Pharm #9 - Acute CHF Drugs Flashcards Preview

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Flashcards in Pharm #9 - Acute CHF Drugs Deck (22):
1

NITRATES (nitroglycerin/ nitroprusside)

-MOA
-Indications (2) and clinical effect

- reduce preload by causing vasodilation of venous capacitance vessels
- reduce after load

3- decrease filling pressures, decrease arterial blood pressure

2

NITRATES (nitroglycerin/ nitroprusside)

- adverse effects (4, 1 main)
- contraindication 1

adverse:
- hypotension
- relfex tachy
- methemglobinemia
- nitrate tolerance**

contra:
- systemic hypotension

3

Nisertide

- MOA
- indication 1 + Clinical effect (2)

MOA: activates vascular smooth muscle and renal BNP receptors
- raise cGMP levels in VSMC and renal epithelial cells


Indication:
- acutely decompensated CHRONIC CHF in hospitalized patients

Clinical: vasodilation (afferente arteriole) to increase GFR, induce natriuresis and vasodilation

4

Nisertide

- adverse effects (2)
- contra (2)

- hypotension
- ventricular arrhythmias

Contra: reduced LV filling pressures
- systemic hypotension

5

B- Agonists (isoproterenol, dopamine, dobutamine, NE)

- MOA
- 2 indications / 3 clinical effects

MOA:
- stimulates cardiac beta receptors to increase cAMP

1. low cardiac output due to acute CHF
2. cardiogenic shock

Clinical:
1. increase HR
2. Increase contractility
3. increase CO

6

B- Agonists (isoproterenol, dopamine, dobutamine, NE)

- adverse effects 3
- 2 contra

1. arrhythmias
2. increased O2 consumption
3. Angina & vasoconstriction(NE)

Contra
- ventricular arrhythmias
- severe peripheral vascular disease

7

Digoxin:

- MOA
- indication (2)
- clinical 2

MOA:
- partially inhibits Na/K ATPase increasing reverse mode Na/Ca exchange and increasing SR Calcium!!!

Indications:
- acute CHF
- atrial fibrillation with rapid ventricular response

Clinical:
- increased contractility
- decreased AV node conduction velocity

8

Digoxin:

Side effects 2 major , 2 others

contra (2)

- Arrhythmias
- heart block

anorexia, nausea/vomiting

1. History of Ventricular tachycardia / ventricular fibrillation
2. hypokalemia

9

Phosphodiesterase inhibitors (name 2)

MOA
Indication
Clinical (3)

Inamrinone
Milrinone

Moa: inhibit degradation of cAMP in cardiomyocytes --> increasing cAMP in cardiac muscle
- inhibit degradation of cGMP in vascular smooth muscle inducing vasodilation

Clinical (3)
- increased contractility
- vasodilation
- increased cardiac output

10

Phosphodiesterase inhibitors (name 2)

Side effects 2

Inamrinone
Milrinone

1. arrhytmias
2. hypotension

11

Nitrates

- name 3

nitroglycerin
-isosorbide dinitrate
-erythrityl tetra nitrate

12

Nitrates (nitroglycerin, isosorbide dinitrate, erythrityl tetranitrate)

MOA
indications (3 types of ___)

MOA: reacts with cysteinyl resides in vessel wall to increase the concentration of nitric oxide in vascular smooth muscle cells
= vasodilation in capacitance vessels (veins)

Indications
1. exertional angina
2. variant angina
3. unstable angina

13

Nitrates (nitroglycerin, isosorbide dinitrate, erythrityl tetranitrate)


adverse effects -4
contra 1

- orthostatic hypotension
-reflex tachycardia
-HA
- nitrate tolerance

Contra: systemic hypotension

14

Ca Channel blockers
-nifedipine
-nicardipine
- verapamil
-diltiazem

MOA
Indication

Block L type C achannels in VSMC and cardiac myocytes
= vasodilation and decreased contractility

Indication:
-exertional angina
- variant angina
- unstable angina

Clinical effect: prevents episodes of exercise induced vasospastic angina

15

Ca Channel blockers
-nifedipine
-nicardipine
- verapamil
-diltiazem

Adverse effects 4 (1 for nifedipine specifically)
Contra 3

Adverse
- bradycardia
-heart block
-CHF
- hypotension & peripheral edema
- REFLEX TACHY in NIFEDIPINE

Contraindication:
- advanced heart block
- CHF
- systemic hypotension

16

B - Blockers
( propranolol, nadolol, atenolol, metoprolol, carvedilol)

MOA
Indications 3
Clinical effect - 1

MOA: block B receptors in cardiac myocytes to reduce contractility

Indications:
- exertional angina
- unstable angina
- post MI prophylaxis

Clinical effect:
- prevent exercise induced myocardial ischemia

17

B - Blockers
( propranolol, nadolol, atenolol, metoprolol, carvedilol)

- adverse effects - ALOT
- contraindication (4)

Adverse:
- bronchospasm
- peripheral vasospasm
- bradycardia
- CHF
- Heart block
- depression/fatigue
-BLOCK INSULIN INDUCED HYPOGLYCEMIA
- impotence

Contra:
- heart block
- ACUTE CHF
- insulin dep. diabetes mellitus
-COPD

18

RANALAZINE

MOA (?)
Indication

MOA: inhibit fatty acid beta oxidation in cardiac myocyte mitochondria

Indication: patients with chronic stable angina unresponsive to other agents
- now approved for EXERCISE INDUCED ANGINA

19

RANALAZINE

- adverse effect
- contraindicated

prolong QT interval

Contra: long QT syndrome & use with other drugs that prolong QT

20

Ivabradine

MOA
Indication

MOA:
- block If current in SA nodal fibers

- indication: chronic stable angina

21

Ivabradine

- adverse 3
- contraindication 2

adverse:
- bradycardia
- heart block
- luminous phenomenon

Contra:
-sick sinus syndrome
- use with calcium channel blockers verapamil or dilitiazem

22

Which dog is contraindicated for use with - use with calcium channel blockers verapamil or dilitiazem

IVABRADINE

- block If current in Sa nodal fiber and prevent exercise induced MI