Podcast
Questions and Answers
Which medication is a digitalis glycoside used to increase intracellular calcium and improve cardiac contractility in HFrEF patients?
Which medication is a digitalis glycoside used to increase intracellular calcium and improve cardiac contractility in HFrEF patients?
- Dobutamine
- Digoxin (correct)
- Milrinone
- Nesiritide
Which beta-blocker is recommended for all patients with chronic, stable HFrEF due to its ability to reduce morbidity and mortality?
Which beta-blocker is recommended for all patients with chronic, stable HFrEF due to its ability to reduce morbidity and mortality?
- Carvedilol (correct)
- Esmolol
- Atenolol
- Propranolol
Which ARB/neprilysin inhibitor is used as a replacement for ACE inhibitors or ARBs in HFrEF patients who remain symptomatic?
Which ARB/neprilysin inhibitor is used as a replacement for ACE inhibitors or ARBs in HFrEF patients who remain symptomatic?
- Losartan
- Irbesartan
- Sacubitril/Valsartan (correct)
- Candesartan
Which medication is a phosphodiesterase inhibitor used for short-term treatment of acute heart failure and can cause thrombocytopenia?
Which medication is a phosphodiesterase inhibitor used for short-term treatment of acute heart failure and can cause thrombocytopenia?
Which HCN channel blocker slows heart rate by inhibiting the If channel, specifically for HFrEF patients with a heart rate > 70 BPM?
Which HCN channel blocker slows heart rate by inhibiting the If channel, specifically for HFrEF patients with a heart rate > 70 BPM?
Which aldosterone receptor antagonist is indicated for symptomatic HFrEF or HFrEF after a recent myocardial infarction?
Which aldosterone receptor antagonist is indicated for symptomatic HFrEF or HFrEF after a recent myocardial infarction?
Which medication is a recombinant B-type natriuretic peptide used in acute decompensated heart failure when IV diuretics are ineffective?
Which medication is a recombinant B-type natriuretic peptide used in acute decompensated heart failure when IV diuretics are ineffective?
Which SGLT2 inhibitor is considered first-line therapy for HFpEF?
Which SGLT2 inhibitor is considered first-line therapy for HFpEF?
Which medication requires renal dose adjustment due to its narrow therapeutic window and long half-life?
Which medication requires renal dose adjustment due to its narrow therapeutic window and long half-life?
Which neurotransmitter is primarily stimulated by beta agonists to increase cardiac contractility?
Which neurotransmitter is primarily stimulated by beta agonists to increase cardiac contractility?
Which electrolyte imbalance increases the risk of digitalis toxicity?
Which electrolyte imbalance increases the risk of digitalis toxicity?
Which beta agonist is preferred for short-term treatment of acute heart failure due to its selective action on beta-1 receptors?
Which beta agonist is preferred for short-term treatment of acute heart failure due to its selective action on beta-1 receptors?
Which enzyme is inhibited by sacubitril, leading to increased levels of natriuretic peptides?
Which enzyme is inhibited by sacubitril, leading to increased levels of natriuretic peptides?
Which receptor is blocked by eplerenone to reduce fluid retention and improve outcomes in HFrEF?
Which receptor is blocked by eplerenone to reduce fluid retention and improve outcomes in HFrEF?
Which diuretic class is preferred when extensive diuresis is required in heart failure patients?
Which diuretic class is preferred when extensive diuresis is required in heart failure patients?
Which peptide is mimicked by nesiritide to promote vasodilation, natriuresis, and diuresis?
Which peptide is mimicked by nesiritide to promote vasodilation, natriuresis, and diuresis?
Which ion's intracellular concentration directly determines the strength of cardiac muscle contraction?
Which ion's intracellular concentration directly determines the strength of cardiac muscle contraction?
Which drug class should be avoided in HFrEF patients due to the risk of exacerbating heart failure?
Which drug class should be avoided in HFrEF patients due to the risk of exacerbating heart failure?
Which medication is associated with visual disturbances such as blurred vision and yellowish vision?
Which medication is associated with visual disturbances such as blurred vision and yellowish vision?
Which adverse effect is uniquely associated with the use of ivabradine due to its effect on retinal ion channels?
Which adverse effect is uniquely associated with the use of ivabradine due to its effect on retinal ion channels?
Which electrolyte abnormality enhances the toxic effects of digitalis glycosides?
Which electrolyte abnormality enhances the toxic effects of digitalis glycosides?
Which beta agonist is preferred in cardiogenic shock due to its combined beta and alpha receptor stimulation?
Which beta agonist is preferred in cardiogenic shock due to its combined beta and alpha receptor stimulation?
