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Flashcards in Drugs Used in Heart Failure Deck (35)
1

Reduces excessive sympathetic stimulation

Beta blockers

2

Reduces preload and afterload

Vasodilators

3

Augments depressed cardiac contractility

Positive inotropes

4

DOC for acute heart failure

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

5

DOC for chronic heart failure

ACEI (slows down cardiac remodeling)

Loop + spironolactone + ACEI
If tolerated, + BB

6

MOA of digoxin

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

7

SE of digoxin

Arrhythmia
Visual changes

8

Drugs with narrow therapeutic index

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

9

Digitalis toxicity is increased by?

Hypokalemia
Hypomagnesemia
Hypercalcemia

10

DOC for digoxin-induced arrhythmia

Lidocaine
2nd line: phenytoin

11

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

Carvedilol
Labetalol
Metoprolol

12

No value in acute heart failure

Beta blockers

13

No value in chronic heart failure

PDEIs (inamrinone and milrinone)
CCB

14

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

Nitroprusside
Nitroglycerine

15

Improve survival in heart failure

ABA! Buhay ka pa!
ACEIs
BB
Aldosterone antagonists

16

Used to remove retained salt and water

Diuretics

17

Positive inotropic drugs used in heart failure

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

18

Vasodilators used in the management of heart failure

PDEI (Inamrinone)
Nitroprusside
Nitrates
Hydralazine

19

MOA of furosemide

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

20

Toxicities of furosemide

Ototoxicity
Hypovolemia
Hypokalemia

21

MOA of hydrochlorothiazide

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

22

Toxicites of thiazides

HyperGlycemia
HyperLipidemia
HyperUricemia
HyperCalcemia
HypoKalemia

23

MOA of spironolactone

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

24

Toxicities of spironolactone

Hyperkalemia
Gynecomastia

25

Reduces afterload and salt and water retention

ACEIs

26

Cardiac effect of ACEIs and ARBs

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

27

MOA of Carvedilol

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

28

MOA of isosorbide dinitrate

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

29

MOA of hydralazine

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

30

MOA of nitroprusside

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

31

MOA of dobutamine

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

32

MOA of dopamine

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

33

MOA of Bypiridines (inamrinone and milrinone)

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

34

MOA of nesiritide (natriuretic peptide)

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

35

Used for acute decompensated heart failure

Nitroprusside
Dobutamine
Dopamine
Inamrinone, milrinone
Nesiritide