Heart Failure Drugs

Question 1

tx for stage A

indications:
-Vascular disease, diabetes, hypertension

Answer 1

ACE inhibitors

ARB

Question 2

tx for stage B

Indications:

1) Recent or remote MI, asymptomatic LVD, hypertensive LVH
2) Recent or remote MI, asymptomatic LVD

Answer 2

1) ACE inhibitor or ARB

2) beta-blocker

Question 3

tx for stage C

Indications: All pt

Answer 3

Ace inhibitor or ARB

Beta blocker

Question 4

tx for stage C

Indication: fluid retention

Answer 4

Diuretics

Question 5

tx Stage C

Indication: Symptomatic LVD, post-MI HF, LVD

Answer 5

Aldosterone antagonist

Question 6

tx stage C

Indication:
Symptomatic HF, African-American race

Answer 6

Hydralazine and nitrates

Question 7

tx stage C

indication: symptomatic HF

Answer 7

ARB and ACEI

Question 8

tx stage C

indication: symptomatic HF, a fib

Answer 8

digoxin

Question 9

tx stage D

indication: All patients unless contraindicated or not tolerated

Answer 9

ACEI or ARB

Question 10

tx stage D

indication:Stable NYHA class IV

Answer 10

beta blocker

Question 11

tx stage D

indication: fluid retention

Answer 11

diuretics

Question 12

tx stage D

indication: Atrial fibrillation with rapid ventricular response

Answer 12

digoxin

Question 13

tx stage D

indication: Bridge to transplantation or end of life

Answer 13

positive inotropes

Question 14

stage A

Answer 14

high risk developing HF

Question 15

stage B

Answer 15

asymptomatic HF

Question 16

stage C

Answer 16

symptomatic HF

Question 17

stage D

Answer 17

refractory end-stage HF

Question 18

drug to increase cytosolic Ca2+

increasing myocardial contractility

Answer 18

Cardiac glycosides - Digitalis (digoxin)

Question 19

drug to Increase myocardial cAMP

increasing myocardial contractility

Answer 19

Phosphodiesterase inhibitors (Amrinone, Milrinone)

Question 20

drug that is an agonist at beta1 receptor

increasing myocardial contractility

Answer 20

beta adrenergic agonists

(Isuprel, Dobutamine, Dopamine, Epinephrine, Norepinephrine)

Question 21

drug that increases beta1 receptor density

increasing myocardial contractility

Answer 21

B1 adrenergic antagonist

Metoprolol and Carvedilol

Question 22

MOA of digoxin

Answer 22

Block Na/K ATPase enzyme – will not get exiting of Na out of cell and get an increase in [Na+]; calcium stops moving out of cell as well –> increase contractility

Question 23

cardiac effects of digoxin

Answer 23

• *Positive inotropic effect
• decrease EDV and ↓ESV
• ↓ pulmonary and systemic venous pressure
• reflex ↓SANS –> (↓preload, afterload & ↓HR)
• *Direct (+) vagal effect –>
• increase vagal tone –> decrease A-V conduction
• increase PR interval (longer ERP)
• ↓APD (shorter QT)

**↑coronary flow (↓hypertrophy)

• *Proarrhythmic
• ST depression (typical hockey stick)*

Question 24

T1/2 of digoxin

Answer 24

36-48 hrs

Question 25

digoxin: Near steady-state blood levels are achieved____ days after initiation of maintenance therapy.

Answer 25

7

Question 26

Digoxin is excreted by the _1_ and is affect by rx that chage _2_

Answer 26

1. kidney | 2. RBF

Question 27

SE of digoxin

Answer 27

1. Low margin of safety 2. Electrolyte disturbances (hypokalemia) & acid-base dysbalance --> susceptibility to side effects --> monitor plasma K+ 2. Arrhythmias 3. CTZ stimulation induces anorexia, nausea, vomiting

Question 28

what is digoxin often used for

Answer 28

HF, especially CHF with AF ( no longer 1st line therapy)

Question 29

how are adverse elvations in plasma digoxin corrected

Answer 29

cholestyramine digoxin immune Fab (des-IgG) [Digibind®]– - IV --> immediate onset of action - clinical effects also reversed

Question 30

cardiovascular effects of what drug? 1) Directly stimulate myocardial contractility 2) Accelerate myocardial relaxation 3. Balanced arterial & venous dilation - -> decrease TPR, PVR, decrease LV, RV filling pressures

Answer 30

Imamrinone and Milrinone (phosphodiesterase 3 inhibitors)

Question 31

what is imamrinone and milrinone approved for?

Answer 31

short-term circulation support in advanced CHF

Question 32

MOA of inamrinone and milrinone

Answer 32

inhibit phosphodiesterase 3 increase cAMP

Question 33

how does digoxin effect mortality rate

Answer 33

no effect