Which phosphodiesterase inhibitor has the unique adverse effect of thrombocytopenia?
Which phosphodiesterase inhibitor has the unique adverse effect of thrombocytopenia?
Which combination of vasodilators is specifically beneficial for Black patients with HFrEF when added to standard therapy?
Which combination of vasodilators is specifically beneficial for Black patients with HFrEF when added to standard therapy?
Which enzyme's inhibition leads to increased bradykinin levels, contributing to cough as a side effect?
Which enzyme's inhibition leads to increased bradykinin levels, contributing to cough as a side effect?
Which drug class is contraindicated in HFrEF patients with asthma due to its bronchoconstrictive effects?
Which drug class is contraindicated in HFrEF patients with asthma due to its bronchoconstrictive effects?
Which medication requires a 36-hour washout period before switching to sacubitril/valsartan to avoid angioedema?
Which medication requires a 36-hour washout period before switching to sacubitril/valsartan to avoid angioedema?
Which medication reduces heart rate by inhibiting the If current in the SA node without affecting blood pressure?
Which medication reduces heart rate by inhibiting the If current in the SA node without affecting blood pressure?
Which medication can cause arrhythmias as a result of increasing intracellular calcium levels?
Which medication can cause arrhythmias as a result of increasing intracellular calcium levels?
Which drug is administered intravenously to treat acute decompensated heart failure when diuretics are insufficient?
Which drug is administered intravenously to treat acute decompensated heart failure when diuretics are insufficient?
Which adverse effect is specifically associated with sacubitril/valsartan, especially if combined with ACE inhibitors?
Which adverse effect is specifically associated with sacubitril/valsartan, especially if combined with ACE inhibitors?
Which electrolyte plays a key role in both cardiac contraction and the mechanism of digitalis glycosides?
Which electrolyte plays a key role in both cardiac contraction and the mechanism of digitalis glycosides?
Which drug can cause luminous phenomena (visual brightness) during early therapy?
Which drug can cause luminous phenomena (visual brightness) during early therapy?
Which loop diuretic is preferred for patients with severe fluid overload in heart failure?
Which loop diuretic is preferred for patients with severe fluid overload in heart failure?
Which inotropic agent is associated with increased myocardial oxygen consumption, limiting its use to short-term treatment?
Which inotropic agent is associated with increased myocardial oxygen consumption, limiting its use to short-term treatment?
Which medication is contraindicated in pregnancy due to its potential effects on fetal heart rate?
Which medication is contraindicated in pregnancy due to its potential effects on fetal heart rate?
Which aldosterone receptor antagonist has fewer endocrine side effects due to its selective receptor binding?
Which aldosterone receptor antagonist has fewer endocrine side effects due to its selective receptor binding?
Which medication requires dosing adjustments based on lean body weight due to its narrow therapeutic window?
Which medication requires dosing adjustments based on lean body weight due to its narrow therapeutic window?
Which mechanism directly underlies the inotropic effect of digitalis glycosides?
Which mechanism directly underlies the inotropic effect of digitalis glycosides?
Milrinone's mechanism of action directly leads to:
Milrinone's mechanism of action directly leads to:
A patient with HFrEF who is already on optimal heart failure pharmacotherapy is prescribed digoxin. Which of the following findings would warrant a reevaluation of the digoxin dose?
A patient with HFrEF who is already on optimal heart failure pharmacotherapy is prescribed digoxin. Which of the following findings would warrant a reevaluation of the digoxin dose?
Which consideration is most important when initiating digoxin therapy in an elderly patient with heart failure and renal impairment?
Which consideration is most important when initiating digoxin therapy in an elderly patient with heart failure and renal impairment?
A patient on digoxin presents with anorexia, nausea, and blurred vision with a yellow tinge. Which electrolyte abnormality would most significantly increase the risk of these symptoms?
A patient on digoxin presents with anorexia, nausea, and blurred vision with a yellow tinge. Which electrolyte abnormality would most significantly increase the risk of these symptoms?
Which mechanism primarily accounts for the inotropic effect of medications used in heart failure management?
Which mechanism primarily accounts for the inotropic effect of medications used in heart failure management?
Why are inotropic agents, excluding digitalis glycosides, generally reserved for short-term use in acute heart failure?
Why are inotropic agents, excluding digitalis glycosides, generally reserved for short-term use in acute heart failure?
How does Beta-adrenergic receptor stimulation lead to increased cardiac contractility?
How does Beta-adrenergic receptor stimulation lead to increased cardiac contractility?
In a patient presenting with acute heart failure and concomitant cardiogenic shock, which inotropic agent is MOST appropriate?
In a patient presenting with acute heart failure and concomitant cardiogenic shock, which inotropic agent is MOST appropriate?
