A-6. Drugs improving cardiac contractility (cardiotonics) Flashcards
groups of drugs that improve cardiac contractility
digitalis glycosides
phosphodiesteras inhibitors
drugs of digitalis glycosides
digoxin
phosphodiesterase inhibitor drugs
Pimobendan
action of those drugs on contractility
positive inotropic
CHF symptoms
cardiac murmur
coughing/pulmonary edema
Stage A of heart failure
bree predisposition (cavalier King Charles)
stage B of heart failure
B1: can hear a murmur
B2: murmur + start of a remodeling (left atrium then ventricule then whole heart)
Treatment: Pimobendan & diet
Stage C of heart failure
start of clinical signs
treatment: Pimobendan, Furosemide, ACE inhibitors, Spironolactone, Sildenafil
Stage D of heart failure
The End
treatment: Pimobendan, Furosemide, ACE inhibitors,Amlodipine (decrease of BP), Sildenafil
diet given for HF
low salt (but not too low cuz activates renin-angiotensin)
high calories
PUFA
Mg
K
action of PDE inhibitors
vasodilation
+ contractility
Digoxin mecanism of action
inhibit Na/K // activates Na/Ca pumps
increase of Ca –> increase of contractility
SE of digoxin
Hypercalcaemia
hypokalaemia
arrythmia
bradychardia
vomiting
effect of digoxin
increase contractility
decrease preload
PK of digoxin
PO, plasma level should be checked after 3 days because accumulation in the muscles
small TI
Renal excretion
add K+ in case of hypokalemia
Indication of digoxin
prolonging survival , supraventricular tachyarythmie
digoxin contraindication
BLOCKED heart flow
Pimobendan mécanisme of action
allows increase of AMPc –> increase of Ca
administration route of pimobendan
PO, 1 hour before feeding
SE of pimobendan
vomiting
Contraindications of pimobendan
Hypertrophic cardiomyopathy
stenosis
in acute heart failure drugs of choice
adrenaline
Dopamine
Dobutamine
all IV
