Drugs For HF

Question 1

Name the beta blockers approved for HF

Answer 1

Carvedilol, bisoprolol, metoprolol XL, Nebivolol

Question 2

Side effects of sacubitril-valsartan

Answer 2

Hypotension, hyperkalemia, renal failure, cough, and angioedema.

Question 3

Name the loop diuretics

Answer 3

Sulfonamide derivatives: Furosemide, Bumetanide, Ethacrynic acid

Question 4

Clinical use of loop diuretics

Answer 4

Acute pulmonary edema and other edema
Acute hyperkalemia
Acute renal failure
Anion overdose: toxic ingestions of bromide, fluoride, and iodide

Question 5

Side effect of loop diuretics

Answer 5

Ototoxicity (don’t use with aminoglycoside)
Hyperuricemia
Hypomagnesemia
Hypokalemic metabolic alkalosis

Question 6

Name the potassium sparing diuretics

Answer 6

Spironolactone, Triamterene, Amiloride and Eplerenone

Question 7

PK of potassium sparing diuretics

Answer 7

Spironolactone has a rather slow onset of action, requiring several days before full therapeutic effect is achieved. Triamterene is metabolized in the liver. It has a shorter half-life and must be given more frequently than amiloride. Amiloride is excreted unchanged in the urine.

Question 8

Clinical use of potassium sparing diuretics

Answer 8

Diuretic, hyperaldosteronism

Question 9

Adverse effects of potassium sparing diuretics

Answer 9

1. Hyperkalemia;
2. Metabolic acidosis;
3. Gynecomastia (only spironolactone);
4. Acute renal failure (Triamterene+indomethacin);
5. Kidney stones (with triamterene)

Question 10

Indications of hydralazine

Answer 10

-Heart failure with reduced ejection fraction (in combination with isosorbide dinitrate). Given orally.

Essential hypertension (when first-line medication(s) unsuitable or inadequate). Given orally.

Acute-onset, severe peripartum or post-partum hypertension (> 15 min). Given IV.

Question 11

Side effects of hydralazine

Answer 11

Flushing
Tachycardia
Hypotension
Hydralazine-induced lupus syndrome (HILS): Athralgia, myalgia, serositis, can. > 6-months use and can be resolved with hydralazine discontinuation

Contraindicated in coronary artery disease due to hydralazine’s stimulation of the sympathetic nervous system  increased cardiac output /oxygen demand  myocardial ischemia.

Question 12

Name all drugs for HF

Answer 12

1. Beta blockers
2. Sacubitril-Valsartan
3. Loop diuretics
4. Potassium sparing diuretics
5. Hydralazine
6. Isosorbide mono/dinitrate
7. Ivabradine
8. Digitalis

Question 13

Clinical use of digitalis

Answer 13

Systolic dysfunction and Atrial fibrillation

Question 14

Side effects of digitalis

Answer 14

1. progressively more severe dysrhythmia: AV block, AF, VF
2. Gastrointestinal effects: anorexia, nausea, and vomiting
3. CNS: headache, fatigue, confusion blurred vision

Question 15

Treatment of digitalis toxicity

Answer 15

1. Discontinue the therapy
2. Correction or potassium or magnesium deficiency
3. Anti arrhythmic drugs and digoxin antibody