Which of the following best describes the mechanism by which phosphodiesterase inhibitors improve cardiac contractility?
Which of the following best describes the mechanism by which phosphodiesterase inhibitors improve cardiac contractility?
A patient with HFrEF is prescribed digoxin. Which of the following monitoring parameters is MOST crucial to prevent potential toxicity?
A patient with HFrEF is prescribed digoxin. Which of the following monitoring parameters is MOST crucial to prevent potential toxicity?
A researcher is evaluating a new inotropic drug. They find that while it significantly increases cardiac output, it also markedly elevates myocardial oxygen consumption. Based on current guidelines, what would be the MOST likely limitation on the clinical application of this drug?
A researcher is evaluating a new inotropic drug. They find that while it significantly increases cardiac output, it also markedly elevates myocardial oxygen consumption. Based on current guidelines, what would be the MOST likely limitation on the clinical application of this drug?
A new drug is developed that selectively enhances calcium reuptake into the sarcoplasmic reticulum of cardiac myocytes without affecting cAMP levels. How would this drug's impact on cardiac function compare to that of dobutamine?
A new drug is developed that selectively enhances calcium reuptake into the sarcoplasmic reticulum of cardiac myocytes without affecting cAMP levels. How would this drug's impact on cardiac function compare to that of dobutamine?
Which of the following best describes the mechanism by which sacubitril/valsartan (ARNI) benefits patients with HFrEF?
Which of the following best describes the mechanism by which sacubitril/valsartan (ARNI) benefits patients with HFrEF?
In a Black patient with HFrEF already on optimal doses of ACE inhibitor, beta-blocker, and diuretic therapy, which additional medication would be MOST appropriate to consider according to current guidelines, assuming no contraindications?
In a Black patient with HFrEF already on optimal doses of ACE inhibitor, beta-blocker, and diuretic therapy, which additional medication would be MOST appropriate to consider according to current guidelines, assuming no contraindications?
A patient with HFrEF and a history of asthma is being considered for beta-blocker therapy. Which of the following beta-blockers would be MOST appropriate, considering their respiratory condition?
A patient with HFrEF and a history of asthma is being considered for beta-blocker therapy. Which of the following beta-blockers would be MOST appropriate, considering their respiratory condition?
A patient with HFrEF is prescribed an ACE inhibitor but develops angioedema. Which of the following is the MOST appropriate alternative medication?
A patient with HFrEF is prescribed an ACE inhibitor but develops angioedema. Which of the following is the MOST appropriate alternative medication?
A patient with HFrEF is on lisinopril, metoprolol succinate, and furosemide when their creatinine increases from 1.0 mg/dL to 2.5 mg/dL within two weeks. Beyond adjusting or holding the diuretic, what is the MOST appropriate next step in managing their medication regimen?
A patient with HFrEF is on lisinopril, metoprolol succinate, and furosemide when their creatinine increases from 1.0 mg/dL to 2.5 mg/dL within two weeks. Beyond adjusting or holding the diuretic, what is the MOST appropriate next step in managing their medication regimen?
How does nesiritide, a recombinant B-type natriuretic peptide, alleviate symptoms in acute decompensated heart failure?
How does nesiritide, a recombinant B-type natriuretic peptide, alleviate symptoms in acute decompensated heart failure?
In heart failure with preserved ejection fraction (HFpEF), what is the primary focus of treatment, beyond first-line SGLT2 inhibitors?
In heart failure with preserved ejection fraction (HFpEF), what is the primary focus of treatment, beyond first-line SGLT2 inhibitors?
What compensatory mechanism in heart failure leads to increased venous return and, consequently, increased preload and cardiac output?
What compensatory mechanism in heart failure leads to increased venous return and, consequently, increased preload and cardiac output?
Which consequence is paradoxically linked to the activation of the renin-angiotensin-aldosterone system (RAAS) in the context of heart failure?
Which consequence is paradoxically linked to the activation of the renin-angiotensin-aldosterone system (RAAS) in the context of heart failure?
How does the activation of natriuretic peptides counteract the effects of the renin-angiotensin-aldosterone system (RAAS) and increased sympathetic activity in heart failure?
How does the activation of natriuretic peptides counteract the effects of the renin-angiotensin-aldosterone system (RAAS) and increased sympathetic activity in heart failure?
What is the rationale behind restricting sodium intake to less than 2000 mg/day in patients with chronic heart failure?
What is the rationale behind restricting sodium intake to less than 2000 mg/day in patients with chronic heart failure?
While loop diuretics are commonly used in heart failure to manage fluid overload, what critical limitation should clinicians be aware of when prescribing these agents?
