CVS Drugs Part 2 HTN and HF Flashcards
Treatment of HTN and HF (193 cards)
1
Q
Thiazides MOA
A
inhibit sodium, potassium, and chloride reabsorption in the distal tubule resulting in mild diuresis (sodium and water excretion)
2
Q
Thiazides most commonly used for primary HTN
A
hydrochlorothiazide (HCTZ) and chlorthalidone
3
Q
HCTZ clinical indications
A
ideal starting agent for HTN, chronic edema or idiopathic hypercalciuria and can also be used to treat kidney stones and Meniere’s Disease
4
Q
HCTZ adverse effects
A
hypokalemia, hyperuricemia (gout), hyperglycemia, hypotension, hyponatremia, and hypercalcemia
5
Q
Thiazide contraindications
A
patients with a history of gout or hypercalcemia, pregnant women, anuria
6
Q
HCTZ pharmacokinetics
A
administered orally and absorbed rapidly, eliminated primarily unchanged
7
Q
HCTZ drug interactions
A
can increase the toxicity of digitalis and lithium and can cause significant hypokalemia if given with corticosteroids or ACTH
8
Q
Chlorthalidone pharmacokinetics
A
only thiazide that is available in IV form, is structurally different from most thiazides, and has a long half life
9
Q
Metolazone pharmacokinetics
A
structurally different from other thiazides and 10 times more potent than HCTZ, excreted unchanged in urine
10
Q
Metolazone clinical indications
A
often used together with loop diuretics for the treatment of excess fluid (edema) in heart failure, safe to use in patients with renal insufficiency
11
Q
Indapamide pharmacokinetics
A
undergoes hepatic metabolism and is excreted in both urine and bile
12
Q
Indapamide clinical indications
A
uncommonly used but can treat hypertension and decompensated heart failure
13
Q
Loop diuretics MOA
A
inhibits reabsorption of Cl-, Na+, K+, Ca2+, Mg2+, and HCO3- in the ascending loop on Henle resulting in loss of sodium, water, and high potassium in urine (more powerful diuretics than thiazides) leading to decreased preload and afterload
14
Q
Loop diuretics
A
Furosemide, Bumetanide, and Torsemide
15
Q
Loop diuretics adverse effects
A
hypokalemia, DEHYDRATION, DOSE-DEPENDENT OTOTOXICITY, hyponatremia, hypomagnesemia, hypotension, hyperuricemia (gout), and hyperglycemia
16
Q
Furosemide clinical indications
A
preferred for treating hypertension in patients with low GFR (renal failure) and in hypertensive emergencies, also can treat peripheral edema in heart failure, decompensated cirrhosis, and acute pulmonary edema (limited mortality benefit)
17
Q
Furosemide drug interactions
A
increases toxicity of ototoxic and nephrotoxic drugs and lithium, inhibited efficacy with probenecid and indomethacin, use caution in patients with sulfa antibiotic allergy as this is a sulfonamide-based med
18
Q
Bumetanide clinical indications
A
most potent loop diuretic with the same clinical indications as Furosemide
19
Q
Bumetanide adverse effects
A
large doses may cause severe myalgias, no ototoxicity, use caution in patients with sulfa antibiotic allergy as this is a sulfonamide-based med
20
Q
Torsemide adverse effects
A
headache and dizziness
21
Q
Potassium-sparing diuretics MOA
A
inhibit potassium secretion and sodium reabsorption in the distal tubule resulting in reduced potassium loss in the urine
22
Q
Potassium-sparing diuretics
A
Amiloride, Spironolactone, Triamterene, and Eplerenone
23
Q
Spironolactone MOA
A
aldosterone receptor antagonist that prevents sodium reabsorption and potassium excretion and androgen receptor blocker that inhibits androgen biosynthesis (conversion of androstenedione to testosterone)
24
Q
Spironolactone clinical indications
A
can be co-prescribed with thiazides to treat edema in heart failure, ascites/cirrhosis, and nephrotic syndrome; resistant hypertension and primary hyperaldosteronism (secondary cause of HTN); acne and hirsutism
25
Spironolactone adverse effects
gynecomastia and increased risk for digitalis toxicity when co-administered, hyperkalemia, anuria, hypovolemia, hypertriglyceridemia, renal dysfunction/failure
26
Eplerenone MOA
aldosterone receptor antagonist that prevents sodium reabsorption and potassium excretion
27
Eplerenone clinical indications
used to treat edema in heart failure, resistant hypertension, and primary hyperaldosteronism
28
Eplerenone adverse effects
hyperkalemia, anuria, hypovolemia, hypertriglyceridemia, renal dysfunction/failure, less risk for gynecomastia than spironolactone
29
Amiloride MOA
distal tubule sodium channel inhibitor that directly increases sodium excretion and decreases potassium excretion in the urine
30
Amiloride clinical indications
