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Pharm 225A > MI/CHF Drugs > Flashcards

MI/CHF Drugs Flashcards

1
Q

ACE-Is in CHF Effect/Use

A
  • blocks conversion of Angiotensin I to II; venous dilation –> decreased afterload
  • for pt’s with HF, EF <40% to improve symptoms/increase survival
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2
Q

ACE-Is in CHF Monitoring

A
  • renal function
  • hyperkalemia
  • hypotension
  • dry cough
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3
Q

ACE-Is contraindications

A
  • angioedema
  • pregnancy
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4
Q

ACE-Is drug examples

A

Lisinopril, Enalapril, Ramipril

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5
Q

ARBs in CHF effect/use

A
  • blocks angiotensin II effects
  • for pt’s with HF, EF <40% to improve symptoms/increase survival
  • alternative to ACEs
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6
Q

Considerations of ARBs

A
  • no bradykinin accumilation –> no cough
  • angioedema in cross-sensitivity
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7
Q

ARBs monitoring

A
  • renal function
  • hyperkalemia
  • hypotension
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8
Q

ARBs drug examples

A
  • losartan
  • valsartan
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9
Q

Angiotensin receptor neprilysin inhibitor (ARNI) in CHF effects

A
  • blocks RAAS system/neprilsyin –> increases natriuretic peptides
  • decreases cardiac hypertrophy and promotes diuresis
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10
Q

ARNI drug/use

A
  • Entresto (valsartan/sacubitril)
  • used for stage C-D
  • in place of ACE/ARB if persistent exacerbation
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11
Q

ARNI Monitoring

A
  • renal function
  • hypotension
  • angioedema
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11
Q

ARNI contraindications

A
  • do not use with ACE-I –> can cause angioedema
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12
Q

Beta Blockers in CHF effect/use

A
  • decrease SNS activation –> decreases HR and contractility
  • asymptomatic EF <40%
  • symptomatic of condition is not worsening
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13
Q

Beta blockers monitoring

A
  • hypotension
  • worsening HF
  • bradycardia
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14
Q

Beta blockers contraindications

A
  • symptomatic bradycardia
  • severe reactive airway disease
  • acute decompensation
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15
Q

Beta blocker drug examples

A
  • Metoprolol tartrate
  • metoprolol succinate
  • carvedilol, labetolol, atenolol
16
Q

Loop diuretics in CHF effect/use

A
  • reduces pulmonary congestion and peripheral edema by decreasing preload
  • admin based on symptoms/daily body weight
17
Q

Loop diuretics considerations

A
  • maintains effect in renal dysfunction
  • dietary sodium intake, NSAIDs
18
Q

Loop diuretics monitoring

A
  • volume depletion –> hypotension
  • electrolyte abnormalities
  • ototoxicity
19
Q

Loop diuretics drugs

A
  • furosemide/lasix
  • bumetanide
20
Q

aldosterone antagonist effect/use

A
  • blocks aldosterone receptors –> decreases preload/afterload and remodeling (potassium sparing)
  • EF </= 35%; symptomatic stage C-D
21
Q

aldosterone antagonist monitoring

A
  • renal function
  • hyperkalemia (d/c potassium supplements)
  • breast tenderness or enlargement
22
Q

aldosterone antagonist drugs

A
  • spironolactone
  • eplerenone
23
Q

Nitrates and Hydralazine Effect/goal

A
  • increase in nitric oxide (vasodilation) & increases cardiac output/stroke volume
  • symptomatic, EF </= 40%
24
Q

Nitrates and Hydralazine monitoring

A
  • hypotension
  • avoid with phosphodiesterase inhibitor (ex. sildenafil aka Viagra)
25
Q

Digoxin effect/use

A
  • PO/IV
  • increases intracellular sodium; reduces calcium transport out; increases contractility
  • symptomatic, EF </= 40%
  • does not reduce mortality
26
Q

monitoring digoxin

A
  • narrow therapeutic level, high toxicity risk –> early signs: N/V, bradycardia
  • monitor electrolytes (antagonistic for K+)
27
Q

Ivabradine class/MoA/Use

A
  • PO
  • sinoatrial node modulator
  • provides HR reduction without loss of contractility
  • EF <35% if BBs stop working; reduced risk of death
28
Q

Ivabradine contraindications

A
  • sinus node dysfunction
  • not in combo with verapamil or diltiazem
  • not in combo with CYP3A4 inhibitiors (ex. -azole antifungals)
29
Q

Ivabradine AEs

A
  • luminous phenomena
  • bradycardia
  • headaches
  • dizziness
  • blurred vision
30
Q

Meds for acute decompensated heart failure (ADHF)

A
  • milrinone
  • amrinone
  • dobutamine

*all IV

31
Q

Milrinone/amrinone MoA

A
  • increases inward Ca –> higher contractility
  • increased vasodilation
32
Q

Dobutamine MoA

A
  • Beta 1 selectivity
  • increased mortality; only use for short term to support BP
33
Q

Nesiritide

A
  • recombinant form of endogenous BNP; IV
  • vasodilation, decreased venous/arterial tone; increased diuresis
  • used in addition to standard ADHF care
34
Q

Sodium glucose co-transporter 2 (SGLT2) inhibitor MoA/route/indications

A
  • prevent renal reabsorption of glucose and increase urinary excretion of glucose
  • PO
  • used in T2DM and CHF to reduce death
35
Q

SGLT2 inhibitor AEs

A
  • hypoglycemia
  • female genital mycotic infections, UTIs and increased urination
  • ketoacidosis
  • acute kidney injury
36
Q

SGLT2 inhibitor drugs

A
  • CanaGLIFLOZIN
  • EmpaGLIFLOZIN
  • DapaGLIFLOZIN

Pharm 225A (7 decks)

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