While loop diuretics are commonly used in heart failure to manage fluid overload, what critical limitation should clinicians be aware of when prescribing these agents?
In which clinical scenario is nesiritide, a recombinant BNP, most appropriately used in acute decompensated heart failure?
In which clinical scenario is nesiritide, a recombinant BNP, most appropriately used in acute decompensated heart failure?
If a patient with heart failure is also taking a medication that inhibits P-glycoprotein (P-gp), what potential interaction should be closely monitored?
If a patient with heart failure is also taking a medication that inhibits P-glycoprotein (P-gp), what potential interaction should be closely monitored?
Given the spontaneous intrinsic rhythm initiated by the SA node in cardiac muscle, what ionic flux is most directly proportional to the strength of myocardial contraction?
Given the spontaneous intrinsic rhythm initiated by the SA node in cardiac muscle, what ionic flux is most directly proportional to the strength of myocardial contraction?
Milrinone, a phosphodiesterase inhibitor used in acute heart failure, increases cardiac output and causes vasodilation by what mechanism?
Milrinone, a phosphodiesterase inhibitor used in acute heart failure, increases cardiac output and causes vasodilation by what mechanism?
What is the most important parameter to consider when determining the appropriate dose of digoxin, a digitalis glycoside, for a patient with heart failure?
What is the most important parameter to consider when determining the appropriate dose of digoxin, a digitalis glycoside, for a patient with heart failure?
Which of the following is a sign of digitalis toxicity that warrants immediate dose evaluation, especially in a patient with predisposing factors such as hypokalemia?
Which of the following is a sign of digitalis toxicity that warrants immediate dose evaluation, especially in a patient with predisposing factors such as hypokalemia?
Which of the following drug classes directly improves morbidity and mortality in HFrEF patients by enhancing natriuretic peptides?
Which of the following drug classes directly improves morbidity and mortality in HFrEF patients by enhancing natriuretic peptides?
A patient with HFrEF who is on optimal heart failure pharmacotherapy is prescribed digoxin. What is the target serum drug concentration range for digoxin to achieve therapeutic benefits while minimizing the risk of toxicity?
A patient with HFrEF who is on optimal heart failure pharmacotherapy is prescribed digoxin. What is the target serum drug concentration range for digoxin to achieve therapeutic benefits while minimizing the risk of toxicity?
In HFrEF management, which of the following is a primary consideration when initiating ACE inhibitor therapy, especially in conjunction with diuretics?
In HFrEF management, which of the following is a primary consideration when initiating ACE inhibitor therapy, especially in conjunction with diuretics?
A patient with acute heart failure is being treated with milrinone via IV infusion. Which of the following adverse effects is uniquely associated with milrinone, requiring careful monitoring during its administration?
A patient with acute heart failure is being treated with milrinone via IV infusion. Which of the following adverse effects is uniquely associated with milrinone, requiring careful monitoring during its administration?
An HFrEF patient who cannot tolerate ACE inhibitors is prescribed which of the following?
An HFrEF patient who cannot tolerate ACE inhibitors is prescribed which of the following?
Which specific aldosterone receptor antagonist is preferred in HFrEF patients to minimize endocrine side effects?
Which specific aldosterone receptor antagonist is preferred in HFrEF patients to minimize endocrine side effects?
The primary pharmacological effect of inotropic medications in the context of heart failure is to:
The primary pharmacological effect of inotropic medications in the context of heart failure is to:
Sacubitril/valsartan inhibits neprilysin, which in turn leads to an increase in which of the following?
Sacubitril/valsartan inhibits neprilysin, which in turn leads to an increase in which of the following?
Most inotropic agents are associated with reduced long-term survival in heart failure patients. Which of the following inotropic agents is considered an exception to this general limitation?
Most inotropic agents are associated with reduced long-term survival in heart failure patients. Which of the following inotropic agents is considered an exception to this general limitation?
Beta-adrenergic agonists increase intracellular calcium in cardiomyocytes primarily by:
Beta-adrenergic agonists increase intracellular calcium in cardiomyocytes primarily by:
In which clinical setting is short-term intravenous infusion of a beta-agonist inotropic agent MOST appropriate for heart failure management?
In which clinical setting is short-term intravenous infusion of a beta-agonist inotropic agent MOST appropriate for heart failure management?
Dobutamine and dopamine are both beta-adrenergic agonists used as inotropes. Dopamine uniquely possesses additional receptor activity at which receptor type?
Dobutamine and dopamine are both beta-adrenergic agonists used as inotropes. Dopamine uniquely possesses additional receptor activity at which receptor type?
