Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVS > Heart failure treatment > Flashcards

Heart failure treatment Flashcards

1
Q

Classes of drugs for HF

A
  1. positive inotropic drugs: increase HR and contractility (for late stages where pt dies without this)
    - Glycosides
    - B agonists, PDE inhibitors
  2. vasodilators: reduce cardiac load for earlier stages
    - nitroprusside, nitrates
    - ACE inhibitor, AT1 blocker
  3. miscellaneous
    - Diuretics
    - B blockers
    - aldosterone antagonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

sodium nitroprusside is a

A

NO donor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

nitroprusside MOA

A

vasodilation (arterioles and veins) –> reduce cardiac load –> reduce work demand of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

nitroprusside PK

A

IV

can give off NO + cyanide + methemoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

nitroprusside clinical uses

A

chronic or refractory HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

nitroprusside adverse effects

A
  1. hypotension
  2. cyanide poisoning
  3. cellular hypoxia - methemoglobin (poor O2 carrying capacity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does thin descending limb of LOH do

A

reabsorption of water by osmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does thick ascending limb of LOH do

A

active reabsorption of NaCl, impermeable to water (the loop has some passive reabsorption of NaCl)
- via Na/K/2CL cotransporter on luminal membrane

  • also results in K accumulation in cell –> diffusion of K back into tubular lumen –> electric potential allows reabsorption of cations like Mg and Ca via paracellular pathway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is DCT permeable to water

A

impermeable to water, most water reabsorption at collecting ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name 3 loop diuretics

A

sulfonamide derivatives:

furosemide, bumetanide, ethacrynic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

loop diuretics MOA

A
  • inhibit luminal Na/K/2Cl cotransporter in thick ascending limb of LOH –> reduce Na reabsorption –> reduce water reabsorption –> reduce BV, reduce cardiac load
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

which loop diuretic increases renal blood flow

A

furosemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what drugs interfere with loop diuretics

A

NSAIDs

- loop diuretics induce renal PG synthesis, NSAIDs reduce PG synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do loop diuretics affect Mg and Ca

A

increase Mg and Ca excretion
- reduced absorption of K –> reduced diffusion of K back into tubular lumen –> reduce reabsorption via paracellular pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

loop diuretics PK

A

IV, readily absorbed, diuretic response rapid

eliminated by tubular secretion and glomerular filtration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

loop diuretics duration of action?

A

2-3 hours for furosemide

17
Q

loop diuretics clinical uses

A
  1. acute PE and other edema
  2. acute hyperkalemia
  3. acute renal failure
  4. anion overdose (due to toxic ingestion of Br, F, I)
18
Q

loop diuretics adverse effects

A
  1. hypokalemic metabolic alkalosis
  2. ototoxicity (cannot take with some antibiotics, eg. aminoglycosides)
  3. hyperuricemia (upset of ion balance affects urea secretion)
  4. hypomagnesemia (Ca not as affected as still can be reabsorbed in DCT)
19
Q

What happens at DCT (3)

A
  1. electrically neutral Na/Cl cotransporter –> NaCl reabsorption
  2. Ca actively reabsorbed via apical Ca channel and basolateral Na/Ca exchanger
  3. PTH has (significant) influence here
20
Q

What are thiazides

A

diuretics that work at DCT

21
Q

Name 3 thiazides

A

hydrochlorothiazide, indapamide, chlorthalidone

22
Q

Thiazide MOA

A

inhibit Na/Cl cotransporter on apical surface of DCT –> inhibit NaCl reabsorption –> reduce water reabsorption –> reduce BV, reduce cardiac load

23
Q

Thiazide effect on Ca

A

enhance Ca absorption (due to reduced intracellular Na)

24
Q

What drug affects thiazides

A

NSAIDs (reduce PG synthesis which is needed for thiazide action)

25
Q

thiazide clinical uses

A
  1. hypertension
  2. CHF
  3. nephrolithiasis due to idiopathic hypercalciuria
  4. nephrogenic diabetes insipidus
26
Q

thiazide adverse effects

A
  1. hypokalemic metabolic alkalosis
  2. hyperuricemia
  3. hyperglycemia, hyperlipidemia
  4. hyponatremia
27
Q

what happens at collecting tubule (3)

A
  1. final site of NaCl reabsorption –> determines final conc of NaCl –> determines water reabsorption
  2. site of K secretion
  3. mineralocorticoids have significant influence here
28
Q

cells at collecting tubule

A

Principle cells:

  • reabsorption of Na coupled to secretion of K
  • regulated by aldosterone
  • water permeability increased by ADH induced fusion of vesicles containing preformed water channels with apical membranes

Intercalated cells:
- proton secretion

29
Q

Name 4 potassium sparing diuretics

A

spironolactone, triamterene, amiloride, eplerenone

30
Q

potassium sparing diuretics MOA

A

Act at collecting tubule

  • spironolactone, eplerenone: inhibit aldosterone receptor –> inhibit Na channel
  • triamterene, amiloride: inhibit Na channel
    => reduce Na reabsorption, reduce K secretion
31
Q

which potassium sparing diuretic has slow onset of action

A

spironolactone

- need time for product of genes that have their expression upregulated by aldosterone to get degraded

32
Q

why is triamterene given more frequently than amiloride

A

triamterene is metabolised in liver and has shroter half life

33
Q

how is amiloride excreted

A

excreted unchanged in urine

34
Q

which potassium sparing diuretic is excreted unchanged in urine

A

amiloride

35
Q

potassium sparing diuretics clinical uses

A
  1. diuretic (CHF, hypertension, etc.)

2. hyperaldosteronism

36
Q

potassium sparing diuretics adverse effects

A
  1. hyperkalemic metabolic acidosis
  2. gynecomastia (except eplerenone)
  3. acute renal failure (esp triamterene + indomethacin)
  4. kidney stones (for triamterene)
37
Q

which potassium sparing diuretics causes kidney stones

A

triamterene

38
Q

which potassium sparing diuretic when used with indomethacin causes acute renal failure

A

triamterene

39
Q

general contraindications

A

CHF: Ca channel blockers cannot
Asthma: B blockers (esp non selective) cannot
Diabetes: B blockers (masks symptoms of hypoglycemia)
Pregnancy: ACEI/AT1 blocker (affect fetus renal function)

CVS (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions