Drugs Used in Heart Failure

Question 1

Reduces excessive sympathetic stimulation

Answer 1

Beta blockers

Question 2

Reduces preload and afterload

Answer 2

Vasodilators

Question 3

Augments depressed cardiac contractility

Answer 3

Positive inotropes

Question 4

DOC for acute heart failure

Answer 4

Loop diuretics

If very severe: positive inotropes (beta-agonists or PDE inhibitors) and vasodilators

Question 5

DOC for chronic heart failure

Answer 5

ACEI (slows down cardiac remodeling)

Loop + spironolactone + ACEI
If tolerated, + BB

Question 6

MOA of digoxin

Answer 6

Inhibits Na/K/ATPase–> increased intracellular sodium–> Sodium-Calcium exchanger is altered–> reduced calcium expulsion –> increased Ca stored in sarcoplasmic reticulum–> increased cardiac contractility

Question 7

SE of digoxin

Answer 7

Arrhythmia

Visual changes

Question 8

Drugs with narrow therapeutic index

Answer 8

WALA na Cyang PaPa! vasTeD na!
Warfarin
Aminoglycoside
Lithium
Amphotericin B
Carbamazepine
Phenobarbital
Phenytoin
Vancomycin
Theophylline
Digoxin

Question 9

Digitalis toxicity is increased by?

Answer 9

Hypokalemia
Hypomagnesemia
Hypercalcemia

Question 10

DOC for digoxin-induced arrhythmia

Answer 10

Lidocaine

2nd line: phenytoin

Question 11

Beta blockers which reduce progression of chronic heart failure; no value in acute failure

Answer 11

Carvedilol
Labetalol
Metoprolol

Question 12

No value in acute heart failure

Answer 12

Beta blockers

Question 13

No value in chronic heart failure

Answer 13

PDEIs (inamrinone and milrinone)

CCB

Question 14

Effective in CHF due to increased afterload (HTN + infarct)

Answer 14

Nitroprusside

Nitroglycerine

Question 15

Improve survival in heart failure

Answer 15

ABA! Buhay ka pa!
ACEIs
BB
Aldosterone antagonists

Question 16

Used to remove retained salt and water

Answer 16

Diuretics

Question 17

Positive inotropic drugs used in heart failure

Answer 17

Cardiac glycosides (digoxin)
Beta agonists (dobutamine)
PDE inhibitors (inamrinone)

Question 18

Vasodilators used in the management of heart failure

Answer 18

PDEI (Inamrinone)
Nitroprusside
Nitrates
Hydralazine

Question 19

MOA of furosemide

Answer 19

Decreases NaCl and KCl reabsorption in thick ascending loop of Henle –> reduces peripheral edema, preload, and afterload
Vasodilates pulmonary vessels –> reduces pulmonary edema

Question 20

Toxicities of furosemide

Answer 20

Ototoxicity
Hypovolemia
Hypokalemia

Question 21

MOA of hydrochlorothiazide

Answer 21

Decreases NaCl reabsorption in the DCT–> Reduces edema and preload

Question 22

Toxicites of thiazides

Answer 22

HyperGlycemia
HyperLipidemia
HyperUricemia
HyperCalcemia
HypoKalemia

Question 23

MOA of spironolactone

Answer 23

Blocks cytoplasmic aldosterone receptors in collecting tubules of nephron –> increases salt and water excretion; reduces remodelling; reduces mortality

Question 24

Toxicities of spironolactone

Answer 24

Hyperkalemia

Gynecomastia

Question 25

Reduces afterload and salt and water retention

Answer 25

ACEIs

Question 26

Cardiac effect of ACEIs and ARBs

Answer 26

Arteriolar and venous dilation; Reduces aldosterone secretion; Increases cardiac output; Reduces cardiac remodelling

Question 27

MOA of Carvedilol

Answer 27

Competitively blocks B1 receptors --> slows heart rate; reduces BP; reduces heart failure mortality; used in CHRONIC heart failure

Question 28

MOA of isosorbide dinitrate

Answer 28

Releases nitric oxide; activates guanylyl cyclase --> venodilation --> reduces preload and ventricular stretch; used for acute and chronic heart failure as well as angina

Question 29

MOA of hydralazine

Answer 29

Probably increases NO synthesis in endothelium --> reduces BP and afterload --> increases CO

Question 30

MOA of nitroprusside

Answer 30

Releases NO spontaneously; activates guanylyl cyclase --> marked vasodialtion --> reduces preload and afterload

Question 31

MOA of dobutamine

Answer 31

Beta 1-selective agonist; increases cAMP synthesis--> increases cardiac contractility and CO

Question 32

MOA of dopamine

Answer 32

Dose-dependent; Increases renal blood flow; higher doses increase cardiac force and BP

Question 33

MOA of Bypiridines (inamrinone and milrinone)

Answer 33

Phosphodiesterase type 3 inhibitors; decrease cAMP breakdown --> vasodilation --> reduces peripheral vascular resistance; Also increases cardiac contractility

Question 34

MOA of nesiritide (natriuretic peptide)

Answer 34

Activates BNP receptors; increases cGMP --> vasodilation; diuresis

Question 35

Used for acute decompensated heart failure

Answer 35

``` Nitroprusside Dobutamine Dopamine Inamrinone, milrinone Nesiritide ```