Beta-agonist inotropic medications such as dobutamine are primarily administered via which route in the acute heart failure setting?
Beta-agonist inotropic medications such as dobutamine are primarily administered via which route in the acute heart failure setting?
Increased intracellular calcium concentration, the primary mechanism of inotropic action, is also directly associated with an increased risk of which adverse effect common to many inotropic agents?
Increased intracellular calcium concentration, the primary mechanism of inotropic action, is also directly associated with an increased risk of which adverse effect common to many inotropic agents?
Given their mechanism and clinical application, why are beta-agonist inotropes like dobutamine primarily indicated for short-term use in acute heart failure, rather than as a long-term prophylactic treatment?
Given their mechanism and clinical application, why are beta-agonist inotropes like dobutamine primarily indicated for short-term use in acute heart failure, rather than as a long-term prophylactic treatment?
What is the primary mechanism of action of nesiritide in treating acute decompensated heart failure?
What is the primary mechanism of action of nesiritide in treating acute decompensated heart failure?
What is the typical duration of effect for nesiritide, considering its half-life?
What is the typical duration of effect for nesiritide, considering its half-life?
What are the first-line therapy for HFpEF?
What are the first-line therapy for HFpEF?
Which of the following is an important therapeutic strategy in managing HFpEF, beyond the use of first-line SGLT2 inhibitors?
Which of the following is an important therapeutic strategy in managing HFpEF, beyond the use of first-line SGLT2 inhibitors?
In the context of cardiac muscle contraction, what ionic concentration is directly proportional to the strength of contraction?
In the context of cardiac muscle contraction, what ionic concentration is directly proportional to the strength of contraction?
What is the initial physiological response to decreased blood flow to the kidneys in heart failure?
What is the initial physiological response to decreased blood flow to the kidneys in heart failure?
What hemodynamic changes trigger the compensatory mechanism of increased sympathetic activity in heart failure?
What hemodynamic changes trigger the compensatory mechanism of increased sympathetic activity in heart failure?
Which of the following is a consequence of myocardial hypertrophy as a compensatory mechanism in heart failure?
Which of the following is a consequence of myocardial hypertrophy as a compensatory mechanism in heart failure?
According to general guidelines, what is the recommended daily sodium intake for patients with chronic heart failure?
According to general guidelines, what is the recommended daily sodium intake for patients with chronic heart failure?
A patient with acute decompensated heart failure is being treated with nesiritide. Which parameter should be monitored closely?
A patient with acute decompensated heart failure is being treated with nesiritide. Which parameter should be monitored closely?
Flashcards
Digoxin
Digoxin
Increases intracellular calcium, improving heart contractillity. Used in Heart Failure with reduced Ejection Fraction (HFrEF)
Carvedilol
Carvedilol
A beta-blocker that reduces morbidity and mortality in chronic, stable HFrEF patients
Sacubitril/Valsartan
Sacubitril/Valsartan
Replaces ACE inhibitors/ARBs in HFrEF if symptoms persist. Inhibits neprilysin to increase natriuretic peptides.
Milrinone
Milrinone
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Ivabradine
Ivabradine
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Eplerenone
Eplerenone
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Nesiritide
Nesiritide
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Empagliflozin
Empagliflozin
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Digoxin
Digoxin
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Epinephrine
Epinephrine
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Hypokalemia
Hypokalemia
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Dobutamine
Dobutamine
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Neprilysin
Neprilysin
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Aldosterone
Aldosterone
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Loop
Loop
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BNP
BNP
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Calcium
Calcium
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NSAIDs
NSAIDs
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Digoxin
Digoxin
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Photopsia
Photopsia
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Hypokalemia
Hypokalemia
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Dopamine
Dopamine
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Milrinone
Milrinone
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Isosorbide/Hydralazine
Isosorbide/Hydralazine
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ACE
ACE
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Beta blockers
Beta blockers
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Lisinopril
Lisinopril
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Ivabradine
Ivabradine
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Digoxin
Digoxin
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Nesiritide
Nesiritide
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Phosphodiesterase Inhibitors
Phosphodiesterase Inhibitors
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Digoxin Mechanism
Digoxin Mechanism
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Digoxin Use
Digoxin Use
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Digoxin Toxicity Symptoms
Digoxin Toxicity Symptoms
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Digoxin Dosing
Digoxin Dosing
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ACE Inhibitors
ACE Inhibitors
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ARBs
ARBs
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Diuretics in HFrEF
Diuretics in HFrEF
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Neprilysin Function
