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D1 Spring > Pharmacology - Drugs for Heart Failure (Exam 4) > Flashcards

Pharmacology - Drugs for Heart Failure (Exam 4) Flashcards

1
Q

What are the drugs used for heart failure?

A

ACE Inhibitors (commonly used)
Diuretics
Vasodilators
B blockers
Angiotensin Receptor Blockers

Digoxin (NOT commonly used)

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2
Q

What is the main difference between the heart and other muscles?

A

Heart cannot rest

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3
Q

Inability to pump blood at sufficient rate to meet metabolic demands of the body

A

Heart failure

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4
Q

Final and most severe manifestation of nearly every form of cardiac disease including things like atherosclerosis, hypertension, MI, CAD, etc

A

Heart failure

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5
Q

What are the most common causes of heart failure?

A

CAD
MI
Hypertension

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6
Q

What are other causes (outside the heart) of heart failure?

A

Hemorrhage
Drug toxicity
Other diseases (ex: diabetes)

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7
Q

Hypertension increases __________, which _________ the chances of pumping blood out of the ventricle

A

afterload; reduces

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8
Q

What does increased afterload due to hypertension cause?

A

Heart becomes hypertrophic and dilated
Leads to heart failure

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9
Q

What is the cardiac output equation?

A

CO = HR x SV

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10
Q

Failing heart means you have a ________ (high/low) cardiac output

A

low

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11
Q

What are the 2 types of heart failure?

A

Left sided
Right sided

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12
Q

Which heart failure?

Systolic dysfunction in ~2/3 of patients due to impaired ventricular contractility and increased afterload

Diastolic dysfunction in ~1/3 of patients due to impaired ventricular filling (decreased preload)

A

Left sided

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13
Q

What are the causes of right sided heart failure?

A

Left sided heart failure (mainly)
Pulmonary embolism

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14
Q

What are the complications of heart failure (what can heart failure lead to if untreated)?

A

Kidney damage/failure
Heart valve problems
Arrhythmia
Liver damage

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15
Q

What do drugs for heart failure target?

A

The body’s compensatory mechanisms

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16
Q

BP equation

A

BP = Flow x TPR

(flow = CO)

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17
Q

In heart failure, you have decreased BP and CO (flow). How can the body try to bring BP back up?

A

Increasing CO (flow) and TPR

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18
Q

How does the body increase CO (flow)?

A

Increase HR, contractility, blood volume

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19
Q

How does the body increase TPR?

A

Vasoconstriction

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20
Q

What are the 3 neurohormonal changes in heart failure?

A
  1. Increase SNS
  2. Increase RAA system
  3. Increase ADH (to save water!)

drugs for heart failure target these

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21
Q

T/F compensatory mechanisms for heart failure are good long term

A

FALSE, they are bad long term because they cause maladaptive structural changes and decreased cardiac performance

22
Q

What do drugs for heart failure target?

A

The compensatory mechanisms:

  1. SNS
  2. RAA system
  3. ADH
23
Q

What is the best drug for short term treatment for heart failure?

A

Dobutamine (B1 agonist)

23
Q

What is the first drug of choice to treat heart failure?

A

ACE Inhibitors

24
Q

What is the suffix for ACE inhibitors?

A

“-pril”

25
Q

Which drug is an aldosterone antagonist?

A

Spironolactone

26
Q

What is the mechanism of Spironolactone

A

K+ sparing diuretic

27
Q

What is the adverse reaction of aldosterone antagonists like Spirolactone?

A

Hyperkalemia

28
Q

What is the suffix for angiotensin receptor blockers?

A

“-sartan”

29
Q

T/F decreasing the preload in patients with heart failure is a bad thing

A

FALSE, it is a good thing because it will decrease pulmonary congestion to improve breathing

30
Q

What is the mechanism of vasodilators?

A

Decrease afterload, end diastolic volume, preload, pulmonary congestion, pulmonary edema

Increase tissue perfusion

31
Q

Which drugs are vasodilators?

A

Nitrates
Hydralazine

32
Q

Which drugs are nitrates?

A

Nitroglycerin
Isosorbide dinitrate

33
Q

What do nitrates do? (ON EXAM)

A

Decrease preload

(“venous vasodilator”)

34
Q

What does Hydralazine do? (ON EXAM)

A

Decrease afterload

(“arteriolar vasodilator”)

35
Q

How do B blockers treat heart failure?

A

Decrease HR, contractility, and oxygen/metabolic demand

36
Q

What do B blockers increase in heart failure patients that could lead to a poor prognosis?

A

Serum catecholamine levels

37
Q

What is the suffix of B blockers?

A

“-lol”

38
Q

T/F Digoxin is not a popular choice and is rarely prescribed

A

True

39
Q

Digoxin has a very ________ (high/low) toxicity

A

high

40
Q

Digoxin increases __________ and decreases ___________

A

contractility; HR

41
Q

Digoxin ___________ (increases/decreases) the need for compensatory mechanisms

A

decreases

42
Q

What is the mechanism of Digoxin?

A
  1. Decrease Na+/K+ ATPase activity
  2. Increase intracellular Ca2+
  3. Increase contractility, SV, CO
43
Q

Digoxin has a ________ (high/low) therapeutic index

A

low

44
Q

What are the 2 side effects of Digoxin? (ON EXAM)

A
  1. Heart block
  2. Ventricular arrhythmias
45
Q

What can Digoxin cause?

A

Hypokalemia

46
Q

What are the drug interactions of Digoxin?

A
  1. Digoxin + B agonist = increased automaticity, ectopic pacemaker activity, & risk of arrhythmia
  2. Digoxin + B blocker = decreased HR & AV conduction velocity; increased risk of bradycardia & AV nodal block
47
Q

What happens when you take Digoxin and antibiotics?

A

Increased absorption of Digoxin from GI tract
Increased potential for toxicity

48
Q

Which drug is an ADH (vasopressin) antagonist?

A

Tolvaptan

49
Q

Which drug is used to treat arrhythmias?

A

Amiodarone

50
Q

How do you treat acute pulmonary edema?

A

“LMNOP”

Lasix (furosemide = diuretic)
Morphine (for pain)
Nitrates (vasodilator)
Oxygen
Position (sit up)

D1 Spring (47 decks)

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