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Questions and Answers
What are the effects of diuretics in congestive heart failure?
What are the effects of diuretics in congestive heart failure?
- Increase heart rate
- Increase circulating volume
- Enhance survival without reducing edema
- Decrease preload and improve ventricular efficiency (correct)
Which of the following is a cardiac glycoside used in CHF treatment?
Which of the following is a cardiac glycoside used in CHF treatment?
- Lisinopril
- Digoxin (correct)
- Spironolactone
- Furosemide
What is one of the main actions of digitalis in cardiac treatment?
What is one of the main actions of digitalis in cardiac treatment?
- Inhibit calcium entry
- Increase heart rate
- Decrease myocardial contraction force
- Increase the force of myocardial contraction (correct)
What is a common side effect of digitalis toxicity?
What is a common side effect of digitalis toxicity?
Why are potassium-sparing diuretics used in CHF treatment?
Why are potassium-sparing diuretics used in CHF treatment?
What is a primary function of ACE inhibitors in managing CHF?
What is a primary function of ACE inhibitors in managing CHF?
Which interaction might precipitate digitalis-related arrhythmias?
Which interaction might precipitate digitalis-related arrhythmias?
How long does it take for Digoxin to reach its maximum effect after oral dosing?
How long does it take for Digoxin to reach its maximum effect after oral dosing?
What is a primary benefit of using diuretics in congestive heart failure?
What is a primary benefit of using diuretics in congestive heart failure?
Which medication is recommended for patients with renal failure instead of Digoxin?
Which medication is recommended for patients with renal failure instead of Digoxin?
What is a characteristic of the therapeutic index of cardiac glycosides?
What is a characteristic of the therapeutic index of cardiac glycosides?
Which of the following is a side effect of digitalis toxicity?
Which of the following is a side effect of digitalis toxicity?
What is the role of potassium-sparing diuretics in the treatment of congestive heart failure?
What is the role of potassium-sparing diuretics in the treatment of congestive heart failure?
What may be a consequence of diuretics causing hypokalemia in patients on digitalis?
What may be a consequence of diuretics causing hypokalemia in patients on digitalis?
Which class of medication is effective in improving survival in patients across all severities of heart failure?
Which class of medication is effective in improving survival in patients across all severities of heart failure?
What interaction affects the absorption of Digoxin?
What interaction affects the absorption of Digoxin?
What is the primary function of glyceryl nitrate in acute heart failure?
What is the primary function of glyceryl nitrate in acute heart failure?
Which medication is primarily a β1 agonist used in acute heart failure?
Which medication is primarily a β1 agonist used in acute heart failure?
What is a common initial dosing recommendation for carvedilol in heart failure treatment?
What is a common initial dosing recommendation for carvedilol in heart failure treatment?
What role does hydralazine play in heart failure treatment?
What role does hydralazine play in heart failure treatment?
What is the dosage range for dopamine when used in cardiogenic shock?
What is the dosage range for dopamine when used in cardiogenic shock?
Flashcards
Diuretics in Heart Failure
Diuretics in Heart Failure
Drugs used to remove excess fluid from the body, particularly in patients with heart failure. They help reduce fluid overload, decrease pressure on the heart, and improve its efficiency.
High-Ceiling Diuretics
High-Ceiling Diuretics
High-ceiling diuretics, like furosemide and bumetanide, are powerful drugs used to rapidly remove significant amounts of fluid in patients with severe heart failure.
Potassium-Sparing Diuretics
Potassium-Sparing Diuretics
These diuretics, such as spironolactone, help remove fluid while preserving potassium levels, which is crucial for heart function.
Cardiotonics
Cardiotonics
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Cardiac Glycosides
Cardiac Glycosides
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ACE Inhibitors in Heart Failure
ACE Inhibitors in Heart Failure
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Beta Blockers & Calcium Channel Blockers in Heart Failure
Beta Blockers & Calcium Channel Blockers in Heart Failure
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Digoxin Toxicity
Digoxin Toxicity
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What are diuretics used for in heart failure?
What are diuretics used for in heart failure?
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What are high-ceiling diuretics used for?
What are high-ceiling diuretics used for?
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What do potassium-sparing diuretics preserve?
What do potassium-sparing diuretics preserve?
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What are cardiac glycosides derived from?
What are cardiac glycosides derived from?
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Why is digitoxin preferred over digoxin in renal failure?
Why is digitoxin preferred over digoxin in renal failure?
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What are the signs and treatment of digoxin toxicity?
What are the signs and treatment of digoxin toxicity?
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What is the role of ACE inhibitors in heart failure?
What is the role of ACE inhibitors in heart failure?
