Notes in 13 Pharmacotherapy of Heart Failure

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Published	07/30/2024	Cardiac Glycosides: DIGOXINPharmacokineticsLipid Solubility: {{c1::Medium}}Oral Bioavailability: {{c2::75%}}Half-life: {{c3::40 hours}}Protein Binding…
Published	07/30/2024	Cardiac GlycosidesT/FDigoxin is lipid soluble, hence it produces CBS side effects{{c1::A}}
Published	07/30/2024	Cardiac GlycosidesT/FDigoxin is lipid soluble, hence it produces CNS side effects{{c1::A}}
Published	07/30/2024	Cardiac GlycosidesT/FDigoxin circulates thr blood bound to plasma proteins, hence it is less toxic.{{c1::B}}
Published	07/30/2024	Cardiac Glycosides: DigoxinTherapeutic Level: {{c1::0.5-1.5 ng/mL}}
Published	07/30/2024	Cardiac GlycosidesVR1) Chronic Kidney Disease2) Digoxin Toxicity{{c1::A}}
Published	07/30/2024	Cardiac GlycosidesVR1) Acute Kidney Injury2) Digoxin Toxicity{{c1::A}}
Published	07/30/2024	Cardiac GlycosidesVR1) Renal Insufficiency2) Digoxin Dose{{c1::B}}
Published	07/30/2024	Cardiac Glycosides: DIGOXIN MOA: {{c1::Inhibit Na/K ATPase Pump}}
Published	07/30/2024	Cardiac Glycosides: DIGOXIN By inhibiting the Na/K pump, there will be increased intracellular {{c1::Na}} that will drive the {{c2::Na/Ca exchanger}} …
Published	07/30/2024	Cardiac Glycosides: DIGOXIN VR1) Digoxin2) AV Node Refractory Period{{c1::A}}
Published	07/30/2024	Cardiac Glycosides: DIGOXIN VR1) Digoxin2) Heart Rate{{c1::B}}
Published	07/30/2024	Cardiac Glycosides: Digoxin T/FA patient complaining of weakness, vomiting, and diarrhea, should be suspected for digitalis toxicity.{{c1::A}}
Published	07/30/2024	Cardiac Glycosides: Digoxin QC: Digoxin Tocixity1) Hyperkalemia2) Hypokalemia{{c1::B}}
Published	07/30/2024	Cardiac Glycosides: Digoxin QC: Digoxin Tocixity1) Hypercalcemia2) Hypocalcemia{{c1::A}}
Published	07/30/2024	Cardiac Glycosides: Digoxin QC: Digoxin Tocixity1) Hypermagnesemia2) Hypomagnesemia{{c1::B}}
Published	07/30/2024	Cardiac Glycosides: Digoxin T/FIn patients with heart failure, digoxin improves symptoms by decreasing ventricular response and therefore increases su…
Published	07/30/2024	Cardiac Glycosides: Digoxin QC: Digoxin Bioavailability1) Macrolides2) Quinidine{{c1::A}}
Published	07/30/2024	Cardiac Glycosides: Digoxin Indication: {{c2::Atrial Fibrillation}}Contraindication: {{c1::Atrial Fibrillation in Wolff-Parkinson-White Sydrome}}
Published	07/30/2024	Beta AgonistsQC: Intrinsic B1 activity1) Dobutamine2) Dopamine{{c1::A}}
Published	07/30/2024	Beta AgonistsQC: Intrinsic B1 activity1) Dobutamine2) Epinephrine {{c1::B}}
Published	07/30/2024	Beta AgonistsQC: Intrinsic B1 activity1) Isoproterenol2) Epinephrine {{c1::C}}
Published	07/30/2024	Beta AgonistsQC: Intrinsic B1 activity1) Dopamine2) Phenylephrine {{c1::A}}
Published	07/30/2024	Beta AgonistsVR: 1) Dobutamine2a) Contractility - {{c1::A}}2b) CO - {{c1::A}}2c) Pulmonary capillary wedge pressure - {{c1::B}}2d) PVR - {{c1::B}}2e) …
Published	07/30/2024	Beta AgonistsQC: Dopamine - Low Dose1) Dopaminergic effect (D1/D2)2) alpha-1 stimulation{{c1::A}}
Published	07/30/2024	Beta AgonistsQC: Dopamine - High Dose1) Dopaminergic effect (D1/D2)2) B1 stimulation{{c1::B}}
