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Cardiovascular System > Heart Failure pharm > Flashcards

Heart Failure pharm Flashcards

1
Q

What are 8 classes of drugs used in HF?

A

1) ACEi
2) ARBs
3) ß-blockers
4) Sacubitril-Valsartan
5) Mineralocorticoid receptor antagonists
6) Hydralazine
7) Ivabradine
8) Nitrates

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2
Q

Which 4 ß-blockers are approved for HF treatment?

A

Cardio(ß1) selective:
1) Bisoprolol
2) Metoprolol XL

Non-selective:
3) Carvedilol

Mixed (3rd gen):
4) Nebivolol

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3
Q

What is the moa of Sacubitril-Valsartan?

A

Sacubitril is a neprilysin inhibitor (so prevents break down of natriuretics)
but neprilysin ↑AT2 so Valsartan added to prevent -ve effects of AT2 as a ARB

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4
Q

When is Sacubitril-Valsartan indicated?

A

Chronic HFrEF

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5
Q

What are 5 AEs of Sacubitril-Valsartan?

A

1) Hypotension
2) Hyperkalemia
3) Renal failure
4) Cough
5) Angioedema

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6
Q

What are 5 examples of loop diuretics?

A

ET is FABulous
Ethacrynic acid
Torasemide
Furosemide
Azosemide
Bumatanide

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7
Q

What is the moa of loop diuretics?

A

Inhibit luminal Na/K/Cl transporter in thick ascending limb of LoH
→ excess intracellular K+
→ K+ back diffusion
→ ↑Mg2+ and Ca2+ excretion

  • furosemide also ↑renal blood flow
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8
Q

How do NSAIDs affect loop diuretics?

A

Loop diuretics induce renal PG synthesis (↓ by NSAIDs)

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9
Q

Loop diuretics are (slowly/rapidly) absorbed and the diuretic response is (slow/rapid) following IV injection.

A

Rapid absorption, extremely rapid response

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10
Q

What are 4 clinical uses of loop diuretics?

A

1) Acute pulmonary edema
2) Acute hyperkalemia
3) Acute renal failure
4) Anion overdose

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11
Q

What are 4 AEs of loop diuretics?

A

1) Hypokalemic metabolic acidosis
2) Ototoxicity
3) Hyperuricemia
4) Hypomagnesemia

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12
Q

What antibiotics should be avoided with loop diuretics?

A

Aminoglycosides (ototoxicity)

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13
Q

What are 4 K+-sparing diuretics?

A

1) Spironolactone
2) Triamterene
3) Amiloride
4) Eplerenone

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14
Q

What is the moa of K+-sparing diuretics?

A

Spironolactone, Eplerenone: inhibit aldosterone receptor on principal cells of collecting duct
Triamterene, Amiloride: inhibit Na+ channel

Both eventually ↓Na/water reabsorption → ↓K+ secretion

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15
Q

Spironolactone has a (fast/slow) onset of action.

A

slow

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16
Q

Where is triamterene metabolised?

A

Liver

17
Q

Triamterene has a (longer/shorter) T1/2 than amiloride?

A

Shorter

18
Q

How is amiloride excreted?

A

unchanged in urine

19
Q

What are the clinical uses of K+-sparing diuretics?

A

1) Diuretic
2) Hyperaldosteronism

20
Q

What are 2 AEs of K+-sparing diuretics?

A

1) Hyperkalemia
2) Metabolic acidosis
3) Gynecomastia (spironolactone)
4) Acute renal failure (triamterene + indomethacin)
4) Kidney stones (Triamterene)

21
Q

What is the moa of hydralazine?

A

Direct arteriole vasodilator:
- inhibit IP3-induced Ca release from SER
→ ↓ peripheral resistance
- compensatory release of E/NE → ↑venous return and CO

22
Q

What are 3 indications for hydralazine?

A

1) HFrEF (with ISDN): oral
2) essential HTN (when 1st line inadequate): oral
3) Acute severe peripartum/post-partum HTN: IV

23
Q

What is the onset and duration of IV and oral hydralazine?

A

IV: onset 5-30min, duration 2-6hrs
Oral: onset 20-30min, duration 2-4 hrs

reaches peak Pc in 2.5 hrs, T1/2 ~ 7hrs

24
Q

When is hydralazine contraindicated?

A

px with CAD
(SNS stimulation → ↑myocardial O2 Dd)

25
Q

What are 4 AEs of Hydralazine?

A

1) Hydralazine-induced lupus syndrome (HILS
- Arthralgia, myalgia, serositis, fever
- dose dependent
- can be resolved w discontinuation

Baroreflex associated SNS activation:
2) Flushing
3) Hypotension
4) Tachycardia

26
Q

What plant is digitalis derived from?

A

Foxglove

27
Q

What is the moa of digitalis?

A

inhibits Ka/K exchanges → ↑intracellular Na
→ inhibit Ca2+ efflux by Ca/Na exchanger
→ ↑intracellular Ca
→ stronger systolic contraction

28
Q

What are 3 cardiac effects of digitalis

A

1) Mechanical:
Contractility ↑ → ↑CO → ↓SNS + ↓ AT2 → ↓Afterload + preload

2) Electrical:
a) ↓QT, ST, T wave inversion
b) ↑PNS → ↑PR ↓Ventricular rate

3) Toxic
- ↑intracellular Ca → ↑ automaticity, extrasystoles, tachycardia, fibrillation

29
Q

What are 2 clinical uses for digitalis?

A

1) Systolic dysfunction
2) Atrial fibrillation

30
Q

What are 3 AEs of digitalis?

A

1) Progressive dysrhythmias: AV block, Afib, Vfib
2) GI effects: anorexia, nausea, vomiting
3) CNS: headache, fatigue, confusion, blurred vision

31
Q

How is digitalis toxicity treated?

A

1) Discontinue
2) Correct K/Mg deficiency
3) Antiarrhythmics (eg. lidocaine, propanolol)
4) Digoxin Abs (FAB fragments, digibind)

Cardiovascular System (12 decks)

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