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pharmacology > Drugs for Heart Failure > Flashcards

Drugs for Heart Failure Flashcards

1
Q

define heart failure

A
  • refers to the inability of the heart to pump enough blood to satisfy the body’s demand for oxygen
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2
Q

what are some leading risk factors for heart failure?

A
  • CV disease
  • previous MI
  • chronic hypertension
  • diabetes
  • mitral stenosis
  • cardiomyopathies
  • congenital heart disease
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3
Q

define preload and what causes an increase in preload?

A
  • the degree to which the muscle fibres are stretched before the heart contracts
  • an increase in blood volume may be because of fluid retention
  • increase in venous pressure or increased ventricular compliance that results in greater filling of the ventricle
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4
Q

what causes pulmonary edema?

A
  • increased preload can cause failure of the left side causing blood to back up into the pulmonary system
  • fluid leaves the pulmonary capillaries and goes into the alveoli and interstitial of the lung causing edema
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5
Q

what causes decreased oxygen supply?

A
  • fluid collection causes congestion and shortness of breath

- fluid reduces the ability to exchange gas and results in decreased oxygen supply

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6
Q

what causes decreased myocardial contractility/stroke volume and cardiac output?

A
  • results in lower blood pressure causing less blood flow to the kidneys which activates the RAA pathway and causes release of ADH
  • ADH and aldosterone causes water and sodium retention and aldosterone also increased peripheral resistance
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7
Q

what happens when after load increases due to an increase in peripheral resistance?

A
  • causes blood to back up into the peripheral circulation resulting in edema in limbs
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8
Q

what is diastolic dysfunction?

A
  • left ventricle has become stiff, the heart cannot relax and cannot fill up as much causing less blood in the ventricle and pumps out less
  • caused by loss of elasticity/contractility
  • the heart compensates by increasing muscle mass or dilate to increase blood flow
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9
Q

what is systolic dysfunction?

A
  • loss of contractility in left ventricle causing less ejection of blood
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10
Q

what are some less common symptoms of heart failure?

A
  • cognitive impairment
  • altered mentation or delirium
  • nausea
  • anorexia
  • oliguria
  • cyanosis
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11
Q

what are the 9 drug classes that are used to treat heart failure?

A
  • ACE inhibitors
  • adrenergic blockers
  • loop diuretics
  • vasodilators
  • phosphodiesterase inhibitors
  • cardiac glycosides
  • angiotensin receptor neprilysin inhibitors
  • Ivabradine
  • aldosterone antagonists (potassium-sparing diuretics)
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12
Q

what is the mechanism of action of ACE inhibitors?

A
  • reduce blood pressure and decrease cardiac workload

- reduces fluid retention via inhibitor of the RAA pathway

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13
Q

what is the mechanism of action of adrenergic blockers?

A
  • alpha and beta blockers lower blood pressure and reduce heart rate
  • decreases workload of the heart by decreasing afterload
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14
Q

what is the mechanism of action of loop diuretics?

A
  • increased urine output lowers blood volume and therefore preload and cardiac workload
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15
Q

what is the mechanism of action of vasodilators?

A
  • acts on arterioles to decrease peripheral, reduce afterload, and increase stroke volume and cardiac output
  • reduced preload by dilating veins and reducing venous pressure
  • decreased proximal capillary hydrostatic pressure which reduces capillary fluid filtration and edema formation
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16
Q

what is the mechanism of action of phosphodiesterase inhibitors?

A
  • increases contractility in the heart increasing stroke volume
  • drug is fast acting and is administered IV, with constant monitoring by ECG
17
Q

what is the mechanism of action for cardiac glycosides?

A
  • slows the heart rate and increases force of contraction

- used in more serious cases of HF

18
Q

what is the mechanism of action of cardiac glycosides?

A
  • slows the heart rate and increases force of contraction

- used in more serious cases of HF

19
Q

what is the mechanism of action of angiotensin receptor neprilysin inhibitors?

A

-valsartan inhibits the effects of angiotensin II at its receptor, inhibiting both arteriolar contraction and the sodium retention effects of RAA system

20
Q

what is the mechanism of action of Ivabradine?

A
  • inhibits the “IF” channel pacemaker current in the SA node, lowering heart rate and increasing blood to flow to the myocardium
21
Q

when is ivabradine used?

A
  • the symptomatic management of HF in patients who are not on beta blockers or already receiving the max beta blocker used
22
Q

what is the mechanism of action of the aldosterone antagonists (potassium-sparing diuretics)?

A
  • blocking the action of aldosterone, mineralocorticoid receptor antagonists enhance the excretion of sodium and the retention of potassium resulting in diuresis
  • reduces the mortality rate in clients with HF
23
Q

why is it important to take daily weights while on a diuretic drug?

A
  • detecting the onset of volume overload
24
Q

what is daily weight gain due to?

A
  • fluid retention and can lead to crisis if symptoms are not managed
25
Q

what are some warning signs that should not be ignored when self monitoring?

A
  • rapid weight gain when accompanied by increasing difficulty in breathing
26
Q

what lifestyle changes should patients with heart failure be encouraged to adopt?

A
  • exercise (regular physical activity, but a stress test is recommended)
  • diet ( salt reduction, low in saturated fats, high in fruits and vegetables
  • fluid restriction (prevent edema and formation of pulmonary congestion)
27
Q

what is the standard guideline directed medical therapy?

A
  • beta blockers
  • aldosterone antagonist
  • ACH inhibitors
  • Hydralizine and Isosorbide dinitrate
28
Q

what is important to monitor with ACE inhibitors or ARB therapy?

A
  • regular CBC to monitor for neutropenia in the first year of therapy
  • monitor potassium and sodium levels; hyponatremia and hyperkalemia
  • hypotension may occur during initial administration
29
Q

what is important to monitor with beta-blocker therapy?

A
  • use with caution in patients with diabetes and hepatic impairment
30
Q

what is important to monitor with aldosterone antagonists?

A
  • monitor for hyperkalemia, impaired renal function and hormone dysfunction
31
Q

what is important to monitor with diuretic therapy?

A
  • monitor for weight gain, potassium levels, electrolytes, blood glucose
32
Q

what is neprilysin?

A
  • an enzyme that breaks down natriuretic peptides that affect fluid balance
33
Q

what is the inhibitor drug to neprilysin?

A
  • sacubitril
34
Q

where are atrial natriuretic peptides (ANP) secreted from?

A
  • the atria
35
Q

where are B-type natriuretic peptides (BNP) secreted from?

A

-cardiac ventricles

pharmacology (14 decks)

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