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Questions and Answers
Which adverse effect is NOT commonly associated with thiazide diuretics?
Which adverse effect is NOT commonly associated with thiazide diuretics?
- Hyponatremia
- Hyperkalemia (correct)
- Hypokalemia
- Hyperglycemia
What is a key characteristic of ivabradine's mechanism of action?
What is a key characteristic of ivabradine's mechanism of action?
- Inhibits sodium channels in the heart
- Inhibits the funny channels in the SA node (correct)
- Prolongs the action potential duration
- Blocks calcium channels to reduce heart rate
Which of the following statements about thiazide diuretics is correct?
Which of the following statements about thiazide diuretics is correct?
- They primarily act on the proximal convoluted tubule.
- They have a common interaction with beta blockers.
- They can be used to treat kidney stones. (correct)
- They are contraindicated in all patients with hyperlipidemia.
What is a primary adverse effect of the angiotensin receptor/neprilysin inhibitor (ARNI) sacubitril?
What is a primary adverse effect of the angiotensin receptor/neprilysin inhibitor (ARNI) sacubitril?
Which drug is a sodium-glucose cotransporter 2 inhibitor (SGLT2)?
Which drug is a sodium-glucose cotransporter 2 inhibitor (SGLT2)?
What is a primary pharmacological effect of Digoxin?
What is a primary pharmacological effect of Digoxin?
Which of the following is a common side effect associated with Digoxin?
Which of the following is a common side effect associated with Digoxin?
What is the role of Milrinone in cardiac pharmacology?
What is the role of Milrinone in cardiac pharmacology?
What adverse effect is specifically associated with ACE inhibitors?
What adverse effect is specifically associated with ACE inhibitors?
Which of the following pharmacological agents can lead to increased potassium levels?
Which of the following pharmacological agents can lead to increased potassium levels?
What therapeutic effect do nitric oxide donors primarily provide?
What therapeutic effect do nitric oxide donors primarily provide?
Which of the following statements about Nitroprusside is true?
Which of the following statements about Nitroprusside is true?
What is the mechanism of action for PDE-3 inhibitors like Milrinone?
What is the mechanism of action for PDE-3 inhibitors like Milrinone?
What is a primary cause of congestive heart failure (CHF)?
What is a primary cause of congestive heart failure (CHF)?
Which class of drugs is primarily used to manage preload in CHF patients?
Which class of drugs is primarily used to manage preload in CHF patients?
What effect does cardiac remodeling have on the heart?
What effect does cardiac remodeling have on the heart?
Which drug class is considered a positive inotropic agent used in CHF therapy?
Which drug class is considered a positive inotropic agent used in CHF therapy?
Which symptom is commonly associated with right ventricular failure in CHF?
Which symptom is commonly associated with right ventricular failure in CHF?
What is the result of increased activity in the renin-angiotensin-aldosterone axis in CHF?
What is the result of increased activity in the renin-angiotensin-aldosterone axis in CHF?
Which of the following drugs can contribute to cardiac remodeling when used improperly?
Which of the following drugs can contribute to cardiac remodeling when used improperly?
What is the role of beta blockers in CHF management?
What is the role of beta blockers in CHF management?
What is the primary effect of beta-adrenergic antagonists on the heart?
What is the primary effect of beta-adrenergic antagonists on the heart?
Which adverse effect is specifically associated with spironolactone?
Which adverse effect is specifically associated with spironolactone?
Which diuretic is known as a ‘high ceiling’ diuretic?
Which diuretic is known as a ‘high ceiling’ diuretic?
What is one of the main uses of calcium channel blockers?
What is one of the main uses of calcium channel blockers?
What effect does hydralazine primarily have on blood pressure?
What effect does hydralazine primarily have on blood pressure?
Which adverse effect is associated with loop diuretics?
Which adverse effect is associated with loop diuretics?
In what scenario might beta blockers worsen a patient's condition?
In what scenario might beta blockers worsen a patient's condition?
A patient undergoing treatment for heart failure might be prescribed which of the following?
A patient undergoing treatment for heart failure might be prescribed which of the following?
