Exam 3, drugs used in HF DSA Flashcards Preview

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Flashcards in Exam 3, drugs used in HF DSA Deck (56)
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1

What are the drugs with positive ionotropic effects

cardiac glycosides- digoxin
Bypyridines- inamrinon and milrinone
beta adrenergic R agonists- dobutamine and dopamine

2

What cardiac drugs do not have a positive ionotropic effect

diuretics, ACEI, ARBs, vasodilators, Beta blockers, Natriuretic peptide

3

what are the loop diuretics

bumetanide
furosemide
torsemide

4

what are the thiazide diuretics

HCTZ

5

what are the aldosterone antagonists

eplerenon and spironolactone

6

what are the vasopressin (ADH) antagonists

conivaptan, tolvaptan

7

What drug class ends in "pril"

ACEI

8

what drug class ends in "sartan"

ARB

9

what drugs specifically venodilate

isosorbide dinitrate

10

what drug is an arteriolar dilator

hydralazine

11

what drug is a combined arteriolar and venodilator

nitroprusside

12

what drug class ends in "olol"

beta blockers

13

what drug do we have that is a ntriuretic peptide

nesiritide

14

what drugs for HF have been proven to reduce HF mortality

ARB, ACEI, beta blocker, aldosterone R antagonist

15

What occurs in systolic heart failure and what drug class is used

reduced CO and contractility
redced EF
typical of acute failure
responds to positive ionotropic agents

16

What occurs in diastolic heart failure and what drug class is used

results from hypertrophy and stiffening of myocardium
CO is reduced
EF is normal
does not typically respond optimally to + ionotropic agents

17

What are signs and dx of HF

tachy, decreased exercise tolerance, SOB, peripheral and pulmonary edema, cardiomegaly, decreased exercise tolerance is major direct consequence of diminished cardiac output while other manifestations result from compensatory adaptations

18

what is digoxin used to Tx

HF and Afib

19

How does digoxin work

inhibits Na K ATPase causing increased contraction of cardiac sarcomere
reduce Na extrusion and Ca efflux then is decreased too. more Ca in sarcoplasmic reticulum for more contractility

20

how does digoxin change myocardial electrical potentials

brief prolongation of AP followed by shortening
increased potassium conductance(rapid repolarization)

21

what are common cardiac manifestations of digoxin toxicity

AV junctional rhythm, premature ventricular depolarization, bigeminal rhythm, second degree AV block

22

What are the therapeutic effects of digoxin on AV node

decrease conduction velocity
increase refractory period

23

how does digoxin change EKG

increase PR interval and decrease QT interval

24

where in the body are digoxin toxicity signs seen

GI - nausea, vomiting, diarrhea
and CNS - vagal and chemoR trigger zone stimulation can cause GI symptoms, disorientation, hallucinations and visual changes
can cause gynecomastia in men

25

what can reduce toxic effects of digoxin

hyperkalemia

26

what can potentiate toxic effects of digoxin

hypokalemia

27

What ion levels increase risk of digoxin induced arrhythmia

hyperCa and hypoMg

28

how do bipyridines work

selective inhibition of phosphodiesterase isozyme 3 PDE3 which increases cAMP
directly stimulating myocardial contractility and acceleartaion of releaxation

29

how does increased cAMP levels affect vasculature

balanced arterial and venous dilation with fall in systemic and pulmonary vascular R
L and R filling P

30

What are Sx of inamrinone toxicity

nausea, vomiting, arrhythmias, thrombocytopenia, liver enzyme changes