Anti- CHF drugs Flashcards Preview

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Flashcards in Anti- CHF drugs Deck (18):
1

Drugs in the acute CHF toolkit

Diuretics
Vasodilators
Inotropes
Morphine

2

Preferred diuretic for acute CHF and physiologic action

-furosemide (Lasix) (loop diuretic)
-lowers central venous pressure, clears up pulmonary edema

3

Vasodilators that can be used for CHF, physiological action and when to avoid

-nitroglycerin
-nitroprusside
-nesiritide

** all decrease preload by venodilation**
**avoid with pts who have low BP**

4

Inotropes and when to use

Dobutamine (B1 and B2 agonist)
Milrinone

**use with patients that have low BP**

5

Vasopressors and when to use

-dopamine
-norepinephrine

**use with patients that have low BP*

6

Actions of morphine on acute CHF

-depresses respiratory centre
-reduces anxiety
-arteriolar and venous dilation

7

Drugs with proven mortality reduction in chronic HF management? Drugs without proven mortality reduction?

-ACEi and B-blockers have proven mortality reduction

-digoxin and diuretics don't and their use should be guided by symptoms

8

All patients with CHF and EF<40% should be treated with...

A B-blocker and ACEi

-start with ACEi, titrate up then add B- blocker

9

ACEi physiologic effects

-vaso and venodilation (AT1 receptor and presence of bradykinin)
- antihypertrophic

10

Clinical course when initiating B-blockers

- Clinical deterioration for 1-2 months then improvement over the next year.

11

B-blocker physiologic effects

- improve EF
-reduce LV size

12

When not to give B-blockers

-symptomatic hypotension
-bradycardia
-significant AV block
-severe asthma

13

When to use ARBs for CHF

- if ACEi is not tolerate
- it doesn't reduce mortality and is not equivalent to ACEi

14

Aldosterone antagonists used in CHF, and when to use and how much to use

-spironolactone, eplerenone
-use when the pt is still symptomatic and is on B-blockers and an ACEi (NYHA II, III)
-Use the lowest dose possible

15

When to use digoxin? Physiologic action

when pt is symptomatic
-digoxin increases contractility ( therefore SV)

16

Vasodilators that can be used in chronic CHF

-nitrates can help nocturnal symptoms and exercise tolerance
-nitrates + hydralazine often used for african-americans

17

When to use ASA in chronic CHF management?

- in CAD +CHF

18

When to use anticoagulants in chronic CHF management?

- If there is AFib, thrombus or severe LV dysfunction on echo