Agents of Heart Failure

Question 1

Afterload

Answer 1

• force which pushing back against heart

blood out is opening door, afterload is pushing back and closing the door

Question 2

Diuretics (heart)

Answer 2

patients with heart failure often have pulmonary congestion, which means too much fluid around lungs and too much fluid being pushed to heart
- diuretics turn down flow of fluid being delivered to the heart, decreasing filling pressures to normal range

Question 3

Inotropic Agents

Answer 3

• increase Ca in heart so there is a stronger force of contraction

Question 4

B Agonists

Answer 4

• stimulate heart to make beat faster; increases force of contraction

Question 5

Vasodilators

Answer 5

• decrease preload and afterload
• ACE inhibitors and ARBs
• makes easier to push through door

Question 6

B antagonists

Answer 6

• reduce arrhythmogenesis
• curtail remodeling
• reduce undesired sympathetic effects
• – make so catecholamines can’t overstimulate heart

Question 7

Short Term Ionotropes for Acute Heart Failure

What do they do?

Answer 7

• increase cardiac output

Question 8

Digoxin (long card)

Answer 8

Inotropic

• short circuits/blocks sodium ATPase, destroying NA gradient
• Na accumulates in cell = Ca stuck in cell
• increase Ca in cell = greater force of contraction
• ** narrow TI = v. dangerous = does NOT increase lifespan (can kill you if K increases in cell)
• can cause many forms of arrhythmias

Question 9

Inotropic Agents (4)

Answer 9

• cardiac glycosides
• B1 agonists
• Ca sensitizers
• bypyridines

Question 10

B1 stimulates:

Answer 10

adenylcyclase which effects cAMP, increasing Ca in cell

Question 11

Bypyridines

Answer 11

MILRINONE

• act on phosphodiesterase 3
• increases cAMP = increased Ca into cell = increased contractility force
• SHORT TERM use only

Question 12

Milrinone

Answer 12

Bypyridine

Question 13

Digoxin

Answer 13

Inotrope

Question 14

Angiotensin II Effects

Answer 14

• vasoconstriction
• Na retention
• effects cardiac remodeling

Question 15

Dobutamine

Answer 15

B- agonist

- stimulates heart; doesn’t effect BP

Question 16

What does ACE do in the body?

Answer 16

part of breakdown which results in creation of Angiotensin II

Question 17

Aldosterone

Answer 17

• helps decrease K+

* ** if not working there will be a K buildup in the body***

Question 18

ACE Inhibitors

Answer 18

Vasodilator
CAPTOPRIL
- first line agent
- effects angiotensin II
- decreases preload and afterload
- decreases aldosterone
- decreases remodeling
- decreases sympathetic activity
*** COUGH AND ANGIOEDEMA!***
*** does reduce mortality***

Question 19

Captopril

Answer 19

ACE Inhibitor

Question 20

ARBs

Answer 20

Losarta

• competitive inhibitor
• blocks AT1 receptor (which binds angiotensin II hence Angiotensin Receptor Blocker (ARB)
• same effects as ACE Inhibitors EXCEPT
• – NO COUGH OR ANGIOEDEMA
• – does NOT effect Bradykinin = makes less effective than ACE inhibitors

Question 21

Losarta

Answer 21

ARB

Question 22

Metoprolol Succinate

Answer 22

B Antagonist

Question 23

Carvedilol

Answer 23

contraindicated with B-blockers

Question 24

BiDil

Answer 24

Vasodilator/ARB

• alternative to ACE inhibitors
• NOT for black patients

Question 25

B-Agonists

Acute Failure

Answer 25

• Dobutamine
• Dopamine (avoided)
• Norepi
• Epi