Published	07/30/2024	Beta AgonistsQC: Dopamine - Much Higher Dose1) B1 stimulation2) alpha-1 stimulation{{c1::B}}
Published	07/30/2024	Beta AgonistsQC: Inhibits release of NE1) Dopamine2) Dobutamine{{c1::A}}
Published	07/30/2024	Beta AgonistsQC: Inhibits reuptake of NE1) Dopamine2) Dobutamine{{c1::C}}
Published	07/30/2024	Beta AgonistsWhen the patient came to you he has cold and clammy extremities with low CO and the patient has distended neck pains and pulmonary conges…
Published	07/30/2024	Phosphodiesterase Inhibitors: MilrinoneMOA: Inhibits PDE {{c1::III::subtype}}
Published	07/30/2024	Phosphodiesterase Inhibitors: MilrinoneVR1) Milrinone2) cAMP{{c1::A}}End Effect: {{c1::INC Inotropicity (via INC Ca influx)}}
Published	07/30/2024	Phosphodiesterase Inhibitors: MilrinoneVR1) Milrinone2) cGMP{{c1::A}}End Effect: {{c1::Vasodilation (via INC Nitric Oxide)}}
Published	07/30/2024	Phosphodiesterase Inhibitors: MilrinoneAdverse EffectsQC: Liver Enzyme Changes1) Milrinone2) Amrinone{{c1::B}}
Published	07/30/2024	Phosphodiesterase Inhibitors: MilrinoneAdverse EffectsQC: Arrhythmia1) Milrinone2) Digitalis{{c1::B}}
Published	07/30/2024	Phosphodiesterase InhibitorsAdverse EffectsQC: Safety1) IV Amrinone2) Oral Amrinone{{c1::A}}
Published	07/30/2024	Cardiac Myotropes{{c1::Omecamtiv MecarbilLevosimendan::Enumerate (2)}}
Published	07/30/2024	Cardiac Myotropes: LevosimendanMOA: {{c1::Acts on troponin and tropomyosin, making them more sensitive and avidly binding to calcium}}
Published	07/30/2024	Cardiac Myotropes: LevosimendanQC: Target Site1) Myosin-Actin2) Troponin-Tropomyosin{{c1::B}}
Published	07/30/2024	Cardiac Myotropes: LevosimendanQC: Effect1) Increase cGMP2) Increase Troponin-Tropomyosin sensitization to calcium{{c1::C}}
Published	07/30/2024	Cardiac Myotropes: Omecamtiv MecarbilQC: Target Site1) Myosin-Actin2) Troponin-Tropomyosin{{c1::A}}
Published	07/30/2024	Cardiac Mitotropes{{c1::TrimetazidinePerhexilineCoenzyme Q10SGLT2 Inhibitors::Enumerate (4)}}
Published	07/30/2024	Cardiac Mitotropes: PerhexilineMOA: {{c1::Inhibits the protein that translocates fatty acids into the mitochondria}}
Published	07/30/2024	Cardiac Mitotropes: TrimetazidineMOA: {{c1::Blocks the mitochondrial oxidation of fatty acids by the enzyme thiolase}}
Published	07/30/2024	Cardiac Mitotropes: SLGT2 InhibitorsIndication: {{c1::Patients with reduced and preserved EF}}
Published	07/30/2024	Give drug classes without positive inotropic effects in heart failure (HF).{{c1::DiureticsRenin-Angiotensin-Aldosterone Inhibitors (ACEis, ARBs)Anti-A…
Published	07/30/2024	Used for heart faillure patients and is considered as the diuretic of choice for patients with pulmonary edema.{{c1::Loop Diuretics (Na+-K+-2Cl-cotran…
Published	07/30/2024	Maintenance diuretics in HF patients.{{c1::Thiazide Diuretics (Na+/Cl- cotransporter inhibitors)}}
Published	07/30/2024	Given in HF patients not for the diuretic effect but their inhibition of Aldosterone.{{c1::Mineralocorticoid Receptor Antagonists (MRAs)/ Type I Recep…
Published	07/30/2024	Among the diuretics, {{c1::Loop Diuretics}} and {{c1::MRAs}} are commonly used and are found to be effective in heart failure patients.
