Heart Failure Drugs

Question 1

Furosemide

Answer 1

Pmcol: Loop diuretic (ascending) - blocks Cl- reabsorption
Indications: Acute and chronic tx pulmonary edema in HF
Adverse Effects: Dehydration, hypotension, hypokalemia, tinnitus, hyperiricemia, hypochloremic alkalosis
Contraindications: Pregnancy, anuria, hypovolemia
Other: Diuretic resistance -> high dose first.

Question 2

ACE Inhibitors

Answer 2

Pmcol: Block ATII formation
Indications: First line HF and asymptomatic LV dysfunction, HTN
Adverse Effects: Hypotension, worsening renal function, hyperkalemia, dry cough, taste disturbances, rash, angioedema
Contraindications: Previous angioedema from ACE-I, pregnancy, caution with aortic stenosis/renal artery stenosis

Question 3

B-Blockers

Answer 3

Pmcol: competitive antag of B-recep
Indications: First line HF, HTN, angina, arrhythmias, secondary prevention of MI, glaucoma, migraine prophylaxis.
Adverse Effects: worsening HF (negative inotrope), fatigue, lethargy, depression, nightmares, hypotension, bradycardia, AV block, bronchospasm, PAD worsening, sexual dysfunction, masked hypoglycemia.
Contraindications: Asthma, bradycardia, AV block, sever PAD, poorly controlled DM
Other: Start low and slow to not worsen HF

Question 4

Digoxin

Answer 4

Pmcol: inhibit cardiac Na-K ATPase to increase Ca
Indications: adjunctive HF (no effect on mortality)
Adverse Effects: GI, CNS, visual disturbances, toxicity
Contraindications: AV conduction disturbances

Question 5

Spironolactone

Answer 5

Pmcol: K Sparing Diuretic
Indications: With ACE-I/B-Blockers if NYHA-FC III/IV
Adverse Effects: hyperkalemia, increased serum creatinine, hypotension, dehydration, gynecomastia
Contraindications: Caution with K supplements

Question 6

Eplerenone

Answer 6

Pmcol: K Sparing Diuretic
Indications: With ACE-I/ARB-B-Blockers if NYHA-FC II
Adverse Effects: hyperkalemia, increased serum creatinine, hypotension, dehydration, gynecomastia
Contraindications: CYP3A4 inhibitors

Question 7

Hydralazine/Nitrates

Answer 7

Pmcol: vasodilation

Question 8

ARB

Answer 8

Pmcol: Block AT1R
Indications: Intolerance to ACE-I or in combo with ACE-I
Adverse Effects: hypotension, increased serum creatinine, hyperkalemia

Question 9

Course of Tx

Answer 9

All: B-Blocker and ACE-I
Most: Furosemide
Symptomatic anyways: others.