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What are beta-blockers and calcium channel blockers used for in heart failure?
What are beta-blockers and calcium channel blockers used for in heart failure?
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Vasodilators in acute heart failure
Vasodilators in acute heart failure
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Hydralazine's role in heart failure
Hydralazine's role in heart failure
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Beta Blockers for Heart Failure
Beta Blockers for Heart Failure
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Cardiac Stimulants for Pump Failure
Cardiac Stimulants for Pump Failure
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Dobutamine Role in Acute Heart Failure
Dobutamine Role in Acute Heart Failure
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Study Notes
Congestive Heart Failure (CHF) Medications
- Diuretics: Used to treat almost all cases of symptomatic CHF, increasing urine output to reduce fluid buildup.
- High Ceiling Diuretics (e.g., Furosemide, Bumetanide): Preferred for mobilizing edema fluids.
- Potassium-Sparing Diuretics (e.g., Spironolactone): Enhance diuresis, maintain potassium levels, and improve CHF survival.
- Mechanism of Action: Decrease preload, improve ventricular efficiency by reducing circulating volume, remove peripheral edema and pulmonary congestion.
Cardiotonics (Cardiac Stimulating Drugs)
- Cardiac Glycosides (e.g., Digoxin, Digitoxin, Ouabain): Derived from digitalis plants.
- Mechanism of Action:
- Increase myocardial contractility by stimulating calcium influx.
- Decrease heart rate (bradycardia) by stimulating the vagal center in the CNS and inhibiting electrical conduction in the SA node.
- Pharmacokinetics:
- Low therapeutic index (narrow margin of safety).
- Variable onset of effect after oral dose (digoxin = 6 hrs, digitoxin = 12 hrs).
- Slow excretion (digoxin = 36 hrs, digitoxin = 150 hrs).
- Digoxin excretion is kidney-dependent, crucial in renal failure; digitoxin preferred when kidney function is impaired.
- Maintenance Doses (approximate): Digoxin (0.012-0.5 mg daily), Digitoxin (0.05-0.2 mg daily).
- Side Effects: High toxicity potential including nausea, anorexia, vomiting, visual disturbances, headache, severe bradycardia, arrhythmias, and gynecomastia.
- Treatment of Toxicity: Discontinue further doses, administer antidotes (lidocaine and phenytoin), give atropine to alleviate bradycardia, and consider beta-blockers (e.g., propranolol).
- Drug Interactions: Diuretics can cause hypokalemia, potentially precipitating digitalis arrhythmias; potassium supplements may be given prophylactically. Quinidine reduces digoxin tissue binding. Calcium channel blockers (CCBs) like diltiazem and verapamil may increase calcium concentration, which can oppose digitalis' positive inotropic action. Propranolol, verapamil, and diltiazem may depress AV conduction, opposing the positive inotropic action of digoxin. Phenobarbital, and other enzyme inducers reduce digoxin absorption. Metoclopramide, antacids, and neomycin reduce digoxin absorption. Succinylcholine can cause arrhythmias in patients taking digitalis.
- Mechanism of Action:
ACE Inhibitors
- ACE Inhibitors (e.g., Captopril, Lisinopril, Enalapril, Ramipril): Improves survival in all severities of heart failure.
- Essential Information:
- Start low, titrate up carefully.
- Examples and approximate starting doses: enalapril (2.5 mg BID), captopril (6.25 mg TID), lisinopril (5 mg BID).
- If not tolerated, consider Angiotensin Receptor Blockers (ARBs) like losartan.
- Mechanism of Action: Inhibit the renin-angiotensin system, relieving symptoms by decreasing the stimulation of the system.
- Essential Information:
Vasodilators
- Used intravenously in acute heart failure
- Glyceryl nitrate provides rapid relief in acute left ventricular failure and significantly lowers preload (used with strong diuretics)
- Hydralazine: Dilates resistance vessels, reduces aortic impedance, and may cause renal vasodilation, potentially useful in renal insufficiency.
Beta-blockers
- Beta-2 blockers (primarily carvedilol) have shown benefit in mild to moderate CHF treated with standard ACE inhibitors, diuretics, and/or digitalis.
- Starting doses are very low: carvedilol (50 mg/day), bisoprolol (10 mg/day), metoprolol (50 mg/day).
Cardiac Stimulants
- Dopamine and dobutamine increase contractility and dilate blood vessels, useful in emergency pump failure.
- Dobutamine: Relatively selective beta-1 agonist, used in acute heart failure (2-8 mcg/kg/min).
- Dopamine: Used in cardiogenic shock (acute heart failure) (3-10 mcg/kg/min).
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