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DT3- EXAM 1 > CHF Drugs- Leah (3)* > Flashcards

CHF Drugs- Leah (3)* Flashcards

1
Q

Five general classes of drugs to treat CHF

A 
Vasodilators 
B blockers 
Diuretics 
\+ Ionotropic drugs 
ACEi/ARBs
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2
Q

What are two types of CHF?

Which is treated with standard drug therapy ?

A
  • CHF with preserved or reduced ejection fraction

- most drugs treat with reduced ejection fraction

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3
Q
  1. What is the main “physiologic” problem in CHF w/ reduced EF?
  2. What are secondary problems?
A
  1. Reduced CO
  2. Reduced CO activates compensatory mechanisms–> ^ preload (good), edema, congestion–> hypertrophy
  • Mechanisms include sympathetics and RAAS
  • Must treat this along with reduced EF*
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4
Q

What are the two main goals of CHF treatment?

A
  1. increase cardiac output

2. decrease negative effects of compensatory mechanisms

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5
Q

In the normal heart, which has greater effect on stroke volume: preload or afterload?

What effect does ^ TPR (^ afterload) have on CO in the normal heart?

A
  • Preload has higher effect than afterload in the normal heart (as in during exercise).
  • Increases return of blood to heart = ^ output

*Increasing TPR does NOT dangerously reduce CO in the normal heart (as occurs during fight or flight)

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6
Q

In the diseased heart, which has greater effect on stroke volume: preload or afterload?

In the CHF heart, what effect does ^ TPR
(^ after load) have on CO?

A
  • In CHF, increasing preload will NOT effectively increase cardiac output
  • Heart can’t pump well, no matter how much blood it gets.
  • Increasing afterload/ peripheral resistance can dramatically decrease CO.
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7
Q

Effect of arterial dilation in CHF?

A

DECREASE afterload–> ^SV –> ^ CO + DECREASE compensatory mechanisms (somewhat)

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8
Q

Effect of venous dilation in CHF (2)?

A
  • DECREASE preload/ LVEDV/ SV/ CO

- DECREASES negative compensatory effects, like congestion, edema, and hypertrophy

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9
Q

What are the vasodilators for treating CHF?

7 classes

A
  1. nitroprusside
  2. nitrates
  3. hydralazine
  4. ACEi
  5. ARBs
  6. Nesiritide
  7. PDEi (both cardiac and vascular effects)
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10
Q

Of the vasodilators, which are only used for IV treatment of ACUTE CHF exacerbation? (3/7)

A
  • nitroprusside
  • nesiritide
  • PDEi
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11
Q

Of the vasodilators, which are used for chronic treatment of CHF? (4/7)

A
  • nitrates (remember tolerance here!)
  • ACEi
  • ARBs
  • Hydralazine
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12
Q

Of the vasodilators, which predominanty dilate arteries? (3/7)

A
  • hydralazine
  • ACEi
  • ARBs
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13
Q

Of the vasodilators, which predominately dilates the venous system? (1)

A

NITRATES effect mostly VEINS

  • Only dilate arteries at very high concentrations
  • this was a step prep question.
  • **MOA for NG is NOT dilation of coronary arteries!!!!!*
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14
Q

Of the vasodilators, which dilate both the venous and arterial system (3)?

A

-nitroprusside (equal effects on vv’s, aa’s)
-nesiritide
-PDEi
(same drugs that are only used acutely the drugs that effect both arteries and veins)

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15
Q

What is the first line vasodilator for CHRONIC CHF?

Second choice?

A
  • 1st choice is ACEi’s
  • All CHF patients that can tolerate ACEi’s take them.
  • 2nd choice = ARBs
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16
Q

Special consideration when treating CHF in African Americans?

A

-Many do not respond to ACEi’s, ARBS, BBs, or aldosterone blockers alone.
-They will often need combination therapy.
*Commonly the combo therapy is Hydralazine/ ISDN
(This was one of the CHF quiz questions.)

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17
Q

How does nesiritide (vasodilator) work?

A
  • Recombinant BNP (naturitic peptide)

- Activates PARTICULATE guanylyl cyclase/ ^cGMP –> Arterial + venous dilation

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18
Q

How do phosphodiesterase inhibitors (type 3) work to treat acute CHF?

A

Inhib PDE-III–>DECREASE cAMP breakdown (^cAMP)

  1. ++cardiac contractility (^CO)
  2. Arterial and venous dilation

*Note: Type FIVE PDEi’s reduce cGMP breakdown/ keep the penis “filled” (The -afil drugs are type 5.)

19
Q

What are the two PDEi inhibitors on the market?

Which is most commonly used?

A
  • Milronone (most commonly used)
  • Inamironone
  • ONE* They are the “ONEs” used today.
  • “ONE” =3letters—> PDEi type 3
20
Q

Why aren’t PDEi good for chronic use? (2)

A
  • proarrhythmic = QT ^^

- cause hypotension

21
Q

What are three B blockers used in the treatment of CHF?