Neprilysin Function
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Inotropics Definition
Inotropics Definition
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Inotropic Action
Inotropic Action
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Inotropics & Survival
Inotropics & Survival
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Types of Inotropics
Types of Inotropics
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Beta Agonists MOA
Beta Agonists MOA
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Phosphodiesterase Inhibitors Risk
Phosphodiesterase Inhibitors Risk
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Beta Agonists Use
Beta Agonists Use
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Heart Failure
Heart Failure
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Compensatory Mechanisms in HF
Compensatory Mechanisms in HF
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Effects of Natriuretic Peptides
Effects of Natriuretic Peptides
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HFrEF (HF with reduced EF)
HFrEF (HF with reduced EF)
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HFpEF (HF with preserved EF)
HFpEF (HF with preserved EF)
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1st line therapy for HFpEF
1st line therapy for HFpEF
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Cardinal Symptoms of HF
Cardinal Symptoms of HF
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Goals of HF Pharmacotherapy
Goals of HF Pharmacotherapy
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Nesiritide's Action
Nesiritide's Action
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Milrinone Use
Milrinone Use
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Digoxin MOA
Digoxin MOA
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Digoxin Therapeutic Range
Digoxin Therapeutic Range
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ACE Inhibitors in HFrEF
ACE Inhibitors in HFrEF
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ARBs in HFrEF
ARBs in HFrEF
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Beta Blockers in HFrEF
Beta Blockers in HFrEF
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Inotropic Action Result
Inotropic Action Result
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Inotropics Issue
Inotropics Issue
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Beta Agonists Mechansim
Beta Agonists Mechansim
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Dobutamine is a...
Dobutamine is a...
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Dopamine is a...
Dopamine is a...
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Inotropics Use
Inotropics Use
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P-gp Inhibitors/Substrates
P-gp Inhibitors/Substrates
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Nesiritide Use
Nesiritide Use
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Nesiritide Type
Nesiritide Type
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Nesiritide Adverse Effects
Nesiritide Adverse Effects
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Nesiritide Half-life
Nesiritide Half-life
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HFpEF Treatment
HFpEF Treatment
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First Line Therapy for HFpEF
First Line Therapy for HFpEF
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Heart Failure Definition
Heart Failure Definition
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Cardinal Symptoms of Heart Failure
Cardinal Symptoms of Heart Failure
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Fluid Restriction in Chronic HF
Fluid Restriction in Chronic HF
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Study Notes
Inotropes
- Improve cardiac contractility to increase cardiac output (CO).
- The inotropic action results from increased intracellular calcium.
- There is a limited use, as are associated with reduced survival.
- Exceptions to the limited use of inotropes include digoxin .
- Beta Agonists increase calcium entry.
- Phosphodiesterase Inhibitors prolong calcium entry.
- Digitalis Glycosides are generally used to treat Heart Failure with reduced Ejection Fraction (HFrEF).
Beta Agonists
- Binding to the beta receptor increases cAMP levels.
- Intracellular calcium levels ultimately increase.
- Beta Agonists are given through IV infusion.
- They provide short term treatment of Acute Heart Failure (HF) in the hopital setting.
- Dobutamine is a beta agonist.
- Dopamine acts on both beta and alpha receptors.
- Use is associated with tachyphylaxis and increased myocardial oxygen consumption.
Phosphodiesterase Inhibitors
- Enhance intracellular calcium by increasing cAMP levels.
- Administered via IV infusion.
- Used for short term treatment of acute HF in the hospital.
- Example medication is milrinone.
- Used for patients with low cardiac output for symptom relief.
- May increase the risk of arrhythmias and mortality.
- Cause vasodilation, which improves cardiac output.
Digitalis Glycosides
- Digoxin is an example of a digitalis glycoside.
- They act by inhibiting the Na+/K+ ATPase.
- Less sodium is pumped from the cell.
- The concentration gradient decreases and the Na+/Ca2+ exchanger is fueled.
- Intracellular calcium increases, boosting the force of heart contractions.
- Effective in HFrEF when the patient is still symptomatic with optimal heart failure pharmacotherapy.
- A low serum drug concentration is necessary, roughly between 0.5 ng/mL and 0.8 ng/mL.
- Can be administered orally and IV.
- The required dose is based on body weight.
- Those taking this require renal dose adjustment due to a long half-life.
- Toxicities include anorexia, nausea/vomiting, blurred vision and a perceived yellowing of vision.
- Arrythmias are also common.
- Hypokalemia is a predisposing factor.
- Avoid use with other substances or inhibitors of P-gp.
Nesiritide
- Indicated for acute decompensated HF that is minimally effective after a trial of IV diuretics.
- It stimulates natriuresis and diuresis.
- It administered via intermittent bolus or continuous IV infusion.
- Has a short half-life of 20 minutes.
- Effects end quickly which reduces preload and afterload.
