Heart Failure Drugs

Question 1

heart failure

Answer 1

the heart is unable to pump blood in sufficient amounts from the ventricles to meet the body’s metabolic needs

Question 2

what do the symptoms of heart failure depend on?

Answer 2

the cardiac area affected

Question 3

what are the two dysfunctions contributing to heart failure and which is less common

Answer 3

systolic dysfunction and diastolic dysfunction

diastolic dysfunction is less common

Question 4

cardiac defects that cause heart failure

Answer 4

myocardial infarction

valve deficiency

Question 5

defects outside the heart that cause heart failure

Answer 5

coronary heart disease
pulmonary hypertension
diabetes

Question 6

supraventricular dysrhythmias that cause heart failure

Answer 6

atrial fibrillation

atrial flutter

Question 7

positive inotropic drugs for heart failure

Answer 7

increase the force of myocardial contraction

Question 8

positive chronotropic drugs

Answer 8

increase heart rate

Question 9

positive dromotropic drugs

Answer 9

accelerate cardiac conduction

used to treat heart muscle failure

Question 10

drug therapy for heart failure

Answer 10

ACE inhibitors
Angiotensin 2 Receptor Blockers
B-type natriuretic peptides
Phosphodiesterase inhibitors
Cardiac glycosides

Question 11

ACE inhibitors

Answer 11

prevent sodium and water resorption by inhibiting aldosterone secretion
diuresis results, which decreases preload, or the left ventricular end-volume, and the work of the heart
-lisinopril
-enalapril
-captopril

Question 12

Angiotensin 2 Receptor Blockers

Answer 12

Potent vasodilators, decrease systemic vascular resistance(afterload)

• valsartan
• candesartan
• losartan

Question 13

B-type natriuretic peptides

Answer 13

nesertide(Natrecor)
-used in severe, life-threatening heart failure

hormone produced by the ventricles
BNP is released from the ventricles in response to increased blood volume in the heart

Question 14

Atrial Natriuretic Peptide

Answer 14

hormone produced by the atria

ANP is produced in the atria in response to increased blood volume in the heart

Question 15

B-type Natriuretic peptide mechanism of action

Answer 15

vasodilating effects on arteries and veins
indirectly increases cardiac output
supresses the renin angiotensin system
diuresis

Question 16

B-type natriuretic peptides adverse effects

Answer 16

hypotension
dysrhythmia
headache
abdominal pain

Question 17

state of cardiac muscle in HF

Answer 17

in HF the cardiac muscle is overstretched and failing

Question 18

where are catecholamines released from

Answer 18

from the SNS in an effort to compensate for the failing heart

Question 19

what do the catecholamines do

Answer 19

bind with beta 1 adrenergic receptors and activate adenylyl cyclase to form cAMP

Question 20

cAMP coupled with other intracellular messengers does what?

Answer 20

increases contractility(inotropy)
heart rate (chronotropy)
conduction velocity(dromotrophy)

Question 21

what enzyme breaks down cAMP

Answer 21

phosphodiesterase

Question 22

what would inhibiting phosphodiesterase do

Answer 22

prevent breakdown of cAMP
increased inotropy
increased dromotrophy
increased chronotropy

Question 23

adverse effects of inamrinone

Answer 23

thrombocytopenia
dysrhythmia
nausea
hypotension
elevated liver enzymes with long-term use

Question 24

adverse effects of milrinone

Answer 24

milrinone
dysrhythmia: mainly ventricular
hypotension
angina
hypokalemia
tremor
thrombocytopenia

Question 25

cardiac glycosides

Answer 25

no longer used as a first line treatment originally obtained from the digitalis plant, foxglove digoxin is the prototype used in heart failure and to control ventricular response to atrial fibrillation or flutter

Question 26

mechanism of action of cardiac glycosides

Answer 26

increase myocardial contractility change electrical conduction properties of the heart -decrease the rate of electrical contraction -prolong the refractory period -area between the SA node and AV node

Question 27

drug effects of cardiac glycosides

Answer 27

positive inotropic effect increased force and velocity of myocardial contraction(without an increase on oxygen consumption) negative chronotropic effect reduced heart rate negative dromotropic effect -decreased automaticity at SA node, decreased AV nodal conduction and other effects

Question 28

cardiac glycosides more drug effects

Answer 28

increased stroke volume reduction in heart size during diastole decrease in venous BP and vein engorgement increase in coronary circulation promotion of diuresis because of improved blood circulation palliation of extertional and paroxysmal nocturnal dyspnea, cough, and cyanosis

Question 29

indications that you need cardiac glycosides

Answer 29

heart failure supraventricular dysrhythmias -atrial fibrilationand atrial flutter

Question 30

adverse effects of cardiac glycosides

Answer 30

``` digoxin(Lanoxin) -narrow therapeutic window drug levels must be monitored low potassium levels increase its toxicity electrolyte levels must be monitored ```

Question 31

adverse effects of digoxin in the cardiovascular system

Answer 31

dysrhythmias, including either bradycardia or tachycardia

Question 32

adverse effects of digoxin on the CNS

Answer 32

headaches, fatigue, malaise, confusion, convulcsions

Question 33

adverse effects of digoxin on the eye

Answer 33

colored vision, halo vision, flickering lights,

Question 34

adverse effects of cardiac glycosides on the GI tract

Answer 34

anorexia, nausea, vomiting, diarrhea

Question 35

digoxin toxicity

Answer 35

hyperkalemia life-threatening cardiac dysrhythmias life-threatening digoxin overdose

Question 36

conditions that predispose to digoxin toxicity

Answer 36

``` jypokalemia use of cardiac pacemaker hepatic dysfunction hypercalcemia dysrhythmias hypothyroid, respiratory, or renal disease advanced age ```