
Heart Failure(CHF) combined with
Atrial Fibralation.

Back 5

Digoxin

Front 6

Arrhythmias are Most-Serious Manifestations.

The earliest signs are
Anorexia
Nausea
Vomiting
Blurred vision
Yellow Green or Blue Chromotropsia

Back 6

Digoxin Toxicity

Front 7

-Increases intracellular sodium by inhibiting sodium pump

-High Na increases Na/Ca exchanger activity so even more Ca flows in to cardiac myocyte

-More Ca release from sarcoplasmic reticulum

Back 7

Digoxin

Front 8

Increases parasympathetic tone while reducing sympathetic tone

Back 8

Digoxin

Front 9

Negative dromotropic effect
(conduction velocity)

affects AV node

slows ventricular rate
inorder to
Tx Atrial Fibrillation

Back 9

Digoxin

Front 10

Describe the role of angiotensin II in heart failure
aka Angiotensin II contributes to heart failure by causing

4ct

Back 10

Angiotensin II contributes to heart failure by causing

- Aldosterone increase (Increasing Secretion of aldo)
- ADH Increase (-Increasing ADH)
- Cardiac Remodeling... Contributes to
- Vasoconstriction

ADH aka =

Hint 10

Argenine vasopressin

Front 11

T or F:
aceis should generally be used before arbs in tx of heart failure

Back 11

TRUE


Name them:
ACEI ? What is the suffix
ARBS ? What is the suffix

Hint 11

Prils
Enalapril & Lisinopril: ACEI (angiotensin-converting enzyme Inhibitors);

Tans
Candesartan & Valsartan: ARBs (Angiotensin Receptor Blockers);

Front 12

these Rx Prevent excessive-stimulation leading to:
Activation of RAS
Cardiac Remodeling
Dilatation
Hypertrophy
Increases O2 demand
Increases infarct size
Tachycardia
Ventricular wall thinning

Back 12

Beta-blockers

Name them:
2ct

Hint 12

Carvedilol

Metoprolol XL

Front 13

These drugs inhibit the production of
-Cardiac Cytokines
-TNF Alpha
-Interlukenes

which all encourage remodeling

Back 13

Beta blockers


What 3 things encourage remodeling

Hint 13

-Cardiac Cytokines
-TNF Alpha
-Interlukenes

Front 14

The most effective means of providing symptom relief to pt
With moderate to severe CHF

Used to reduce plasma volume and edema
and thereby relieve the symptoms of
circulatory congestion such as SOB
(shortness of breath.)

Back 14

Diuretics

Front 15

ADVERSE-REACTIONS
from this Class of Rx include:

Hypokalemia
and
intravascular volume depletion with resulting :

Hepatic Dysfunction.
Hyperglycemia
Hyperuricemia
Neutropenia
Prerenal Azotemia
Skin Rashes
Thrombocytopenia

Back 15

Thiazides

Name the representative Thiazide

Hint 15

Hydrochlorothaizide

Front 16

Intravascular volume depletion
Prerenal Azotemia
Hypotension
Hypokalemia

particularly with accompanying digitalis therapy
is a major problem.

Back 16

Loop diuretics

Furosemide

Front 17

Side Effects include:

Hyperkalemia
GI Symptoms
Renal Dysfunction.

Back 17

Potassium-Sparing Diuretics =

Spironolactone

Front 18

Aldosterone mediates some of the major effects of renin–angiotensin–aldosterone system activation
such as
myocardial remodeling and fibrosis
so this drug should also be considered as a neurohormonal antagonist.

Back 18

Spironolactone

Front 19

Hydralazine and nitrates have a special niche...what is it?

Back 19

A potentially beneficial therapy for African American patients with severe HF

Front 20

This overall class

Act by releasing nitric oxide in vascular and smooth muscle cells
Relax venous smooth muscle
and
have a relatively smaller effect on Arteriolar-Smooth-Muscle.

Back 20

Organic Nitrites and Nitrates

Front 21

T or F:
the nitrates have a direct effect on cardiac tissue

Back 21

False

Front 22

Influx of calcium into cardiac muscle cells leads to membrane depolarization and initiates or strengthens muscle contraction
What effect does blocking these channels have?

Back 22

Smooth muscle relaxation and suppress cardiac activity.

Front 23

PREVENT Ischemic Episodes

because of their ability to

PREVENT
- exercise-induced tachycardia
- increased myocardial oxygen demand

They can also prevent
- reflex tachycardia

Back 23

B-Adrenoreceptor antagonists
aka: BB

Name Them 2ct

Hint 23

Carvedilol

Metoprolol XL

Front 24

They have negative inotropic effects that can be hazardous to patients with heart failure if large doses are given.