- An example recombinant of Brain Natriuretic Peptide (BNP).
Heart Failure
- Exists along a spectrum of four stages, from least to most severe.
- Patients with overt HF often receive loop diuretics first to alleviate signs or symptoms of volume overload like dyspnea and peripheral edema.
- ACE inhibitors or ARBs (if ACE inhibitors are not tolerated) are added after diuretic therapy is optimized.
- Beta-blockers were generally prescribed after ACE inhibitor or ARB therapy optimization.
- Patients newly diagnosed with HFrEF usually start on low doses of both ACE inhibitor and beta-blocker after initial stabilization.
- Aldosterone antagonists and fixed-dose hydralazine and isosorbide dinitrate are prescribed for patients who still suffer HF symptoms after optimal doses of an ACE inhibitor and beta-blocker.
- ACE inhibitors or ARBs can be replaced by sacubitril/valsartan once an optimal dose is achieved with those medications.
- Digoxin and ivabradine are added to achieve full symptomatic relief after all other options.
HFpEF
- SGLT2-Inhibitors are first line therapy.
- Management is focused on HTN control and reducing fluid overload.
- Management of comorbid conditions is necessary as atrial fibrillation is common.
Compensatory Cycle of Damage
- Insufficient cardiac output.
- Activation of SNS and RAAS .
- Cardiac remodeling, fibrosis further reduce CO.
- The main symptoms are Dyspnea, fatigue and fluid retention.
Treatment Strategies for Chronic HF
- Fluid limitations < 1.5-2 L/day.
- < 2000 mg/day sodium.
- Diuretics help improve symptom relief just to promote Sx control.
Drugs That Block The RAAS
- ACE-I is nearly always considered as a 1st line medication for patients with Heart Failure with reduced Ejection Fraction (HFrEF).
- Indicated nearly all for stages of left ventricular HF.
- Should bestarted at a low dose and titrated to target / max tolerated.
- Patients may experience symptomatic hypotension, especially when used with a loop diuretic.
Beta Blockers & Diuretics
- Is Contra Indicated in asthma.
- Beta Blockers, such as Carvedilol, Bisoprolol,and Metoprolol are Recommended for all with chronic, stable and HFrEF, in order to Reduce morbidity and mortality.
- Improves systolic function & reverses cardiac remodeling.
- It is best to start low and go slow with dosing.
- Diuretics help with Reduce signs and symptoms of fluid overload and with extensive diuresis when needed.
AB/Neprilysin Inhibitor, Sacubitril / Valsartan
- Replace an ACE inhibitor or ARB in HFrEF if the patient is already symptomatic with a beta blocker plus an ACE I or ARB.
HCN Channel Blocker: Ivabradine
- Used to improve symptoms in Heart Failure with patients who are on optimized HF pharmacotherapy.
- Should be on optimal dose of a beta blocker or have a CI to a beta blocker.
- Bradycardia and luminous phenoman can occur, but can not be used in pregnancy.
- Inhibits the "If" channel which allows sodium to enter cells of the sinoatrial (SA) node.
- Reduces depolorization and heart rate when in synthyhm and above 70 bpm .
Dilators
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Reduce preload and afterload.
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Fixed dose combo approved for in black for patients of standard therapy (BB, plus ACE I or ARB).
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Examples are Isosorbide and Hydralazine.
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Digoxin is a digitalis glycoside that increases intracellular calcium and improves cardiac contractility in HFrEF patient.
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Carvedilol, a beta-blocker, is recommended for all chronic, stable HFrEF patients to reduce morbidity and mortality.
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Sacubitril/Valsartan, an ARB/neprilysin inhibitor, replaces ACE inhibitors or ARBs in symptomatic HFrEF patients.
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Milrinone is a phosphodiesterase inhibitor for the short-term treatment of acute heart failure and can cause thrombocytopenia.
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Ivabradine, is an HCN channel blocker, slows heart rate by inhibiting the If channel, specifically for HFrEF patients with a heart rate > 70 BPM.
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Eplerenone,is an aldosterone receptor antagonist, is indicated for symptomatic HFrEF or HFrEF after a recent myocardial infarction.
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Nesiritide, is a recombinant B-type natriuretic peptide, and that's used in acute decompensated heart failure when IV diuretics are ineffective.
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Empagliflozin,is an SGLT2 inhibitor is considered first-line therapy for HFpEF.
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Digoxin requires renal dose adjustment due to its narrow therapeutic window and long half-life.
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Epinephrine is primarily stimulated by beta agonists to increase cardiac contractility.
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Hypokalemia increases the risk of digitalis toxicity.
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Dopamine is preferred for the short-term treatment of acute heart failure because of its action on beta-1 receptors.