3rd or 4th line agent to treat hypertension or heart failure specifically to compensate for potassium loss by other diuretics and can also be used to treat ascites and polyuria/polydipsia due to lithium-induced nephrogenic diabetes insipidus
31
Amiloride pharmacokinetics
more rapid onset than spironolactone
32
Triamterene MOA
distal tubule sodium channel inhibitor that directly increases sodium excretion and decreases potassium excretion in the urine
33
Triamterene clinical indications
typically paired with a thiazide to treat hypertension and also can be used to treat edema from various causes
34
Triamterene adverse effects
may turn urine blue, cause crystalluria and cast formation, and decrease renal blood flow (use caution in patients with renal disease)
35
Acetazolamide MOA
inhibits carbonic anhydrase in the proximal renal tubule promoting renal excretion of sodium, potassium, bicarbonate, and water
36
Acetazolamide adverse effects
metabolic acidosis, kidney stones, hyperammonemia in cirrhotic patients,
37
Acetazolamide clinical indications
used in prophylaxis for altitude sickness and in the treatment of open-angle glaucoma, less effective than thiazide or loop diuretics and used more commonly for its pharmacologic actions other than its diuretic effect
38
Acetazolamide pharmacokinetics
administered orally or IV, 90% protein-bound and eliminated renally, use caution in patients with sulfa antibiotic allergy as this is a sulfonamide-based med
39
Mannitol MOA
osmotic diuretic that promotes diuresis in the kidney by increasing the concentration of filtrates in the kidney and inhibiting the reabsorption of water in the proximal renal tubule and the glomerulus
40
Mannitol adverse effects
headache, nausea, dizziness, polydipsia, confusion, and chest pain, and may initially increase central venous pressure (BP) and induce heart failure in susceptible patients
41
Mannitol clinical indications
administered IV only and used to decrease intraocular pressure in glaucoma and decrease intracranial pressure, can also be used to increase lithium excretion in states of lithium toxicity
42
Mannitol contraindications
heart failure and pulmonary edema
43
Treatment of acute hypercalcemic crisis
immediate treatment with Furosemide (Lasix) and saline rehydration to achieve urine output of 200 mL/hr
44
Calcium levels indicative of acute hypercalcemic crisis
calcium levels greater than 14 mg/dL or calcium levels greater than 12 mg/dL in symptomatic patient
45
Symptoms of acute hypercalcemic crisis
hypertension, vascular calcification, shortened QT interval on ECG, impaired concentration, confusion, fatigue, muscle weakness, nausea, abdominal pain, anorexia, constipation, pancreatitis, polydipsia/polyuria resulting from nephrogenic diabetes insipidus, and nephrolithiasis resulting from hypercalciuria
46
Nephrogenic diabetes insipidus
disease process where the kidneys have partial or complete resistance to the effects of antidiuretic hormone (vasopressin) resulting in the excretion of large amounts of diluted urine, it is often hereditary but also can be caused by drugs (lithium, amphotericin B, ofloxacin, orlistat) or other disorders
47
Treatment of nephrogenic diabetes insipidus
Hydrochlorothiazide alone or in combination with other drugs such as Amiloride ( helps maintain potassium level), for some patients a low sodium and low protein diet is suggested
48
ACE inhibitors MOA
suppress the synthesis of angiotensin II and release of aldosterone from adrenals resulting in natriuresis (decreased preload) and decreased peripheral vascular resistance - vasoconstriction (decreased afterload)
49
ACE inhibitors
enalapril, captopril, and lisinopril
50
ACE inhibitors clinical indications/advantages
first-line treatment of HTN in patients with high coronary artery disease (CAD) risk, diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease - preferred in patients with diabetic nephropathy because they are renoprotective (stabilize renal function) and blood glucose levels are not impacted significantly
51
ACE inhibitors adverse effects
first dose hypotension, dizziness, proteinuria, rash, tachycardia, hyperkalemia, headache, cough, and angioedema
52
Enalapril pharmackinetics
administered oral or IV where the oral form is a prodrug that is converted to active form intestinally - enalaprilat
53
Captopril adverse effects
agranulocytosis or neutropenia - not common first line agent
54
Enalapril clinical indications
used to treat heart failure, hypertension, and diabetic kidney disease
