Drugs to treat heart failure

Question 1

What do venodilator drugs do for Heart failure

Answer 1

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

Question 2

what drugs are used first in chronic heart failure

4

Answer 2

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

Question 3

What therapies are used in acute heart failure

6 total

Answer 3

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

Question 4

What therapies are used in chronic heart failure

List 8

Answer 4

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

Question 5

what are cardiac glycosides? what is the MOA

Answer 5

Digoxin
inhibits Na+/K+ATPase

Question 6

Main indications of Digoxin

Answer 6

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

Question 7

What should happen post-digoxin administration

Answer 7

monitor the serum concentration (bc narrow therapeutic index)

Question 8

Symptoms of cardiac glycoside (digoxin) poisoning

4

Answer 8

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

Question 9

Is digoxin quickly overdosed? why

Answer 9

yes it is quickly overdosed because of the narrow therapuetic index

Question 10

Firrst line treatment for cardiac glycoside poisoning

Answer 10

administration of digoxin-specific antibodies

Question 11

What is the onset of effect of Digoxin

Answer 11

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

Question 12

What is the half life of digoxin

Answer 12

36-40 hours

Question 13

what is the clearance rate of Digoxin

Answer 13

renal clearance is proportional to creatinine clearance

Question 14

What is the protein binding percentage of digoxin

Answer 14

20-40%

Question 15

When is Digoxin indicated

Answer 15

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

Question 16

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

Answer 16

Maintenance dose of
Oral: 0.125 or 0.25mg QD

Question 17

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

Answer 17

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

Question 18

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

Answer 18

reduce dosage by 20-35%

Question 19

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

Answer 19

therapuetic concentrations, renal impairment
monitror serum digoxin

Question 20

Pharmodynamics of digoxin

Answer 20

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

Question 21

What does digoxin do to the cardiomyocytes

Answer 21

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

Question 22

What does digoxin do to neurons of the vagal nerve

Answer 22

1. increased velocity of electric conduction
2. reduced heart rate

Question 23

are toxic effects of cardiac glycosides in the GI tract

Answer 23

1. anorexia
2. nausea
3. vomiting
4. diarrhea

Question 24

Cardiac glycosides effect on CNS

Answer 24

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

Question 25

What two ways do digitalis and K+ interact?

Answer 25

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

Question 26

How does calcium increase the risk of digitalis induced arrhythmia?

Answer 26

excess calcium accelerates the overloading of intracellular calcium stores

Question 27

Types of drugs without positve inotropic effects used in heart failure

Answer 27

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

Question 28

what can Vasodilators do to treat acute heart failure

Answer 28

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**

Question 29

why are beta blockers used to treat heart failure?

Answer 29

decrease the workload

Question 30

Acute heart failure episode associations? | list 6

Answer 30

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