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PHARMACOLOGY I > drugs for HF > Flashcards

drugs for HF Flashcards

1
Q

what are signs of left sided congestive HF

A
  • pulmonary venous congestion
  • edema (cough, tachypnea, dyspnea, orthopnea, pulmonary crackles, tiring, hemoptysis, cyanosis)
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2
Q

chronic L sided CHF can lead to..?

A

pulmonary hypertension and R sided HF signs

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3
Q

signs of R sided CHF

A

systemic venous hypertension with resting jugular venous distension, hepatic congestion, pleural effeusion, ascites, small pericardial effusions and sometimes subcutaneous edema

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4
Q

what are the diuretic drugs (3)

A
  • Furosemide
  • Spironolactone
  • Hydrochlrothiazide
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5
Q

what are the ACE inhibitors (4)

A
  • Enalapril
  • Benazepril
  • Lisinopril
  • Ramipril
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6
Q

what drug is a calcium sensititzer

A

Pimobendan

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7
Q

what drug is a digitalis

A

Digoxin

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8
Q

what are the sympathomimetic drugs (2)

A

dobutamine
dopamine

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9
Q

what drugs are beta blockers (3)

A

atenolol
metoprolol
propranolol

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10
Q

what drug is both a beta and alpha blocker

A

Carvedilol

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11
Q

what drugs are Ca channel blockers

A

Diltiazem
Amlodipine besylate

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12
Q

what is the major determinant of CO

A

preload; filling pressure of heart

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13
Q

resistance that ventricles need to push through to eject blood

A

afterload

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14
Q

what things regulate contractility

A
  • filling pressure (afterload)
  • sympathetic tone
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15
Q

HR is determined by ______ tone

A

vagal

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16
Q

Type of HF: severe cardiogenic pulmonary edema

A

Acute HF

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17
Q

type of HF: Pleural effusion and ascites (fluid in abdomen)

A

chronic HF

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18
Q

what is the goal when treating hypertrophic cardiomyopathy

A

you want to avoid sustained elevations in HR = improve cardiac relaxation, want to increase filling time and reduce ischemia

ACE inhibitor+furosemide

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19
Q

hypertrophic cardiomyopathy

A

affects the Left ventricle; impairs ventricular filling

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20
Q

what drugs would be useful in treating hypertrophic cadiomyopathy and why

A
  • ACE Inhibitor - reduces the effects of neurohormonal activation (dilates arterioles and venules)
  • furosemide - loop diuretic for cardiogenic edema/effusion
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21
Q

what is cardiac tamponade

A

impaired filling of ventricles
abnormal amts of fluid accummulate in the pericardial sac, compressing the heart so that it cannot fill properly - causes a huge drop in bp

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22
Q

how is cardiac tamponade treated

A

pericardiocentesis w/ or w/out subsequent pericardiectomy

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23
Q

what is the purpose of diuretic drugs

A

control edema/effusions

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24
Q

loop diuretic used in animals w/ cardiogenic edema or effusion

A

Furosemide, a loop diuretic

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25
Q

the smallest ED of this drug are used for chronic HF but agressive therapy w/ this drug is indicated for acute fulminant pulmonary edema

A

Furosemide

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26
Q

this drug should not be used as a monotherapy txt for CHF

A

Furosemide

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27
Q

drug primarily used to reduce exercise induced pulmonary hemorrhage in race horses

A

Furosemide

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28
Q

adverse effects of furosimide

A

excessive fluid / electrolyte loss

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29
Q

Potassium sparing loop diuretic that can be an adjunct therapy for chronic refractory HF; all use is ELDU

A

Spirolactone

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30
Q

refractory HF

A

end stage or chronic

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31
Q

what drug is absolutely contradicted in hyperkalemic patients

A

Spirolactone

32
Q

adverse effects of Spirolactone

A

related to excess K retention and GI disturbances

33
Q

Spirolactone use in patients receiving _____ or ________ is sketchy

A

ACE inhibitor, K supplement

34
Q

drug recommended for dogs and cats that have become refractory to furosemide and can be an adjuncitve txt for hyperkalemic periodid paralysis in horses (HyPP)

A

Hydrochlorothiazide
(Thiazide diuretic)

35
Q

how do ACE inhibitors block the action of ACE

A

block conversion of inactive precursor peptide (Angiotenis I) into acive Angiotensin II

36
Q

these drugs decrease the effects of the RAAS cascade

A

ACEI

37
Q

More ACEIs are _____ that are converted into their active form in the liver

A

prodrugs

38
Q

why might use of ACEIs in patietns with liver dysfunction not be as slay as in a patient with a normally functioning liver

A

ACEIs have to be converted from prodrug into active form in the liver

39
Q

ACE inhibitors target what enzyme

A

Angiotensin converting enzyme (kininase II)

40
Q

ACEIs have what effect on arterioles and veins

A

vasodilation

41
Q

vasodilating effects of ACEIs can be enhanced by….

A

bradykinin
(ACE degrades bradykinins) so ACEIs keep it around

42
Q

these drugs are considered as the first choice agent in the management of systemic arterial hypertension
in dogs

A

ACEIs

43
Q

in addition to their use in chronic management of most causes of chronic heart failure, these drugs might also be useful for the treatment of renal failure in cats and slowing the progression of chronic renal failure in dogs

A

ACEIs

44
Q

what are the adverse effects of ACEIs

A
  • hypotension
  • GI upset
  • renal function deterioration, and hyperkalemia (especially when used with a K+ -sparing diuretic or K+ supplement).
45
Q

how do you proceed if a patient becomes azotemic while on ACEIs?

