Cardiac 2 drugs

Question 1

Drugs to manage heart failure

Answer 1

Diuretics
Inhibitors of RAAS
Beta-Adrenergic Blockers
Cardiac Glycosides
SGLT-2 Inhibitors

Question 2

Drugs to manage dysrhythmias

Answer 2

Beta-Adrenergic Blockers
Calcium Channel Blockers
Potassium Channel Blockers

Question 3

Definition of heart failure

Answer 3

Syndrome in which the heart is unable to pump sufficient blood to meet metabolic needs of tissue

Question 4

What is heart failure characterized by?

Answer 4

Inadequate tissue perfusion (fatigue, SOB, exercise intolerance)
Volume overload (venous distension, peripheral/ pulmonary edema)

Question 5

General objectives when treating heart failure

Answer 5

1. Identification of underlying cause
2. Correct Na and water retention & volume overload
3. Reduce cardiac workload
4. Improve myocardial contractility

Question 6

What is the most effective diuretic?

Answer 6

Furosemide (Lasix)

Question 7

MOA of furosemide (Lasix)

Answer 7

Acts on loop of Henle to block reabsorption of Na and Cl, preventing passive reabsorption of water

Question 8

Indications for furosemide (Lasix)

Answer 8

Situations that require rapid or massive removal of fluid ex. pulmonary edema, edema of hepatic, cardiac, or renal cause, HTN

Question 9

Adverse effects of furosemide (Lasix)

Answer 9

Hyponatremia, hypochloremia, dehydration, dry mouth, thirst, oliguria, excessive weight loss, hypotension, hypokalemia, otoxotoxicity

Question 10

Hydrochlorothiazide MOA

Answer 10

Blocks reabsorption of Na and Cl in distal convoluted tubule, causing water to be retained. Maximum diuresis considerably lower than loop diuretics

Question 11

Indications for hydrochlorothiazide

Answer 11

Hypertension, edema (mild to moderate HF)

Question 12

Hydrochlorothiazide adverse effects

Answer 12

dehydration*, dry mouth, thirst, oliguria, excessive weight loss,

Question 13

Spironolactone MOA

Answer 13

Blocks actions of aldosterone in distal nephron. Maximum diuresis considerably lower than loop and thiazide diuretics. Delayed effect up to 48 hours

Question 14

Spironolactone indication

Answer 14

Hypertension, edema, HF (decreased mortality)

Question 15

Spironolactone adverse effects

Answer 15

Hyperkalemia (never use if K > 5, caution with ACE inhibitors, ARBS), can have endocrine effects (gynecomastia, impotence, menstrual irregularities)

Question 16

Results of using diuretics

Answer 16

Lowers blood volume
Results in:
Lowered preload (venous pressure)
Lowered pulmonary edema
Lowered peripheral edema

Question 17

Big idea of ACE inhibitor Captopril

Answer 17

Work on RAAS
Decreases BP (monitor)
Can cause K retention (monitor)
Side effects: cough/ angioedema

Question 18

Results from Captopril

Answer 18

Vasodilation, lowered blood volume, lowered cardiac remodeling

Question 19

Big idea of using Angiotensin II receptor blockers Losartan (Cozaar)

Answer 19

Works on RAAS (different than ACE)
Lowers BP (monitor)
S/E: angioedema
Doesn’t cause cough as frequently as ACE
2nd line of drug for HF

Question 20

Angiotensin receptor neprilysin inhibitor drug example

Answer 20

Sacubitril/ Valsartan (Entresto)

Question 21

Sacubitril/ Valsartan (Entresto) MOA

Answer 21

Sacubitril - inhibits neprilysin leading to increased natriuretic peptides; induces vasodilation and natriuresis. Valsartan - ARB

Question 22

Sacubitril/ Valsartan (Entresto) big idea

Answer 22

Combo drug
Lowers blood pressure
Watch for dehydration and electrolyte imbalance, renal failure

Question 23

Metoprolol (Lopressor) SR (Sustained release) big idea

Answer 23

Slows heart rate, decreases BP, decreases contractility (less work for the heart) *If you slow the heart too much can tip into heart failure when CO drops below metabolic demands

Question 24

Adverse effects of metoprolol (Lopressor)

Answer 24

Hypotension, dizziness, signs of HF (dyspnea, crackles, weight gain, peripheral edema)

Question 25

Drug example of cardiac glycosides

Answer 25

Digoxin

Question 26

Digoxin big idea

Answer 26

Increased force of contraction, decreased heart rate SE: dysrhythmias (esp with decreased K, bradycardia, hypotension, GI disturbances)

Question 27

Metoprolol (Lopressor) & Diltiazem MOA

Answer 27

Decreases movement of Ca into cells

Question 28

Metoprolol (Lopressor) & Diltiazem results

Answer 28

Decreased contractility, decreased AV conduction, decreased automaticity in SA node

Question 29

Indication for metoprolol (Lopressor) & Diltiazem

Answer 29

Afib

Question 30

Potassium channel blocker drug example

Answer 30

Amiodarone

Question 31

Amiodarone MOA

Answer 31

Prolongs the effective refractory period (ERP is time during which cell is unable to respond to excitation and to initiate a new action potential)

Question 32

Amiodarone additional cardiac effects

Answer 32

Decreased SA automaticity, decreased contractility, decreased AV conduction

Question 33

Amiodarone adverse effects

Answer 33

Increased arrhythmias, pulmonary toxicity, thyroid toxicity, liver toxicity

Question 34

Antidysrhythmic summary

Answer 34

These 2 drug BB, CCB, Amio all slow the movement of ions through gated channels in cardiac cells. This has the overall effect of slowing conduction which is helpful in controlling or converting arrhythmias. Risk for blood clots (Warfarin & Apixaban are used). Amio has unique side effects