55
Lisinopril clinical indications
used to treat hypertension and heart failure and also helps slow down the progression of diabetic kidney disease
56
Lisinopril pharmacokinetics
not a prodrug
57
Lisinopril adverse effects
side effects of all ACE inhibitors and can also cause some lowering of blood glucose
58
ARB MOA
antagonist at angiotensin II receptors in vascular smooth muscle that produce arteriolar and venous dilation and block aldosterone secretion
59
ARB advantages
have been shown to help slow the effects of diabetic neuropathy
60
ARB adverse effects
dry cough, hyperkalemia, skin rash, hypotension, and altered taste
61
ARBs
Losartan, Valsartan, Candesartan, Olmesartan
62
Losartan pharmacokinetics
administered once daily and undergoes extensive first-pass metabolism converting it to an active metabolite
63
Losartan clinical indications
treatment of HTN (especially in patients with LVH) and diabetic neuropathy, lowers serum uric acid levels, reduces chance of stroke
64
Valsartan pharmacokinetics
administered twice daily and metabolized to inactive metabolites
65
Valsartan clinical indications
treatment of HTN, the first ARB approved for the treatment of heart failure
66
Candesartan pharmacokinetics
administered once daily and metabolized to inactive metabolites
67
Olmesartan pharmacokinetics
administered once daily and metabolized to inactive metabolites
68
Olmesartan clinical indication
used to significantly reduce mean blood pressure
69
Aliskiren MOA
inhibits renin which prevents the conversion of angiotensinogen to angiotensin I, acting early in the RAAS
70
Aliskiren clinical indication
treatment of HTN
71
Aliskiren adverse effects
diarrhea, cough, angioedema
72
Aliskiren pharmacokinetics
metabolized by CYP3A4 so there is potential for many drug interactions
73
Aliskiren contraindications
pregnancy
74
Ambrisentan MOA
selective type A endothelin receptor antagonist
75
Bosentan MOA
nonselective endothelin receptor antagonist
76
Ambrisentan clinical indications
used alone or in combination with tadalafil in the treatment of pulmonary arterial hypertension (PAH) to improve exercise ability and delay clinical worsening of PAH
77
Ambrisentan adverse effects
edema, nasal congestion, palpitations, abdominal pain, constipation
78
Bosentan clinical indications
treatment of pulmonary arterial hypertension (PAH) to improve exercise capacity and delay clinical worsening of PAH, also can be used to reduce digital ulceration in patients with scleroderma
79
ACE inhibitors and ARBs contraindications
pregnancy
80
Phenoxybenzamine MOA
irreversible noncompetitive inhibitor of peripheral alpha 1 and alpha 2 adrenergic receptors (nonselective)
81
Phenoxybenzamine clinical indications
used in the treatment of sweating and HTN associated with pheochromocytoma, effectiveness limited due to reflex tachycardia
82
Phentolamine MOA
reversible nonselective competitive inhibitor of alpha 1 and 2 receptors resulting in potent vasodilation
83
Phentolamine clinical indications
used short-term to treat hypertensive emergencies associated with pheochromocytoma, abrupt withdrawal of clonidine, or ingestion of tyramine-containing foods in patients on MAOIs, also can be used to prevent dermal necrosis following extravasation of norepinephrine
84
Phentolamine pharmacokinetics
administered parentally and effects last approximately 4 hours
85
Prazosin MOA
selective inhibitor of alpha 1 receptors causing vasodilation and resulting in decreased peripheral vascular resistance and blood pressure by relaxation of both arterial and venous smooth muscle
86
Prazosin clinical indications
treatment of BPH due to relaxation of urethral and prostate muscles and also can be used in treatment of PTSD-associated nightmares
87
Prazosin adverse effects
orthostatic hypotension, dizziness, lack of energy, nasal congestion, headache, drowsiness
88
Doxazosin
longest-acting selective alpha 1 receptor inhibitor with similar indications to Prazosin
89
Propranolol clinical indications
used to treat performance anxiety, postural tremor, migraine prevention, thyrotoxicosis, and portal hypertension - does not reduce blood pressure in normotensive patients making it very useful for other things (does not have much anti-hypertensive potency compared to other beta blockers)
90
Propranolol adverse effects
depression, dizziness, fatigue, weakness, hallucinations, short term memory loss, vivid dreams, and visual disturbances
91
Nadolol clinical indications
approved for treatment of HTN and management of chronic (stable) angina but rarely used in practice
