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pharmacology > Drugs to treat heart failure > Flashcards

Drugs to treat heart failure Flashcards

Diuretics, ACE inhibitors, B-agonists, B blockers

1
Q

What do venodilator drugs do for Heart failure

A

reduce preload
-redistributes blood from the chest and toward the peripheral veins

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2
Q

what drugs are used first in chronic heart failure

4

A
  1. diuretics
  2. ACE inhibitors
  3. B-agonists
  4. B-blockers
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3
Q

What therapies are used in acute heart failure

6 total

A
  1. diuretics
  2. vasodilators
  3. beta-agonists
  4. bipyridines
  5. natiuretic peptide
  6. L ventriculsar assist devies
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4
Q

What therapies are used in chronic heart failure

List 8

A
  1. diuretics
  2. aldosterone receptor antagonists
  3. ACE inhibitors
  4. Angiotensin receptor blockers
  5. Beta Blockers
  6. Cardiac glycosides
  7. vasodilators
  8. cardiovesrsion
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5
Q

what are cardiac glycosides? what is the MOA

A

Digoxin
inhibits Na+/K+ATPase

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6
Q

Main indications of Digoxin

A
  1. A-fibb
  2. Heart failure
    in treatment resistant cases
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7
Q

What should happen post-digoxin administration

A

monitor the serum concentration (bc narrow therapeutic index)

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8
Q

Symptoms of cardiac glycoside (digoxin) poisoning

4

A
  1. nausea
  2. vomiting
  3. blurry visino
  4. cardiac arrhythmias that cause death
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9
Q

Is digoxin quickly overdosed? why

A

yes it is quickly overdosed because of the narrow therapuetic index

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10
Q

Firrst line treatment for cardiac glycoside poisoning

A

administration of digoxin-specific antibodies

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11
Q

What is the onset of effect of Digoxin

A

oral: 30 minutes-2hours
IV: 15-30 minutes

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12
Q

What is the half life of digoxin

A

36-40 hours

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13
Q

what is the clearance rate of Digoxin

A

renal clearance is proportional to creatinine clearance

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14
Q

What is the protein binding percentage of digoxin

A

20-40%

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15
Q

When is Digoxin indicated

A
  1. congestive heart failure (symptomatic patients with NYHA >11 despite prior tx)
  2. A-fibb
  3. SVT
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16
Q

what is the dosage of digoxin in adult patients with HFrEF <70 yo

A

Maintenance dose of
Oral: 0.125 or 0.25mg QD

17
Q

What 3 factors indicated dosage change of digoxin? What should the dose be?

A
  1. > 70yo
  2. renal dysfunction
  3. low lean body mass
    Low dose: 0.125mg daily or every other day
18
Q

What happens to dosage when changing digoxin from PO to IV?

A

reduce dosage by 20-35%

19
Q

When can toxicity of digoxin occur? What should you do to prevent toxicity of digoxin

A

therapuetic concentrations, renal impairment
monitror serum digoxin

20
Q

Pharmodynamics of digoxin

A

inhibits Na+/K+ATPase: which causes high Na+ ICF, reduced efficacy of Na+/Ca2+ exchangers, which results in high ICF Ca2+

21
Q

What does digoxin do to the cardiomyocytes

A

-positive inotropic effect
-negative dromotropic effect via AV node depression
-negative chronotropic effect via SA node depression

22
Q

What does digoxin do to neurons of the vagal nerve

A
  1. increased velocity of electric conduction
  2. reduced heart rate
23
Q

are toxic effects of cardiac glycosides in the GI tract

A
  1. anorexia
  2. nausea
  3. vomiting
  4. diarrhea
24
Q

Cardiac glycosides effect on CNS

A
  1. vagal and chemoreceptor trigger zone stimulation
  2. disorientation and hallucinations (esp in eldery)
  3. visual disturbances
25
Q

What two ways do digitalis and K+ interact?

A
  1. inhibit binding eachother to Na+/K+ATPase (hypo and hyperkalemia)
  2. increased cardiac automaticity is inhibited by hyper kalemia (digitalis toxicity is inhibited)
26
Q

How does calcium increase the risk of digitalis induced arrhythmia?

A

excess calcium accelerates the overloading of intracellular calcium stores

27
Q

Types of drugs without positve inotropic effects used in heart failure

A
  1. diuretics
  2. ACE inhibitors (-pril)
  3. Angiotensin receptor antagonists (-sartans)
  4. Aldosteron antagonists (-one)
  5. B-blockers (-lol)
28
Q

what can Vasodilators do to treat acute heart failure

A
  1. reduction in preload (through venodilation)
  2. reduction in afterload (through arteriolar dilation)
  3. Bonus** hydralazine and isosorbide dinitrate reduce damaging of remodeling of the heart**
29
Q

why are beta blockers used to treat heart failure?

A

decrease the workload

30
Q

Acute heart failure episode associations?

list 6

A
  1. increased exertion
  2. stress
  3. excess salt intake
  4. nonadherence to medical therapy
  5. increase metabolic demand (fever, anemia, etc)
  6. AMI
31
Q
A

pharmacology (19 decks)

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