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951 Block 3 > 10. Vasodilators and Diuretics > Flashcards

10. Vasodilators and Diuretics Flashcards

1
Q

Why is vasoconstriction important during HF?

A

redistributes blood flow to the brain and heart

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2
Q

Peripheral vasoconstriction increases ________.

A

afterload

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3
Q

What other tissues are compromised when blood is shunted away from periphery?

A
  • kidney
  • skeletal muscle
  • liver
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4
Q

What class of vasodilators produces the most venous dilation?

A

nitrovasodilators

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5
Q

What class of vasodilators produces the least venous dilation?

A

hydralazine

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6
Q

What class of vasodilators produces the most arterial dilation?

A

hydralazine

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7
Q

What class of vasodilators produces the least arterial dilation?

A

nitrovasodilators

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8
Q

What is the MOA of organic nitrates in HF?

A
  • biotransformation to NO
  • activates guanyl cyclase to ↑ cGMP
  • produces SMC relaxation
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9
Q

The smooth muscle relaxation produced by organic nitrates mainly has what action on the heart?

A

reduces preload

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10
Q

Organic nitrates are not approved as monotherapy for HF. (T/F)

A

True

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11
Q

What are organic nitrates often combined with to treat HF?

A

hydralazine

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12
Q

What is the only organic nitrate approved for HF?

A

isosorbide dinitrate

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13
Q

Isosorbide dinitrate is approved for what class of HF?

A

HFrEF Class III-IV

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14
Q

What is nitroprusside approved for?

A

acute decompensated HF

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15
Q

Nitroprusside is spontaneously converted to ____.

A

NO

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16
Q

What is the route of administration of nitroprusside?

A

IV

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17
Q

What is the boxed warning of nitroprusside?

A

prolonged infusions = high potential for cyanide toxicity

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18
Q

What is the infusion duration maximum of nitroprusside?

A

≤ 10 minutes

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19
Q

What is the MOA of hydralazine?

A

unknown

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20
Q

Hydralazine reduces afterload in HFrEF patients by doing what?

A

relaxing arterial smooth muscle

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21
Q

Hydralazine has the most significant effect on preload. (T/F)

A

False: minimal effect on preload

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22
Q

Hydralazine is often combined with _______ to decrease preload.

A

isosorbide dinitrate

23
Q

What class of vasodilator is the most effective at reducing renal vascular resistance/ ↑ renal blood flow?

A

hydralazine

24
Q

What drug can be used to counteract the renal dysfunction created by ACE inhibitors or ARBs?

A

hydralazine

25
Q

What other vasodilators are rarely used in HF and have questionable efficacy?

A
  • Prazosin

- CCBs

26
Q

What CCBs are not recommended in systolic dysfunction and why?

A
  • verapamil
  • diltiazem
  • negative inotropic effect
27
Q

The treatment guidelines now recommend what with the treatment of CCBs?

A

avoid use of all CCBs in HF

28
Q

What 2 processes contribute to extracellular fluid volume expansion?

A
  • adrenergic stimulation

- RAAS

29
Q

What is the adrenergic effect on fluid volume?

A

β receptor mediated release of ADH (vasopressin) from pituitary gland

30
Q

What is the effect of the RAAS on fluid volume?

A

Ang II increases aldosterone and stimulation of thirst

31
Q

What is the primary goals of diuretic therapy?

A
  • reduce edema and pulmonary congestion by reducing preload

- reduce ventricular filling pressure

32
Q

Diuretic therapy causes clinically important reduction in CO. (T/F)

A

False: only when there is a rapid decline in intravascular volume

33
Q

In HF patients, reduction in preload decreases CO. (T/F)

A

False: this happens in healthy patients

34
Q

How do loop diuretic produce significant diuresis?

A

increased urinary excretion of Na, K, Cl

35
Q

What is the most widely used class of diuretics?

A

loop

36
Q

Loop diuretics can be used as a single agent in moderate and advanced HF. (T/F)

A

True

37
Q

What is the most significant problem with loop diuretics?

A

hypokalemia can precipitate life-threatening ventricular arrhythmias

38
Q

What other HF drug, when combined with diuretics, can enhance arrhythmias?

A

digoxin

39
Q

What class of diuretics can be used as monotherapy in the beginning stages of HF?

A

thiazide

40
Q

What is the site of action of thiazide diuretics?

A

distal tubule

41
Q

What are the potential complications of thiazide diuretics?

A
  • ↑ excretion of K (contribute to arrhythmias)

- effectiveness reduced in patients with renal failure

42
Q

What are the Na channel inhibiting K sparing diuretic agents?

A

amiloride and triamterene

43
Q

What are the aldosterone receptor antagonist K sparing diuretics?

A
  • spironolactone

- eplerenone

44
Q

What is nesiritide?

A

a purified preparation of human B-type natriuretic peptide

45
Q

What is nesiritide approved for?

A

acute decompensated HF

46
Q

What is the route of administration for nesiritide?

A

IV

47
Q

What is the mechanism of action for Ivabradine?

A

Blocks the iNa (slow) in the SA node to slow HR

48
Q

What class of HF is Ivabradine recommended for?

A

class II and III with EF ≤ 35%

49
Q

What are contraindications for Ivabradine?

A
  • acute decompensated HF
  • rhythm disturbances
  • AV block
50
Q

What 2 drugs make up Entresto?

A

sacubitril and valsartan

51
Q

What class of HF is Entresto recommended for?

A

Class II – IV

52
Q

Sacubitril is a prodrug that is metabolized into what?

A

neprilysin

53
Q

What is neprilysin?

A

peptidase that degrades multiple endogenous peptides, including natriuretic peptides and bradykinin

951 Block 3 (10 decks)

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