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Pharm > Chapter 48- drugs for heart failure > Flashcards

Chapter 48- drugs for heart failure Flashcards

1
Q

What are the 4 clinical manifestations of left-sided heart failure that deal with lungs?

A

-pulmonary congestion
-orthopnea
-PND (Paroxysmal nocturnal dyspnea)
-Cough

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2
Q

What are clinical manifestations of right-sided heart failure?

A

-perepheral edema
-weight gain
-hepatomegaly
-JVD (jugular vein distention)

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3
Q

What are the 4 main classification of drugs recommended for treatment in those with heart failure?

A

-diuretics
-Beta blockers
-Cardiac glycosides
-Drugs that inhibit the RAAS

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4
Q

What are 3 specific mechanisms r/t pharmacotherapy of heart failure?

A
  • Slowing the heart rate
    -increasing contractility
    -reducing cardiac workload
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5
Q

What is the first line diuretic for immediate relief from volume overload and why?

A

Furosemide
It is more rapid and effective

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6
Q

What is the reason for avoiding excessive diuresis?

A

To prevent compromised tissue PERFUSION d/t reduces cardiac output and blood pressure.

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7
Q

What is released to compensate for deteriorating cardiac function?

A

Natriuretic peptides

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8
Q

ANP is secreted in response to atrial stretching or _______?

A

Pressure

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9
Q

BNP is secreted in response to ventricular dilation or________?

A

Volume

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10
Q

ANP acts as an antagonist to ________ and ________?

A

Renin and aldosterone

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11
Q

BNP acts as a _______ and ________.

A

Vasodilator and diuretic

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12
Q

Cardiac glycosides are best known for their ________ inotropic actions which mean they _________ the force of myocardial contraction.

A

positive
increase

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13
Q

What are the 2 groups of inotropic drugs?

A

-Sympathomimetics
-Phosphodiesterase inhibitors

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14
Q

What 3 receptors can dopamine activate?

A

-dopamine
-Beta-1
-Alpha-1

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15
Q

Dobutamine does not activate which receptor?
therefore, what is not increased?

A
  • Alpha-1
  • vascular resistance
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16
Q

What drug increases the level of calcium which also increases myocardial contraction?

A

milrinone

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17
Q

What enzyme does the drug milrinone inhibit?

A

PDE3

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18
Q

Milrinone promotes_______?

A

Vasodilation

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19
Q

Inhibiting PDE3 and the promotion of vasodilation increases________?

A

Cardiac output

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20
Q

Which drug can cause hepatotoxicity?

A

milrinone

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21
Q

What is an ADR of milrinone?

A

Thrombocytopenia ( person may have excess bleeding because of this)

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22
Q

What are the 3 MOA’s of nesiritide?

A

-suppression of sympathetic outflow from the CNS
-Suppress the RAAS
-Directly dilates arterioles and veins

23
Q

Nesiritide is a synthetic form of ______?

A

B-Natriuretic peptide

24
Q

What can nesiritide cause?

A

Severe, symptomatic hypotension.

25
Q

Can you give nesiritIde >48 hours?

A

NO

26
Q

Which drug classification increases secretion of natriuretic peptides and suppresses negative effects of the RAAS?

A

Angiotensin receptor Neprilysin inhibitor

27
Q

Angiotensin redp5o4 neprilysin inhibitor is a combination drug that contains an ___?

A

ARB

28
Q

Digoxin has direct effects on what 2 things?

A

-Cardiac muscle
-electrical conduction system

29
Q

What drug causes severe cardiac dysrhythmias?

A

Digoxin

30
Q

Digoxin exerts a ________ inotropic effect and a _______ chronotropic effect on the heart.

A

positive, negative

31
Q

What drug has a narrow margin of safety?

A

Digoxin

32
Q

What enzyme does digoxin inhibit?

A

NA+-K+-ATPase

33
Q

The inhibition of NA+-K+-ATPase promotes ______ accumulation within myocytes.

A

Calcium

34
Q

The calcium facilitates the interaction of what 2 myocardial contractile proteins?

A

-actin
-myosin

35
Q

What electrolyte leads to the rise in intracellular calcium?

A

Sodium

36
Q

Due to the inhibition of soidum, the uptake of sodium is blocked, as the extrusion of __________.

A

Potassium

37
Q

What electrolyte competes with digoxin for binding to this enzyme?

A

K+

38
Q

An increase in potassium can impair _____ responses of digoxin and a decrease in potassium can cause _______________?

A

Therapeutic
digoxin toxicity

39
Q

normal physiological ranges of potassium?

A

3.5-5.0 mEq/L

40
Q

Does digoxin improve exercise tolerance and reduce fatigue?

A

YES

41
Q

What hormone does digoxin suppress in the kidneys?

A

Renin

42
Q

What 2 actions are seen when digoxin produces its effects on the vagus nerve?

A
  • decreased sympathetic outflow from CNS
    -increased sensitivity of cardiac baroreceptors
43
Q

Due to the vagotonic effects, what is the result that digoxin has on the SA and AV node?

A

decrease

44
Q

What is digoxin considered a positive or negative dromotropic agent?

A

Negative dromotropic

45
Q

What is the optimal therapeutic range for digoxin?

A

0.5-0.8 ng/mL

46
Q

If Digoxin toxicity occurs what drug should you administer?

A

Digibind (Fab Antibody Fragments)

47
Q

What is the most frequent CNS ADR effect of digoxin?

A

Fatigue

48
Q

What effects on vision does digoxin have?

A

Yellow-tinge to their vision and/or seeing halos around dark objects

49
Q

What should you teach a pt while taking digoxin?

A

teach pt how to take their pulse rate. Hold the drug if it falls below 60 bpm

50
Q

What is the use of a loading dose to achieve therapeutic plasma levels quickly?

A

Digitalization

51
Q

Does digoxin have a short or long half life?

A

Long

52
Q

How many days does digoxin reach a steady state if a loading dose were not administered?

A

6 days

53
Q

nesiritide causes a _____ in preload and afterload

A

reduction

Pharm (11 decks)

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