92
Nadolol half-life
more potent than propranolol and has half-life of 14-24 hours
93
Pindolol MOA
Nonselective beta blocker with partial agonist sympathomimetic activity at high doses causing limited epinephrine-like effects such as increased heart rate, blood pressure, and bronchodilation
94
Pindolol contraindications
patients with prior MI or angina due to sympathomimetic effects
95
Pindolol clinical indications
used to treat HTN only
96
Pindolol half-life
3-4 hours
97
Timolol clinical indications
primarily used in ophthalmic solution form to treat open-angle glaucoma and reduce the production of aqueous humor in the eye, can be used orally to treat HTN but not commonly used for this in the US
98
Timolol half-life
4-6 hours
99
Metoprolol MOA
cardioselective beta-1 receptor blocker that decreases heart rate, contractability, cardiac output, and blood pressure at rest and during exertion
100
Metoprolol clinical indications
used to treat HTN, angina, acute MI, supraventricular tachycardia, ventricular tachycardia, congestive heart failure, and prevention of migraine headaches
101
Metoprolol pharmacokinetics
extensively metabolized with half-life of 3-4 hours
102
Atenolol MOA
cardioselective beta-1 receptor blocker that decreases heart rate, contractability, cardiac output, and blood pressure at rest and during exertion
103
Atenolol clinical indications
has the same indication as metoprolol but is less effective at preventing complications of HTN
104
Atenolol pharmacokinetics
excreted primarily in urine with half-life of 6 hours
105
Nebivolol MOA
the most cardioselective beta-1 receptor blocker at low doses that loses some of that selectivity at higher doses, it also has a vasodilating effect in that it is nitric-oxide-potentiating and stimulates beta-3 receptors in peripheral vasculature
106
Nebivolol half-life
10-12 hours
107
Nebivolol clinical indications
used to treat HTN and heart failure
108
Carvedilol MOA
mixed alpha-1, beta-1, and beta-2 receptor blocker with more blood pressure-lowering potential than many other beta-blockers due to combined alpha and beta-adrenoceptor blocking activity
109
Labetalol MOA
mixed alpha-1, beta-1, and beta-2 receptor blocker with more blood pressure-lowering potential than many other beta-blockers due to combined alpha and beta-adrenoceptor blocking activity
110
Carvedilol clinical indications
used primarily to treat heart failure and to decrease mortality in patients after myocardial infarction (MI), commonly co-prescribed with ACE inhibitors and diuretics and used second line as an anti-hypertensive
111
Carvedilol pharmacokinetics
administered twice daily with half-life of 7-10 hours
112
Labetalol clinical indications
used to treat hypertension associated with pheochromocytoma and in hypertensive emergencies, considered safe in pregnancy, and often also used to manage hypertension in pre-eclampsia
113
Labetalol pharmacokinetics
administered orally, dosed up to 3 times per day, or in IV form which is advantageous for slow titration in the treatment of hypertensive emergencies
114
Lebatalol half-life
4-6 hours
115
Propranolol half-life
4-6 hours
116
Metoprolol half-life
3-4 hours
117
Verapamil MOA
non-dihydropyridine cardioselective calcium channel blocker with negative inotropic effect that decreases heart rate, slows AV conduction, and mainly affects the myocardium
118
Verapamil clinical indications
used to treat atrial tachycardias like atrial fibrillation
119
Verapamil contraindications
patients with sick sinus syndrome, AV nodal disease, and heart failure due to the potential of worsening heart failure and heart block
120
Diltiazem MOA
non-dihydropyridine cardioselective calcium channel blocker with negative inotropic effect that decreases heart rate, slows AV conduction, and mainly affects the myocardium
121
Diltiazem clinical indications
used mostly for its immediate anti-arrhythmic effects though can also lower blood pressure
122
Diltiazem contraindications
patients with sick sinus syndrome, AV nodal disease, and heart failure due to the potential of worsening heart failure and heart block
123
Nifedipine MOA
dihydropyridine vascular selective calcium channel blocker that is a potent vasodilator but has no effect on conduction through the AV node
124
Nifedipine clinical indications
long-acting form used to treat HTN, angina, and Raynaud's disease
125
Nifedipine adverse effects
increases heart rate and poses a risk for tachycardia and increased oxygen demand, peripheral dilatory effects can decrease coronary perfusion
