Heart Failure Drugs

Question 1

Inhibits Na+/K+ ATPase –> increase intracellular Na+, decreasing the driving force for Ca2+ extrusion by Na+/Ca2+ exchanger –> directly increases intracellular Ca2; Positive Inotrope

Answer 1

Digoxin

Question 2

Secondary effects of digoxin

Answer 2

decreases HR, arterial and venous dilation

Question 3

Adverse effects of Digoxin

Answer 3

Low therapeutic index
Effects all excitable tissues (GI, visual disturbances, neurologic, muscular, cardiac arrhythmias)
Drug interactions (Quinidine, Verapamil, Amiodarone)

Question 4

Clinical use of Digoxin

Answer 4

Not 1st line

Limited to HR patients with LV systolic disfunction in a. fib - administer low dose

Question 5

B-adrenergic agonists, Inotropes

Answer 5

Dobutamine, Dopamine

Question 6

Uses of B-adrenergic agonists

Answer 6

IV temporarily for hemodynamic support for acutely ill patients (acute decompensated HF)

Question 7

Phosphodiesterase inhibitor, Inotrope

Answer 7

Milrinone

Question 8

Use of Milrinone

Answer 8

IV for acutely ill patients, also vasodilates

Question 9

Decrease fluid volume and preload, decreases edema

Improves heart efficiency and decreases wall stress

Answer 9

Diuretics

Question 10

Loop diuretic, promotes K+ loss

Answer 10

Furosemide

Question 11

Thiazide diuretic, rarely used alone–combined with loop diuretic, promotes K+ loss

Answer 11

Chlorothiazide

Question 12

K+ sparring diuretics, weak but limited K+ and Mg2+ wasting

Answer 12

Amiloride, Triamterene

Question 13

ACE inhibitors – decrease SVR (afterload), decrease LV filling pressure (preload), decrease Na+ retention, cardiac fibrosis, hypertrophy.
Increase survival.
Can decrease renal function.
SE–> hypokalemia

Answer 13

Captopril, Lisinopril, Enalapril

Question 14

Angiotension receptor blocker, similar effects to ACE inhibitor

Answer 14

Losartan

Question 15

Mixed arterial and venous dilation, used when ACE inhibitors and ARBS not tolerated

Answer 15

Isosorbide dinitrate/Hydralazine combo

Question 16

Aldosterone Antagonists – decrease edema, decrease fibrosis of myocardium and vessels
Improves mortality
SE–> Hyperkalemia, monitor

Answer 16

Spironolactone

Eplerenone

Question 17

B-Adrenergic Receptor Antagonists– improves symptoms, ventricular function, mortality rate
Decreases arrhythmias, O2 demand, BP

Answer 17

Metoprolol, Carvedilol

Question 18

Increases levels of substances counteracting the neurohormonal activation that contributes to vasoconstriction, Na+ retention and maladaptive remodeling

Answer 18

Neprolysin inhibitor/ARB combo

Question 19

Non-drug therapies for heart failure

Answer 19

Salt restriction
Biventricular pacing 
Implantable cardiodefibrillator Devices (ICD) 
LV assist device (LVAD) 
Heart transplant

Question 20

Ca2+ sensitizer and vasodilator; acts on troponin C to increase sensitivity to Ca2+; PDE inhibitor at high concentrations

Answer 20

Levosimendan

Question 21

Vasodilators–decrease afterload, increase SV, decrease LVEDP, decrease preload

Answer 21

Nesiritide, IV Nitroglycerine, Nitroprusside

Question 22

Recombinant natiuretic peptide acts as potent vasodilator

No longer recommended

Answer 22

Nesiritide

Question 23

Venodilator, decrease filling P at low dose, at high dose decrease SVR, Increase CO, increase coronary BF

Answer 23

Nitroglycerin

Question 24

SE of Nitroglycerin

Answer 24

Hypotension, H/A, bradycardia, tachypnea

Question 25

Balance vasodilator (veins and arteries); decrease filling pressures, SVR, PVR and increase CI

Answer 25

Nitroprusside

Question 26

SE of Nitroprusside

Answer 26

Cyanide toxicity, accumulation of thiocyanate