Miscellaneous Quiz / CHF drugs

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Can you name the CHF drugs?

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IV only for acute HF
Toxicity increased by HYPOkalemia
B1 agonists - inotropes
Tx of MI with power failure (decreased atrial pressure, elevated LV filling pressure, decreased CO)
SE: direct decrease in LV function
Block angiotension type 1 (AT1) receptors without effects on bradykinin
Decreases ACE thus preventing conversion of angiotensin I --> angiotensin II and also inhibits breakdown of bradykinin --> decreased PVR without reflex --> decreased preload, after
Start at low doses and work up slowly over weeks
Given as a bolus followed by continuous infusion
Digoxin has a wide OR narrow therapeutic window
B1 agonist SE
Reduces preload and afterload --> decreased LVH and remodeling
B-type naturetic peptide drug
Released in response to ventricular pressure increases --> opposition of vasoconstrictor and Na and H2O retaining effects of S-ANS, RAAS --> decreased renin formation --> vasodilat
Reversibly inhibits the Na/K/ATPase which causes vagal nerve hyperpolarization and --> increased intracellular Ca and contraction
Drugs that may increase dig toxicity
Tx of MI with peripheral vasodilation
Methylxanthine phosphodiesterase inhibitor
SE: hyperkalemia, gonadal hormone issues (gynecomastia, decreased libido, hirsutism, impotence, menstrual irregularities), gastric dyspepsia and ulcers
Dosage related to creatinine clearance and body wt.
First line tx of CHF with reduced mortality
Tx for MI with pulmonary congestion
Phosphoesterase inhibitors - inotropes
MOA: Inhibit NaCl transport in DCT preventing Na reabsorption
Treats symptoms of CHF - dyspnea, orthopnea, edema, rales, JVD. Controls filling pressures
HintAnswer
Drugs that decrease afterload and preload
SE: increased SM tone of the gut, anorexia, diarrhea, hallucinations, visual disturbances, agitation, convulsions, gynecomastia, arrhythmias (AV junctional rhythm, bigeminy, PVCs,
SE: initial dose severe hypotension, RF, dry cough, angioedemia, hyperkalemia if RF present
Tx of MI with severe shock
ACEI
Inotrope contraindicated in WPW. Usually used in rate contral and in the treatment of atrial arrhythmias
MOA: inhibit Na-K-Cl exchanger in TAL
Half life of 40 hours, steady state reached in 1 week
Tx for hypovolemic MI
Direct effect of digoxin
SE: n/v, thrombocytopenia, liver enzyme changes, bone marrow changes
Watch dose in antibiotic use
Class used for LV systolic dysfunction
Tx of MI with RV infarct, MR, and/or VSD
Class reserved for end-stage HF, refractory HF, and acute HF
Cardiac glycoside - inotrope
Reduces mortality and improves CHF symptoms by blocking high levels of catecholamines --> decreased remodeling, upregulating beta receptors, decreasing HR, and decreases renin rele
INdirect effect of digoxin
MOA: inhibit aldosterone receptor and thus aldosterone-mediated increase in Na pump uptake of Na from lumen to blooc
Class that increases cAMP mediated phosphorylation of voltage-gated Ca channels --> increased Ca conduction
Treatment of Dig toxicity
Bipyridine phosphodiesterase inhibitor
DOC for refractory HF
Contraindicated in pregnancy and affected by NSAIDs

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