A

diuretic dosage is decreased; then if needed ACEI dose decreased or stopped

46
Q

Drugs that are ACEIs have the ending…

A

-prils
* enalapril
* benzaepril
* lisinopril
* ramipril

47
Q

this drug increases myocardial contractility by increasing myofilament sensitivity to Ca2+

A

Pimobendan

48
Q

what is the labeled use of pimobendan

A

for use in dogs with HF from dilated cardiomyopathy or chronic mitral valve disease

Use in cats is ELDU

49
Q

how does pimobendan cause vasodilation

A

inhibits phosphodiesterase III (which breaks down cAMP)

49
Q

how does pimobendan cause increased mycaridal contractions

A

increases myocardial cAMP levels which activates protein kinase A, PKA then activates L-type Ca2+ channels which ↑ myocardial contractions

50
Q

how do loop diuretics (furosemide) work

A
  • they inhibit the Na/K/Cl cotransporter causing ions to accumudate in medulla of kidney
  • less water can be reabsorbed, lowers bp and increases urination
51
Q

what ACEI is labeled for use in dogs

A

Enalapril

52
Q

how do thiazide diuretics work

A
  • inhibiti the Na+/Cl− cotransporter in the renal distal convoluted tubule
  • decrease Na reabsorption,** decreasing water reabsorption**
53
Q

what is the main difference b/w Enalapril & Benazepril (ACEIs)

A

enalapril is mainly cleared (95%) by the kidney while benazepril is cleared by both renal (45%) and hepatic (55%) routes.

54
Q

what are the effects of Ca sensitizers (Pimobendan)

A
  • increases myocardial contractility
  • vasodilation
55
Q

How does Pimobendan (Ca sensitizer) increase myocaridal contractility

A
  • by increasing myofilament sensitivity to Ca
  • by increasing myocardial cAMP levels –> activates PKA, PKA activates L-type Ca channels –> increases myocardial contractions
56
Q

how does Pimobendan (Ca sensitizer) cause vasodilation

A

it inhibits phosphodiesterase II which breaks down cAMP

57
Q

what is the indicated use for Pimobendan

A

HF from dilated caridomyopathy or chronic mitral valve disease

58
Q

where is Pimobendan metabolized

A

liver
excreted in feces

59
Q

Adverse effects of Pimobendan

A
  • reduced appetite, lethargy, D+, dyspnea
  • azotemia if underlying HF
60
Q

what is the primary use for Digoxin (digitalis)

A

atrial fibrilations; has antiarrythmic effects

61
Q

what are the antiarrythmic effects provided by Digoxin

A
  • increased parasympathetic tone to sinus & AV nodes and atria
  • improves arterial baroreceptor sensitivity to increase vagal tone in HF
62
Q

how does digoxin cause an increased intracellular [Ca]

A

competitively inhibits Na/K ATPase pump, decreasing extracellular Na transport causes intracellular Ca accumulation b/c Na/Ca exchange is decreased

63
Q

what patients is Digoxin use contraindicated in

A

cats w/ hypertrophic cariomyopathy

64
Q

what are the most common adverse effects of Digoxin

A
  • cardiac toxicity
  • stimulation of various arrythmias –> sinus bradycardia
65
Q

what is the treatment for digitalis toxicity

A

oral or IV K+
NEVR Ca
also: lidocaine, phenytoin, propranolol

66
Q

what is the interaction b/w digoxin and K+

A

they inhibit each other’s bidnding to the NA/K ATPase receptors; K+ counteracts digitalis toxicity; K+ reduced abnormal caridac automaticity

67
Q

what is the interaction b/w Ca and digoxin

A

Ca enhances digitalis toxicity

68
Q

Mg and digitalis (Digoxin)

A

decreases digitalis toxicity

69
Q

indicated use of sympathomimetics (Dobutamine & Dopamine)

A
  • myocardial failure
  • hypotension that doesn’t respond to fluid loading
70
Q

what are the effects of Dopamine at low, medium and high doses

A
  • low: stimulate D1 receptors - vasodilation in kidney
  • medium: stimulate β receptors - positive inotropic effect
  • high: stimulate α receptors - peripheral vasoconstriction in dogs
71
Q

dobutamine is a synthetic analog of…

A

dopamine

72
Q

what is the effect of dobutamine at low infusion rates

A
  • stimulates B receptors
  • increased contractility with minimal effects on HR/BP
73
Q

adverse effects of sympathomimetics

A
  • arrhythmias
  • increased myocardial O2 demand
74
Q

what interactions lead to increased digitalis toxicity

A
  • hypokalemia - diurects, D+
  • β antagnosits - decrease SA/AV node activity
  • Ca+ channel blockers - decrease contractility
  • decrease plasma binding proteins - increase toxicity
  • decreased renal clearance
75
Q

serum digoxin concentrations are increased in cats and dogs with ____ dysfunction

A

reanl
reduced total body clearance & volume of distribution

PHARMACOLOGY I (21 decks)

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