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Study Notes
Congestive Heart Failure Management
- Goal of CHF management - Improve heart function, reduce symptoms of heart failure, and slow down progression of the disease
- Pathophysiology of CHF is the heart's inability to pump blood effectively; a consequence of conditions like recent MI, uncontrolled hypertension, and arrhythmia
- Cardiac remodeling post MI leads to fibrosis, collagen deposition, and myocyte hypertrophy
- Left ventricular failure - the heart cannot maintain the body's blood flow needs
- Right ventricular failure - the right ventricle cannot pump blood to the lungs leading to fluid buildup (ankle edema, congested liver)
Pharmacology of CHF
- Drug Management categories:
- Decrease preload - diuretics, ACEIs/ARBs, venodilators
- Decrease afterload - ACEIs/ARBs, arteriodilators
- Improve contractility - digoxin, B1 agonists, PDE3 blockers
- Decrease remodeling - ACEIs/ARBs, spironolactone, beta blockers
Positive Inotropic Drugs
- Digoxin (Digitalis)
- Increases contractility and parasympathetic tone, thereby decreasing heart rate
- Adverse effects: Nausea, vomiting, diarrhea, anorexia, ventricular arrhythmias, yellow vision, gynecomastia
Vasodilators
- ACEIs (Angiotensin-converting enzyme inhibitors) and ARBs (Angiotensin II receptor blockers)
- Chronic CHF therapy - decrease preload and afterload by blocking the renin-angiotensin-aldosterone system
- Hydralazine - Arteriole dilation, decrease afterload
- Nitric Oxide donors - Nitroglycerin, isosorbide dinitrate, nitroprusside
- Adverse effects - tolerance, headache, hypotension
- Nesiritide
Renin-Angiotensin-Aldosterone System (RAAS)
- ACEIs and ARBs Block the RAAS pathway, thereby reducing blood pressure and improving heart function
- RAAS adverse effects - First-Dose Phenomenon, hyperkalemia, cough, angioedema (brace yourself for severe allergic reaction to the drug)
Beta Blockers
- Beta 1 selective (atenolol, metoprolol) - decrease heart rate, cardiac output, and renin release
- Beta 1 and 2 blockers (nadolol, propranolol, timolol) - bronchoconstriction, hypoglycemia, peripheral vascular disease
- Labetalol and Carvedilol - alpha and beta blockers; have antioxidant potential and are preferred in CHF
- Pindolol and Acebutolol (ISA) - worsen CHF
- Esmolol - ultrashort acting
- Nebivolol - nitric oxide effect
Aldosterone Blockers (MRAs)
- Spironolactone and Eplerenone
- Antagonize aldosterone receptors
- Spironolactone causes androgen blocker effects
- Use: high aldosterone/ CHF, acne, hirsutism
- Adverse effects: Hyperkalemia, acidosis, gynecomastia, impotence
Loop Diuretics
- Furosemide, Bumetanide, Torsemide, Ethacrynic acid
- Inhibit Na/K/2Cl- cotransport in the thick ascending loop of Henle
- Reduce preload
- Adverse effects: hypokalemia, hypomagnesemia, hypocalcemia, hyperuricemia, metabolic alkalosis, ototoxicity
Thiazide Diuretics
- Hydrochlorothiazide, Chlorthalidone, Indapamide
- Use: hypertension, CHF, kidney stones, nephrogenic diabetes insipidus
- Adverse effects: Hypokalemia, alkalosis, hyperglycemia, hypercalcemia, hyperlipidemia, hyperuricemia, hypovolemia, hyponatremia
Ivabradine
- Selective If inhibitor (“funny channel” blocker)
- Inhibits action in the SA node
- Use: CHF and stable angina, especially those who can't tolerate or be managed with beta antagonists
- Adverse effects: bradycardia, vision changes
Other Drugs
- Angiotensin receptor/neprilysin inhibitor (ARNI) - Sacubitril (prodrug) inhibits neprilysin to enhance natriuretic peptides (combined with Valsartan)
- Adverse effect: hypotension, hyperkalemia.
- Sodium-glucose cotransporter 2 inhibitor (SGLT2) - dapagliflozin
- Conivaptan - Blockade of V1a receptor decreases PVR. V2 blockade causes water secretion.
- Subtype 2 sodium-glucose transport protein (SGLT2) inhibitors
- Canagliflozin, dapagliflozin, empagliflozin
- Glucose excreted by kidney via proximal tubule
- CHF management: promotes diuresis and reduces A1c
- Adverse Effects: UTIs, monitor GFR (not for CrCl <30ml/min)
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