Heart Failure Drugs

Front 1

Digoxin:
Mechanism & Effect

Back 1

Inhibits Na/K ATPase
Increases PNS activity

Increases inotropy
Decreases AV Nodal Conduction

Front 2

Digoxin:
Indications

Back 2

CHF
A-Fib
Combo: CHF with A-Fib

Front 3

Digoxin:
PK

Back 3

well-absorbed
long t1/2
renal clearance
*narrow safety margin*

Front 4

Digoxin:
Toxicity

Back 4

Cardiac: arrhythmia, AV block, V-tach/V-fib
GI: N/V, diarrhea
CNS: disorientation, visual disturbances

Front 5

Digoxin:
Interactions

Back 5

Increased levels: Quinidine, Verapamin, Amiodarone, Propafenone
Increased toxicity: Diuretics

Front 6

Dobutamine:
Mechanism and Effect

Back 6

beta-agonist, leading to increased cAMP

Increased contractility, Decreased SVR (beta 1&2)

Front 7

Dobutamine:
Side Effects

Back 7

angina
tachyarrhythmia

Front 8

Dobutamine:
Indications

Back 8

COLD, wet or dry

Short-term, acute CHF only

Front 9

Milrinone:
Mechanism and Effect

Back 9

Phosphodiesterase-Inhibitor, leading to increased cAMP

Inotropic, Vasodilator

Front 10

Milrinone:
Side Effects

Back 10

ventricular arrhythmias, headache, hypotension

Front 11

Milrinone:
Indications

Back 11

WARM & WET

Short-term, acute CHF only

Front 12

beta-agonist or PDE-inhibitor:
Mechanism

Back 12

Increase cAMP
Increased PKA
Increased phosphorylation:
L-type channels, Ca2+ influx
Phospholamban, accelerates SRCA

Front 13

BNP:
Mechanism & Effect

Back 13

Increases cGMP on blood vessels:
vasodilation, diuresis

Front 14

BNP: Indications

Back 14

WARM & WET

Acute decomp. HF only

Front 15

BNP:
Side Effects

Back 15

hypotension
severe renal damage

Front 16

Loop Diuretics

Back 16

Furosemide
Bumetanide
Torsemide
Ethacrynic Acid

Front 17

Loop Diuretics:
Mechanism & Effect

Back 17

Inhibit Na/K/Cl transporter at TAL
Reduce preload, decrease SVR over time

Front 18

Thiazide Diuretics:
Mechanism & Effect

Back 18

Inhibit Na/Cl transporter at DCT
Reduce preload, exhibit synergy w/ loops

Front 19

Diuretics: Side Effects

Back 19

Hypokalemia
Gout

Front 20

Diuretics: Indication

Back 20

Most HF patients, relieve acute/chronic sx (congestion, edema) - Don't remove too much volume!

Front 21

ACE-I

Back 21

Captopril, Enalapril, Lisinopril, Ramipril

Front 22

ARB

Back 22

Valsartan, Candesartan

Front 23

ACEI/ARB Effect

Back 23

Decrease preload & afterload, which also decreases O2 demand
Decrease SNS Activation
Decrease remodeling triggered by Ang II

Front 24

ACEI/ARB:
Side Effects

Back 24

hypotension, cough (acei), hyperkalemia, angioedema, rash, neutropenia, dysgeusia, incr. SCr

Front 25

ACEI/ARB:
Contraindications

Back 25

pregnancy, angioedema, anuric renal failure, bilateral renal artery stenosis

Front 26

Beta-blockers:

Back 26

Selective: Metoprolol, Bisoprolol
Nonselective: Carvedilol

Front 27

Beta-blockers:
Mechanism/Effects

Back 27

Block binding NE/Epi to beta-receptor (inhibit SNS)

Improve LV structure and function
Anti-arrhythmic, anti-ischemic
RAAS-inhibiting
Decrease mortality

Front 28

Beta-blockers:
Monitor

Back 28

Heart Rate must stay >50!!!
Weight
SOB

Front 29

Beta-blockers:
Side Effects

Back 29

SOB, rales, edema, weight gain, decr. heart rate, fatigue, depression, impotence

Front 30

Beta-blockers:
Selection

Back 30

Carvedilol, if pt has good BP

Toprol XL, if pt BP is low (or if asthmatic)

Front 31

Aldosterone Antagonists:

Back 31

Spironolactone
Eplerenone

Front 32

Aldosterone Antagonists:
Mechanism & Effect

Back 32

Decrease myocardial fibrosis and collagen synthesis, decrease baroreceptor dysfunction, Prevent ventricular remodeling/hypertrophy

Front 33

Aldosterone Antagonists:
Side Effects

Back 33

hyperkalemia (&brings Mg with it)
Gynecomastia
Hirsuitism

Front 34

Aldosterone Antagonists:
Contraindications

Back 34

Renal Insufficiency
SCr >2.5 or CLCR<30
K+>5.0
Close K+ Monitoring required!

Front 35

Aldosterone Antagonists:
indications

Back 35

Pt already on optimal HF therapy, need more

Recent post-MI pts, LVEF<40 = start w/in 2 weeks!

Front 36

ISDN & Hydralazine:
Mechanism/Effect

Back 36

ISDN: Incr cGMP, relaxation
Decrease preload
May protect against remodeling

Hydralazine: Opens K+ channels, Inhibits Ca2+ release from SR, Reduce ROS
Dilates arterioles, Decreases afterload

Front 37

Signs & Symptoms of Congestion ("WET")

Back 37

Orthopnea/PND
JV Distention
Hepatomegaly
Edema (pitting)
Rales
Abdominal-jugular reflex
Nausea/vomiting/anorexia

Front 38

Signs & Symptoms of Low Perfusion ("COLD")

Back 38

Narrow pulse pressure
Sleepy/obtunded
Low serum Na+
Cool extremeties (ashen, cold)
Hypotensive w/ ace-i
Renal dysfunction