A
  • metoprolol
  • bisoprolol
  • carvedilol

(MEet me at the BIStro and bring the CAR. I can’t walk home because of my CHF!)

22
Q

How do B blockers improve the outcome of CHF? (3)

A
  • prevent remodeling (by decreasing NE/catecholamine)
  • decrease O2 demand
  • prevent arrhythmias
23
Q

Special consideration when starting a patient on a B blocker for CHF (2)?

A

Dose must be gradually titrated; CHF must be compensated

Never give B blocker to someone with a really low EF.

24
Q

Digoxin: MOA

This was an Rx question

A

Inhibits Na-K ATPase–> Inhibit Na/Ca XGE–>
- ^ intracellular Na+ and Ca++
- ^ serum K+
(normal function of Na-K = K+ in, Na+ out)

25
Q

How does dignoxin effect the SA node, AV node? contractility? CHF compensatory mechanisms?

A
  1. Vagomimetic: DECREASE AV/SA node rates
    (possible AV block at high dose)
    *This is because Na/ K block decreases extracellular Na, which is needed for nodal depolarization.
  2. INCREASES contractility
    * This is because decreasing extracellular Na prevents Na/Ca exchange to ^^ Ca levels.
  3. DECREASES compensatory mechanisms (via ^ cntrxn)
26
Q

Two important kinetic issues to remember with digoxin?

A

-You HAVE to renal adjust
“DI-d you renally adjust for DIgoxin?”
-Incomplete absorption; various generics have failed for this reason.

27
Q

Aside from CHF, for what reasons might digoxin be used therapeutically?

A

-Decrease V-rate in Afib/flutter

28
Q

What are 4 of the symptoms of digoxin toxicity?

Rx question!

A

1: GI upset

  1. Arrhythmias
  2. CNS effects: delirium, hallucination, etc.
  3. Visual: GREEN-YELLOW Halos

“DIGO: Delirium, I(eye), GI upset, Out-of-control heart”

29
Q

Under what 4 conditions is digoxin toxicity most likely?

A
  1. HYPOKALEMIA
    (You’re preventing the entry of K+ into the cell, add a lack of potassium to this, and you are in trouble!)
  2. HYPERCALCEMIA (You’re adding Ca to cells with digoxin, giving extra = bad)
  3. RENAL/ THYROID FAILURE (renally excreted)
  4. ACIDOSIS (Acidosis inhibits Na/K channels.)
30
Q

Treatment of Digoxin toxicity? (4)

Rx question, they like digoxin. Better know it cold.

A
  1. Reduce absorption (ex: give resin)
  2. give K +/ Mg (cofactor for Na/K pump)
  3. Give digoxin antibodies (Fab-Ab-Dig)
  4. Anti-arrhythmics (Lidocaine, Atropine)
31
Q

Two drug classes that may compound/ increase digoxins effects?

A

K+ wasting diuretics; sympathomimetics

32
Q

Drug class that may decrease digoxins effects?

A

resins, prevent absorption

Good to know in case of toxicity

33
Q

Aside from digoxin, what are two other + ionotropic drugs?

A
  1. dobutamine
  2. dopamine

(all three positive ionotropic drugs are “d” drugs)

34
Q

For what are dobutamine and dopamine used?

A

IV for acute CHF

35
Q

How does dobutamine effect the heart/ MOA?

A

increases contractility (beta 1 agonist)

36
Q

How does dopamine effect the heart? (2)

A
  1. vasodilates

2. increases contractility (beta 1 agonist)

37
Q

What diuretics are used to treat CHF? (3)

A

thiazide/ loops +/- K sparing adjunct

38
Q

When and why are K + sparing diuretics added to thiazide/ loop diuretic regimens?

A

-Prevent Hypokalemia and therefore arrhythmias esp when also taking digoxin.

39
Q

Risk of K-sparing Diuretics w/ ACEi’s (ARBs)?

A

HYPERkalemia (Remember ACEi stops Aldo–> ^K)

40
Q

Which drug causes Gynecomastia/ Menstrual Irreg?

A

Spironolactone

41
Q

DD toxicity w/ Thiazides and Loop Diuretics; why?

A

Digoxin–due to potential K+ depletion

42
Q

6 Thiazides/ related drugs

A
  1. Hydrochlorothiazide
  2. Chlorothiazide
  3. Polythiazide
  4. Chlorothalidone
  5. Indapamide*
  6. Metolazone*
43
Q

4 Loop Diuretics

A
  1. Furosemide
  2. Bumetanide
  3. Torsemide
  4. Ethacrynic Acid (EA)– NOT a Sulfadrug!

“FURuity LOOPs BUMp TOgether in my cerEAl”

44
Q

Do Venodilators or diuretics have an effect on SV in patients with CHF?

A

No they only help clear congestive symptoms in CHF patients

DT3- EXAM 1 (26 decks)

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