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Sacubitril inhibits neprilysin, which that leads to increased levels of naturietic peptides.
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Eplerenone blocks the aldosterone receptor to reduce fluid retention and improve outcomes in HFrEF.
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A loop diuretic is considered for patients with severe fluid overload in the treatment of heart failure patients.
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Nesiritide mimics BNP to promote vasodilation, natriuresis, and diuresis.
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Intracellular calcium concentration determines the strength of cardiac muscle contraction.
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NSAIDs should be avoided in patients with HFrEF patients because they can exacerbate heart failure.
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Digoxin is associated with visual disturbances ,like blurred vision and yellowish vision.
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Photopsia is considered to be an adverse effect uniquely associated with Ivabradine due to its effect on retinal ion channels.
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That is also to say Hypokalemia enhances that toxic effects of digitalis glycosides.
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While Dopamine is preferred beta agonist in cardiogenic shock due to its combined beta and alpha receptor stimulation.
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Milrinone has had adverse effect of thrombocytopenia.
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Isosorbide/Hydralazine is beneficial for Black patients with HFrEF when added to standard therapy.
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That said ACE inhibition leads to increased bradykinin levels, which can contribute to cough as a very potential side effect.
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It is generally seen that Beta blockers are contraindicated in the patients with asthmatic HF because those drugs have bronchoconstrictive effects. And with That, Lisinopril requires approximately 36-hour washout period before switching to sacubitril/valsartan to avoid angioedema.
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Further Ivabradine it causes one to be able reduces heart rate by inhibiting the If current in the SA node without greatly affecting all together blood pressure.
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Digoxin can cause arrhythmias due to increased intracellular levels of calcium. In the same nature of how Nesiritide is administered intravenously for treating decompensated heart failure insufficient to diuretics...
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Angioedema can be considered to be a side effect which comes from using sacubitril/valsartan, especially if combined with ACE inhibitors, which generally enhance the the risks or severity to calcium related cardiotoxicity and other effects.
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Even to which where ither drugs are contraindicated and generally you should dose as low as possible.
Nesiritide
- Indicated for acute decompensated HF that does not respond to IV diuretics.
- It stimulates natriuresis and diueresis.
- It administered via intermittent bolus or continuous IV infusion.
- Has a short half-life of 20 minutes.
- Effects end quickly which reduces preload and afterload.
- An example recombinant of Brain Natriuretic Peptide (BNP).
Heart Failure
- Exists along a spectrum of four stages, from least to most severe.
- Patients with overt HF often receive loop diuretics first to alleviate signs or symptoms of volume overload, such as dyspnea and or generally swelling in feet.
- Generally, ACE inhibitors or ARBs after diuretic therapy are optimized.
- Beta-blockers were generally prescribed after ACE inhibitor or ARB therapy optimization.
- Patients with HF patients are diagnosed with ACE inhibitor + beta-blocker.
- ACE inhibitors will generally be optimized for HF patients and patients with HF.
HFPEF
- Management is focused on HTN control and reducing fluid overload.
- A lot of these patients are diagnosed with Atrial Fibrillation.
Compensatory Cycle of Damage
- Insufficient cardiac output.
- Activation of SNS and RAAS .
- Cardiac remodeling, and the creation of scartissue further reduce CO.
- The main symptoms are Dyspnea, fatigue and fluid retention.
Drugs That Block The RAAS
- Nearly always prescribed for HF and is almost always used 1st line for medical approaches .
- Generally a standard for the therapy for both ventricals.
- Usually starts with only a really low dose.
Beta Blockers & Diuretics
- CONTRAINDICATED in general Asthma.
- Betta such as Bisoprolol and others are highly recomended for patients with chronic and stable to Reduc e the Morbidity and all causeMortality.
- Can help Improve all Systolic issues with reversed the remodeling.
AB/Neprilysin Inhibitor, or generally Sacubitril / Valsartan
- Is generally a good replacement overall if the ARea's is not effective in medical HF therapy.
HCN Channel Blocker: Ivabradine
- Can enhance the HF pharmacotherapy because the HF gets slowed/ improved within the therapy.
- And to which some potential side effects may be included here; like pregnancy.
- In general an effective medicine that reduces heart rate.
Dilators
- Can help preload and or afterload to improve HF overall.
- Such as Isotrobide for the A and a B patient of black heritage to decrease morbidity or and mortality.
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Description
Review of medications used in the treatment of heart failure, including digoxin, carvedilol, sacubitril/valsartan, milrinone, ivabradine and eplerenone. Also covers nesiritide and empagliflozin. Focus on their mechanisms of action and indications for use.