126
Amlodipine MOA
dihydropyridine vascular selective calcium channel blocker that is a potent vasodilator but has no effect on conduction through the AV node
127
Amlodipine clinical indications
used commonly to treat HTN
128
Amlodipine contraindications
patients with heart failure
129
Benefits of co-prescribing CCBs and ARBs
they complement each other's functions where CCBs increase sympathetic nervous system and renin-angiotensin activity and ARBs decrease sympathetic nervous system and renin-angiotensin activity
130
Nitroglycerin MOA
venous vasodilator that is converted to nitric oxide in the body
131
Nitroglycerin clinical indications
used to treat chronic angina and severe HTN
132
Nitroglycerin pharmacokinetics
administered sublingually usually but can also be administered through IV, ointment, or a patch forms - has short half-life and broken down by the liver
133
Isosorbide dinitrate MOA
a nitrate which is a venous vasodilator that causes release of nitric oxide in the body when metabolized
134
Isosorbide clinical indications
used in prophylaxis of acute angina and esophageal spasm, also used together with hydralazine in the treatment of heart failure in black patients
135
Isosorbide pharmacokinetics
administered sublingually or as an immediate-release tablet with sublingual administration having a quicker onset of action - 2-5 minutes but shorter duration of action - 1-2 hours (risk for tolerance if taken daily)
136
Hydralazine MOA
arterial vasodilator thought to cause the release of nitric oxide from drug or endothelium primarily affecting arterioles and decreasing afterload
137
Hydralazine clinical indications
used in combination with nitrates to treat HFrEF in patients who can't tolerate ACEIs or ARBs or in African American patients to improve mortality, can also be used to treat HTN in pregnancy
138
Hydralazine adverse effects
headache, hypotension, tachycardia, nausea, anorexia, palpitations, sweating and flushing, and lupus-like syndrome including glomerulonephritis at high doses is also possible
139
Hydralazine pharmacokinetics
absorbed and rapidly metabolized by the liver during first-pass metabolism
140
Diazoxide MOA
long-acting potassium channel opener that causes arterial vasodilation and salt and water retention
141
Diazoxide clinical indications
used to treat acute or malignant HTN and hypoglycemia in hyperinsulinism or insulinoma due to inhibition of insulin release from pancreas
142
Diazoxide adverse effects
excessive hypotension which in some cases can result in stroke and MI
143
Minoxidil MOA
arterial vasodilator which causes hyperpolarization of cell membranes through the opening of potassium channels allowing for greater blood flow and oxygenation to hair follicles
144
Minoxidil clinical indications
used topically (Rogaine) as a stimulant for hair growth
145
Nitroprusside MOA
venous and arterial vasodilator that causes relaxation of vascular smooth muscle and dilation of peripheral arteries and veins
146
Nitroprusside clinical indications
administered IV in hypertensive emergencies
147
Nitroprusside adverse effects
hypotension, cyanide toxicity, and hepatotoxicity
148
Clonidine MOA
a centrally acting agonist of centrally-located alpha-2 adrenoreceptors reducing sympathetic outflow from the brainstem and inhibiting release of norepinephrine - slows heart rate and reduces renin and aldosterone levels
149
Clonidine clinical indications
used to treat HTN, menopausal flushing, opioid or alcohol withdrawal, Tourette's syndrome, and second-line for ADHD
150
Clonidine adverse effects
risk of rebound hypertension due to major vasoconstriction if stopped abruptly
151
Methyldopa MOA
a prodrug that is a centrally acting agonist of alpha-2 adrenoreceptors that reduces peripheral vascular resistance
152
Methyldopa clinical indications
used primarily to treat HTN during pregnancy
153
Methyldopa adverse effects
sedation most common, occasional lactation associated with increased prolactin secretion in both men and women, if used for > 12 months it can lead to reversible autoimmune hemolytic anemia
154
First-line agents used in the treatment of HTN in patients with no other comorbidities
thiazide diuretic, ACE inhibitor or ARB, or dihydropyridine CCB
155
When combination drug therapy should be used for HTN
if BP is greater than 20 mmHg above systolic BP goal or 10 mmHg above diastolic BP goal or if BP is inadequately controlled
156
Drugs safe to use in treatment of HTN in patients with CKD
