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pharma 2 > 19. heart failure 1 > Flashcards

19. heart failure 1 Flashcards

1
Q

define cardiac failure

A

pump failure due to structural & functional disorder iimpairing the ability of ventricles to fill or eject blood decreasing CO

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2
Q

decompensation

A

in spite of compensatory mechanisms the CO not able to supply the tissue in O2

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3
Q

factors determining cardiac performance

A
  • HR
  • prefload and afterload
  • contractility
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4
Q

what are the underlying causes

A
  • MI
  • IHD
  • valvular pathologies
  • CMP
  • congential heard defects
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5
Q

types of heat failures

A

systolic = decreased contractility and EF <40%

diastolic = decreased relaxation and ej can be mild or normal

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6
Q

stages of NYHA

A

4 classes look them up on google

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7
Q

treatment

A
  1. prevention + non pharmacological
  2. drug treatment
  3. invasive therapy
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8
Q

drugs used in HF

A

positive ionotropic drugs
vasodilators
miscellaneous drugs for CHF

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9
Q

postiive ionotropic drugs

A
  • cardiac glycosides (digoxin)
  • b-agonists (dobutamine)
  • PDE inhibitors (inamrinone)
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10
Q

vasodilators

A

PDE inhibitors (inamrinone)
nitroprusside, nitrates, hydralazinw
-loop diuretics, ACEi, nesiritide

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11
Q

Aims

A

decrease the preload, afterload, remodelling,

increase the contractility

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12
Q

what’s used in decreasing pre & after load

A

diuretics, vasodilators, RAAS i

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13
Q

what’s used in order to increase contraction

A

+ ionotropic agents

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14
Q

aim in treating chronic HF

A
  • relieve sypmtoms
  • improve hemodynamic state
  • decrease hospitalization
  • decrease mortality
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15
Q

NYHA 1-2

A

diuretics, ace, ARBs, b blockers, aldosterone antagonists

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16
Q

NYHA 3-4

A

duiretics, cardiac glycosides, sympathomimitics, vasodilators

17
Q

RAAS inhibitors: MOA, drugs

A

HF activates RAAS because it decreases perfusion of kidney, renin release, promoted by SY stimulation

drugs: Captopril (ACEi)
losartan (ARB)

18
Q

ACEi captopril

A
  • decrese vasocontriction, after & preload leading to increased CO
  • increase brandykinin leading to dialtion,
  • decreasing aldosterone
    indication: HF with reduced ejection fraction and is combined with other drugs
19
Q

ARB’s losartan

A

competitive inhibition of angiotensin 2 on AT1 receptors

- decrease afterload and preload leading to a increase cardiac output

20
Q

diuretics 1st line for? some examples

A

1st line for both systolic and diastolic HF, decreases preload and oafterload

  • aldosterone antagonists
  • potassium excreting
21
Q

Aldosterone antagonists

A
  • eplerenone, sprionolactone
  • prevents salt retention, mycardial hypertrophy, hypokalemia and decreases remodeling
    indication: sever hf with reduced ejectionf raction + MI
22
Q

potassiu, excreteing

A
  • relieve pulmonary HT + peripheral edema
  • decrease sypmtoms of volume overload
  • decrease the preload leading ot decrease cardiac work and O2 demand
  • decrease the afterload leading to decreased pressure
    indication: increase survival of HF patients with renal insufficiency
23
Q

vaso and veno dilators

use, examples, indication, adverse effects

A
  • decrease pre and afterload
  • nitrates, hydralazine, nitroprusside
  • HF w/ EF + intolerance to ACEi + BB
24
Q

Heart rate controllers

A

ivabradine: block I.f channel ->decreasing HR

- Ranolazine - block late Na ch-> decreasing ca -> decreased contractility

25
Q

BB use, examples, indication, adverse effects

A

-increase systolic function, reverse cardiac remodelling
-decrease HR, decrease hyper trophy
-inhibit renin reliease
bisprolol, nebivolol, metoprolol, carvedilol
- indication: HF, HF r EF

26
Q

+ ionotropicdrugs

A 
1- heart glycosides
2-B agonists
3-PDE inhibitors
4-calcium sensitizers
5-new grugs for acute HF
27
Q

examples of B agonists

A

dobutamine

dopamine

28
Q

dobutamine use, examples, indication, adverse effects

A

b1 stimulation -> gs-> increase in cAMP leading to + ino,dromo, chronotropy
racemic + isomer = b1 agnosits + alpha1 antagonist
-short half life, drop infusion
-indication:acute HF : cardiogenic shock, MI,heart surgery, OD on BB, acute decompensation in congestive HF
- adverse effects: tachycardia, arrythmia, tachypylaxis

29
Q

dopamine use, examples, indication, adverse effects

A
  • low dose D1 leading to decrease in NE -> vasodilation in viscera
  • meduim dose b1 stimulation -> +ionotropy
  • high dose: alpha1 -> vasoconstriction
  • indication: cardiogenic shock, increase perfusion in kidneys + splanchnic area
  • adverse effects: tachycardia, tolerance, bad pharmacokinetics
30
Q

PDE inhibitors use, examples, indication, adverse effects

A

-increase cAMP, vasodilation leading to a decrease in TPR, used in acute HF
adverse effects: thrombocytopenia , hepatotoxic, HF
contraindicated in aortic stenosis, HCM
examples:
bipyridines: amirone, milrinone
methylxanthine derivatives: theophyllin, aminophyllin
other: vesnarinon

31
Q

calcium sensitizers

A

enhancement of ca sensitivity of tropinin c myofibrils,
they dont increase cAMP or ca
indication: acture decompensation of severe chronic HF
benzimadazoles: primobendan: oral,iv, inhibit PDE, narrow T.I
levosimendan: infusion IV, open ATP dep K ch. leading to vasodilation

32
Q

new drugs for acute HF:

A

-endothelin 1 ATG: bosetan ambrisentan
oral, toxic, (i) pulm HT, raynaud
-endothelin convertase inhibitor: phosphoramidon
-BNP: nesiritide, IV bolus t1/2 about 20 min. (I) absolute refractory HF
leads to an increase in cGMP leading to VD
its nephrotoix
-othersL coEZ Q10, aliskiren, serelaxin

pharma 2 (11 decks)

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