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Flashcards in Pharm: CHF drugs Deck (23):
1

What is acutely decompensated CHF?

Acute CHF superimposed on the setting of chronic CHF

2

What are the treatment objectives for acute CHF?

Early recognition and treatment
Decrease symptoms
- Reduce pulmonary congestion: loop diuretics, venodilators, nesiritide
-Increase CO:
--Increase contractility: beta blockers, phosphodiesterase inhibitors
--Reduce afterload: nitroprusside

3

Why are diuretics useful for acute CHF?

Reduced preload and pulmonary venous pressure
Increases oxygenation

4

What diuretics are used to treat acute CHF?

Furosemide
Thiazides

5

What is the major effect of nitrates?

Dilation of venous capacitance vessels

6

What is Niseritide and what is it used for clinically?

Niseritide is a recombinant form of BNP
Used to treat CHF by inducing vasodilation and natriuresis

7

What inotropic agents are used to treat CHF?

Beta agonists: dobutamine, dopamine, isoproterenol and norepinephrine
Phosphodiesterase inhibitors: inamrinone, milrinone
*These drugs increase cAMP levels

8

What are the actions of cAMP in cardiac muscle?

Opens L-type Ca2+ channels
Increased reuptake of Ca into SR
Increased pacemaker current
Increased rate of conduction

9

Why are vasodilators beneficial for CHF patients?

Reduced afterload due to reduced systemic vascular resistance allows for increased SV and CO

10

Are Calcium channel blockers used for CHF patients?

No. Contraindicated for CHF due to negative inotropic effects

11

What are the non-pharmacological therapies for acute CHF?

PCI/surgical therapy: revascularization and/or valve repair
Ultrafiltration
Intra-aortic balloon pump
Ventricular assist devices

12

What are the treatment objectives for chronic CHF?

Early recognition of ventricular dysfunction
Prevent ventricular remodeling
Decrease symptoms: decrease congestion, increase CO
Prolong survival

13

What drugs prevent ventricular remodeling?

ACE inhibitors, ARB's, LCZ696
Beta blockers
Aldosterone antagonists (spironolactone)

14

What is the mechanism of action of digitalis glycosides?

Inhibit the Na/K ATPase pump which increase the Na inside the cell, this leads to increased activity of the Na/Ca exchanger, bringing more Ca into the cell and more Ca stored in the SR

15

What are the mechanical effects of digitalis glycosides?

Increased contractility
-increased velocity of shortening, force of contraction, ventricular emptying
-Decreased ESV and EDV

16

What are the systemic effects of digitalis glycosides?

Increased CO
Increased renal perfusion
Decreased sympathetic tone

17

What are the side effects of digitalis?

VERY NARROW THERAPEUTIC WINDOW
Causes DADs and abnormal automaticity, arrhythmias

18

What is the difference in vasodilator drugs used for acute versus chronic CHF?

Acute CHF drugs (nitroprusside, nitroglycerin) are given IV and have rapid onset of action
Chronic CHF drugs (ACEi's, ARBs, hydralazine, minoxidil, prazosin, LCZ696) are given orally and have slower onset of aciton

19

What is the mechanism of action for ACE inhibitors preventing ventricular remodelling?

1) Ang II is a cardiomyocyte growth factor and fibroblast mitogen
2) Inhibit RAA system
3) Decreased wall stress

20

What is LCZ696?

A combination of valsartan (ARB) and sacubitril (Neprilysin inhibitor)
Valsartan blocks the AT1a receptor on cardiac and vascular smooth muscle
Sacubitril causes vasodilation and reduced ECF volume via sodium excretion

21

How are beta blockers useful for chronic CHF treatment?

Increased survival due to reduced LV deterioration
Mechanism: reduced HR and blocking deleterious effects of chronic sympathetic stimulation

22

What specific beta blockers are used for chronic CHF therapy?

Carvedilol
Metoprolol
Bucindolol

23

What are the nonpharmacological treatments for chronic CHF?

Surgical therapy
Left ventricular assist devices
Biventricular pacing
Cardiac transplantation