ACE inhibitors or ARBs
157
Drugs safe to use in treatment of HTN in patients with history of recurrent stroke
ACE inhibitors
158
Drugs safe to use in treatment of HTN in patients with previous myocardial infarction
beta-blockers, ACE inhibitors, and aldosterone receptor antagonists
159
Drugs safe to use in treatment of HTN in patients with diabetes
diuretics, ACE inhibitors, and ARBs
160
Drugs safe to use in treatment of HTN in patients with high-risk angina pectoris
beta-blockers and CCBs
161
heart failure
a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood
162
common causes of heart failure
ischemia (CAD), valvular defect, alcohol, viral illnesses, peripartum, stress, chemotherapy, familial, congenital, idiopathic
163
AHA/ACC stage A HF
cardiac risk factors no structural heart disease
164
AHA/ACC stage B HF
structural heart disease without HF (asymptomatic)
165
AHA/ACC stage C HF
structural heart disease with HF (symptomatic)
166
AHA/ACC stage D HF
end-stage HF (symptomatic even at rest)
167
patients considered high risk for HF or stage A
patients with HTN, atherosclerotic disease, DM, obesity, metabolic syndrome, or family history of cardiomyopathy
168
drugs used for stage A HF
ACEI or ARB and statins as appropriate
169
drugs used for stage B HF
ACEI or ARB and beta-blockers as appropriate
170
drugs used for stage C HFrEF
diuretics, ACEI or ARB, beta-blockers, and aldosterone antagonists
171
most common cause of HF
coronary artery disease resulting in myocardial infarction
172
common causes of heart failure
CAD/MI, HTN, cardiomyopathy, and valvular dysfunction
172
overall result of RAAS activation
increases sodium and water retention (increases preload) and increases peripheral vascular tone (increases afterload)
173
short-term effects of RAAS
initial boost in cardiac output (increases preload and afterload)
174
long-term effects of RAAS
left ventricular remodeling
175
common causes of diastolic HF
untreated sleep apnea and untreated HTN
176
ACEI indications for HF
used to treat asymptomatic and symptomatic HFrEF
177
benefits of ACEIs in HF
improves morbidity and mortality outcomes, reduces cardiac remodeling, and slows the progression of kidney disease, especially in diabetics, increases potassium reabsorption in patients on diuretics
178
ACEI and ARB contraindications
pregnancy
179
aldosterone antagonists indications for HF
used to treat stage C and D HFrEF to improve mortality and reduced remodeling
180
Sacubitril (Entresto = Sacubitril + Valsartan) MOA
inhibits neprilysin which is an endopeptidase that degrades BNP, ANP, and angiotensin II resulting in increased diuresis and vasodilation when combined with an ARB like Valsartan
181
Sacubitril adverse effects
hypotension, hyperkalemia, dizziness, renal failure, cough, and angioedema
182
Sacubitril contraindication
pregnancy
183
Digoxin MOA
cardiac glycoside that inhibits the Na-K-ATPase causing an increase in intracellular Ca2+ and cardiac contractability and an increase in parasympathetic tone (vagal tone) resulting in decreased renin release and slowed SA node firing and AV conduction
184
Digoxin clinical indications
recommended only for patients with stage C and D HF with EF <25%, reduces morbidity at low concentrations by improving symptoms, increasing exercise tolerance, and reducing hospital admission rates (can be useful for the treatment of HF and Afib simultaneously)
185
goal therapeutic digoxin level in treatment of HF
0.5 - 1.1 ng/mL
186
factors that increase risk of digoxin toxicity
Digoxin has a narrow therapeutic window - things that increase risk of toxicity include renal insufficiency, increased age, drug interactions (amiodarone and verapamil), hypokalemia, hypomagnesemia, hypernatremia, hypercalcemia, and acid-base disturbances
187
Signs of digoxin toxicity
bradycardia, AV blocks, and tachyarrhythmias/ventricular arrhythmias
188
Symptoms of digoxin toxicity
fatigue, nausea, vomiting, delirium, blurred vision, anorexia, diarrhea, abdominal pain, headache, dizziness, confusion
189
Milrinone MOA
phosphodiesterase III inhibitor (PDEi) that decreases the breakdown of cAMP resulting in increased cAMP levels and calcium influx in cardiac myocytes and vasodilation in vascualr smooth muscle
190
Milrinone clinical indications
used short-term for acute hemodynamic and symptomatic relief in patients with advanced HFrEF or stage C or D HF
191
Dobutamine MOA
beta-1 adrenergic receptor agonist with positive inotropic activity
192
Drugs to avoid with sulfa allergy
Loop diuretics and acetazolamide