(inotropic - Contractility)

Back 24

Beta blockers
2ct?

Hint 24

Carvedilol

Metoprolol XL

Front 25

Produces the same pharmacologic effects as nitroglycerin but has a slightly slower onset of action and a greater duration of action.

Back 25

Isosorbide dinitrate

Front 26

What routes of administration can nitroglycerin be given that isosorbide dinitrate cannot?
(3)

Back 26

Transdermal
topical
IV

Front 27

What routes of administration of nitroglycerin extend its pharmacokinetics and enable it to be used prophylactically?
(3)

Back 27

Transdermal
topical (can be used for acute sx)
sustained release

Front 28

Continuous administration of nitroglycerin and other organic nitrates often leads to

Back 28

Tolerance to their vasodilative effects.

Front 29

To prevent nitrate tolerance and loss of therapeutic effect
skin patches should be removed for at least

Back 29

10 hrs each day

Front 30

Adverse Reactions are:
headache
hypotension
dizziness
and reflex tachycardia

However,
Beta blockers used in conjunction with these Rx-s can prevent reflex tachycardia.

Back 30

Nitrates

Front 31

Episodes of coronary spasm (in variant angina) generally respond well to nitrates
and the combination of nitrates and what other drugs are effective prophylactically?

Back 31

CCBs

Name the CCBs

Hint 31

the Dihydropyridine CCBs:
Amlodipine
Nifedipine

the NON-Dihydropyridine CCBs:
Diltiazem
Verapamil

Front 32

In chronic stable angina or variant angina
which class of ccbs are preferable as first-line agents because they produce less reflex tachycardia?

Which drug may cause fewer side effects?

Back 32

Non-dihydropyridines

Diltiazem

Front 33

These drugs
which are potent vasodilators
can reduce blood pressure sufficiently to evoke reflex tachycardia
At therapeutic doses
they do not suppress cardiac function as much as the other ccbs do.

Back 33

Dihydropyridines

Front 34

Investigators found a higher incidence of

-MI
-CHF
-Deaths from CHD

in patients who took immediate release forms of what cardiac drug class?

Back 34

Ccbs

Front 35

The safest CCB
in pts with

HF-due-to-CAD.

Back 35

Amlodipine

Front 36

What agents should be avoided unless they need to be utilized to treat associated hypertension or angina?

For these indications what drug should you use?

Back 36

CCBs

Amlodipine

Front 37

Often used in
-typical angina pectoris
-acute MI

but are not used to treat
- vasospastic angina
- acute angina attacks.

Back 37

B-blockers

Name them:
2ct

Hint 37

Carvedilol

Metoprolol XL

Front 38

The only antianginal agents that have been demonstrated to prolong life in patients with coronary disease (post-MI).

Back 38

Beta-blockers

2ct?

Hint 38

Carvedilol

Metoprolol XL

Front 39

B-blockers should be considered for first-line therapy in most patients with

Back 39

Chronic angina.

Front 40

Can prevent reflex tachycardia
induced by

nitrates or dihydropyridine ccbs.

Back 40

Beta-blockers

Name them?
2ct

Hint 40

Carvedilol

Metoprolol XL

Front 41

Major contraindications are

- severe bronchospastic disease
-bradyarrhythmias
-decompensated heart failure.

Back 41

Beta blockers
(aka)
B-Adrenoceptor Antagonists

Name the BB
2ct

Hint 41

Carvedilol

Metoprolol XL

Front 42

Avoid the combination of _________? and B-blockers because they significantly reduce cardiac output

Back 42

Verapamil

What CCB is preferred?

Hint 42

Diltiazem

Front 43

Acts by modifying myocardial metabolism
It improves exercise capacity and reduces angina episodes without causing hemodynamic changes

Back 43

Ranolazine

Front 44

Reduces frequency of angina attacks in stable angina
A useful alternative or combination to other antianginal agents
Improves cardiac diastolic function
Safe to use with erectile dysfunction drugs
Significantly lower rate of ventricular arrhythmias

Back 44

Ranolazine

Front 45

Contraindicated in pts with existing QT prolongation
Also contraindicated in pts with liver and kidney disease
Do not use for treatment of acute anginal episodes.

Back 45

Ranolazine

newer antianginal agent
non- BB, CCB, ARB etc it's its' own thing

Front 46

Recommended for all patients with angina
unless contraindicated.

Back 46

Aspirin and/or clopidogrel

Clopidogrel contra-indicators =

Hint 46

Breast feeding
Bleeding
Ulcers