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SketchyPharm CV and Renal

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01 - Heart Failure Drugs - Digoxin, milrinone, nesiritide - ACE Inhibitors, ARBs, Aliskiren Others: dobutamine, β-blockersDigoxin, milrinone, nesiritide Digoxin Inhibition of Na+/K+ ATPase ATPase ↑ intracellular ...

01 - Heart Failure Drugs - Digoxin, milrinone, nesiritide - ACE Inhibitors, ARBs, Aliskiren Others: dobutamine, β-blockersDigoxin, milrinone, nesiritide Digoxin Inhibition of Na+/K+ ATPase ATPase ↑ intracellular Na ↑ Na → Ca influx by Na+/Ca2+ exchanger ↑SR Ca stores → (+)inotropic For chronic systolic HF symptoms Direct stimulation of vagus n. S/E: hyperkalemia S/E: induce arrhythmias S/E: chronic use → “scooped” concave ST segments S/E: ↑PS on SA node → bradycardia S/E: ↑PS on AV node → heart block C/I in heart block, e.g. w/ β-blockers S/E: nausea, vomiting, abd. pain S/E: neurological and xanthopsia (see yellow) C/I w/ hypokalemia → exacerbates toxicity C/I w/ renal insufficiency → ↑ serum half-life C/I w/ antiarrhythmics → ↓ renal clearance e.g. amiodarone, verapamil, diltiazem, quinidine Anti-digoxin Fab Ab for toxicity Milrinone Inhibits PDE ↑cAMP (+)inotropic Dilates a. → ↓afterload Nesiritide Synthetic BNP → ↑ cGMP Dilates a/v. → ↓pre-/ after-load S/E: ↓Na For atrial arrhythmiasACE inhibitors, ARBs, Aliskiren Renin JGA secretes renin Angiotensinogen → Angiotensin I ACE in lungs Angiotensin I → AT-II by ACE in lungs AT-II causes vasoconstriction → ↑TPR AT-II constricts efferent a. → ↑GFR AT-II ↑NaHCO3 reabsorption at PCT AT-II ↑aldosterone from adrenal cortex Aldosterone ↑Na and H2O retention & ↓K at collecting duct -pril suffix ACE inhibitor Blocks AT-I → AT-II Reverse ALL the effects of AT-II ↑ creatinine S/E: hypotension and syncope S/E: ↓aldosterone → hyperkalemia ↑AT-I and renin 1° for HF Reduce mortality in HF & MI ↓AT-II mediated LV remodeling For acute MI 1° for hypertension ↓ progression of diabetic nephropathy For pts w/ albuminuria and BP >130/80 S/E: dry cough d/t ↑bradykinin C/I in hereditary angioedema (↓C1es inhibitor) C/I in pregnancy C/I w/ NSAIDs → acute renal injury C/I in renal a. stenosis AT rec. blockers (ARBs) -sartan suffix S/E: hyperkalemia No dry cough Aliskiren Direct renin inh. S/E: hyperkalemia ↑Cr02 - Diuretics - Acetazolamide, mannitol - Loop diuretics (furosemide, ethacrynic acid) - Thiazides (hydrochlorothiazide, chlorthalidone) - K+ sparing diuretics (amiloride, triamterene, eplerenone, spironolactone)

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