Published	07/30/2024	Provides relief of dyspnea due to pulmonary congestion BEFORE its diuretic effect becomes evident{{c1::Furosemide (Loop Diuretic)}}
Published	07/30/2024	Why is it that there is an immediate relief of congestion following intake of furosemide before you can even see its diuretic action?{{c1::via pu…
Published	07/30/2024	Furosemide (Loop Diuretic): What is the mechanism of benefit in the right ventricle?{{c1::Release of prostacyclin and nitric oxide}}
Published	07/30/2024	INC or DEC: DEC pulmonary capillary wedge pressure through a {{c1::DEC}} in preload via venodilation.{{c1::DEC}} in circulating blood volume{{c1::INC}…
Published	07/30/2024	This antagonizes the effect of aldosterone, preventing fibrosis.One of the drugs that increase survival in patients with heart failure and help preven…
Published	07/30/2024	ACEis {{c1::DEC}} afterload and preload (to a lesser extent) through vasodilation
Published	07/30/2024	ACEis MOA:Inhibition of ACE (angiotensin-converting enzyme) will lead to:{{c1::inhibition}} of production of Angiotensin II{{c1::inhibition}} of degra…
Published	07/30/2024	ACEis in HF patients can:{{c1::INC}} exercise tolerance{{c1::REDUCE}} morbidity and mortality
Published	07/30/2024	QC: Inhibition of Angiotensin II Effect1. ACEi   2. ARBs{{c1::B (2 is greater than 1)}}
Published	07/30/2024	Drug class considered in patients who cannot tolerate ACEi in HF patients.{{c1::ARBs (-sartans)}}
Published	07/30/2024	This drug class benefit HF patients in that it is:more selective blockers of Angiotensinhas no effect on bradykinin metabolismpotential for more compl…
Published	07/30/2024	This combination drug does the following:induce diuresis → help treat and prevent congestionproduce vasodilationdecrease cardiac fibrosis and hypertro…
Published	07/30/2024	Drug class recommended for patients w/ asymptomatic LV systolic dysfunction and history of MI.{{c1::Beta Blockers (Bisoprolol, Carvedilol, Metoprolol)…
Published	07/30/2024	3 most important beta blockers in HF management.reduce mortality in patients w/ Stable Class IIand III HFcontraindicated in Class IV patients{{c1::Bis…
Published	07/30/2024	QC: Beta-1 Blockade1. Carvedilol     2. Metoprolol{{c1::C (no difference)}}
Published	07/30/2024	QC: Vasodilating properties1. Carvedilol     2. Bisoprolol{{c1::A (1 is greater than 2)}}
Published	07/30/2024	This drug classification is also called "deloaders."effective in ACUTE HF{{c1::Vasodilators (ex. Hydralazine, ISDN}}
Published	07/30/2024	Venodilation → {{c1::DEC}} in preloadArteriodilation → {{c1::DEC}} in afterload
Published	07/30/2024	Choosing Vasodilators:For patients with w/ high filling pressures w/ dyspnea as the principal symptom{{c1::Choose VENODILATOR}}
Published	07/30/2024	This drug is a competitive inhibitor of Endothelin. Primarily indicated in pulmonary hypertension, however has significant teratogenic and hepatotoxic…
Published	07/30/2024	Used in patients with persistent tachycardia and HF patients w/ HR > 70/min. This decreases tachycardia WITHOUT decreasing the blood pressure.{{c1:…
Published	07/30/2024	Drugs especially useful in patients w/ dilutional hyponatremia or hypovolemic hyponatremia. {{c1::Vasopressin Antagonists (Tolvaptan, Coniva…
Published	07/30/2024	Inotropic agent that does NOT promote entry of calcium inside the cell. It INC contractility WITHOUT risks associated w/ elevated intracellular C…
Published	07/30/2024	This is a mechanical way of improving the function of the heart. Indicated for patients with wide QRS complexes and do NOT improve with…
Published	07/30/2024	Treatment of HFPharmacologic treatment will depend on the patient’s clinical presentation:Patient may be dry and warm, wet and warm, dry and cold or w…
Published	07/30/2024	Goal of Treatment of HF: Achieve a {{c1::"DRY AND WARM"}} condition.
Published	07/30/2024	Identify what NYHA Class:Asymptomatic LV dysfunctionPresence of LV dysfunction on 2D-echo with absence of symptomsEjection fraction < 50%Initiate t…
Published	07/30/2024	Identify what NYHA Class:There is already presence of congestion (wet)Treat with diuretics, neurohumoral inhibitors (B-blockers, ACEI, ARBs, MRAs, dig…
Published	07/30/2024	Identify what NYHA Class:These patients are already decompensatedAdminister inotropes (especially for wet and cold patients) and CRTPerform cardiac tr…
Published	07/30/2024	Subsets of MI Patients:For hypovolemic patients, initiate {{c1::volume replacement}}.
Published	07/30/2024	Subsets of MI Patients:In peripheral vasodilation, there is high filling pressure and high cardiac index but decreased systolic blood pressure, thus y…
Published	07/30/2024	Hemodynamic Effects of Drugs for HF:A combination of an {{c1::inotrope (e.g. digitalis)}} and a {{c1::vasodilator (with ACEIs and ARBs)}} is the …
Published	07/30/2024	Therapeutic Management in Diastolic HF:In administering drugs for heart rate control: it is preferred to give{{c1:: beta blockers (w/ afterload p…
Published	07/30/2024	This drug class reduces incidence of cardiovascular death and hospitalization in people w/ and w/o diabetes and those w/ and w/o prevalent HF.{{c1::SG…
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