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Pharmacology > Cardiac Contractility/Positive Inotropic medications > Flashcards

Cardiac Contractility/Positive Inotropic medications Flashcards

1
Q
  • LV End Diastolic Volume (EDV)-
A

amount of blood in left ventricle at the
end of diastole
* LV EDV = Preload

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2
Q
  • Afterload-
A

pressure heart has to overcome to eject blood
 Afterload = Systemic blood pressure

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3
Q
  • LV End Systolic Volume (ESV)-
A

amount of blood in left ventricle at the end
of systole

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4
Q
  • Stroke Volume (SV):
  • Ejection Fraction (EF):
  • Cardiac Output (CO):
A

SV= EDV – ESV (mL)
EF= SV/EDV X 100% (%)
CO= HR X SV (mL/min)

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5
Q

ionotrophy

A

the ability of the heart to contract

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6
Q

Positive Inotropic medications
(5)

A
  • Cardiac glycosides
  • Digoxin- inhibits Na-K ATPase
  • DOBUTamine- b1 adrenocepter agonist
  • Milrinone- phosphodiesterase inhibitor
  • Levosimendan- calcium sensitizer
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7
Q

Positive Inotropic medications
Digoxin
* Brand name: (3)
* MOA:
* Use: (2)

A

Digitek, Lanoxicaps, Lanoxin (available IV/PO)
inhibition of Na+-K+ ATPase/ vagal tone to heart
heart failure, atrial fibrillation (rate-control)

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8
Q

Positive Inotropic medications
Digoxin
ADRs (narrow therapeutic index medication):
(3)

A
  • Nausea, vomiting, diarrhea
  • Bradycardia/ heart block
  • Visual disturbances (green-yellow halo)
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9
Q

Positive Inotropic medications
Digoxin
Drug-Drug interactions:
(3)

A
  • Other drugs that cause bradycardia or hypokalemia
  • Increased levels with macrolide antibiotic
  • Increase risk of arrhythmia with adrenergic agonists or succinylcholine
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10
Q

Digoxin
— effects with – K+

A

increase
decrease

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11
Q

Positive Inotropic medications
Digoxin- Dental Implications
* Monitor …
* Increased — may make dental procedures,
such as taking radiographs or impressions difficult
* After supine positioning, …
* Use — with caution (adrenergic stimulation)
* Avoid ..
* — protocol

A

vital signs
gag reflex
have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension (bradycardia)
vasoconstrictors
dental light in patient’s eye/offer dark glasses
Stress reduction

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12
Q

Positive Inotropic medications
DOBUTamine
* Brand name:
* MOA:
* Use: (2)

A

Dobutrex (only available IV)
b1- adrenergic receptor agonist
acute decompensated heart failure, cardiogenic shock

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13
Q

Positive Inotropic medications
DOBUTamine
ADRs:
(3)
* Drug-Drug interactions: none of significance
* Dental Implications: none

A
  • Increased heart rate and blood pressure
  • Arrhythmias
  • Chest pain
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14
Q

Positive Inotropic medications
Levosimendan
* Brand name:
* MOA:
* Use:

A

Simdax (not available in the U.S.)
Sensitize troponin to Ca2+ (inotropy) and KATP channel activation
in smooth muscle (vasodilation)
acute decompensated heart failure

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15
Q

Positive Inotropic medications
Levosimendan
* ADRs:
(3)
* Drug-Drug interactions: none of significance
* Dental Implications: none

A
  • Arrhythmias (ectopic beats, NSVT, VT)- supposedly less than DOBUTamine
  • Hypotension
  • Headache
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16
Q

Myocardial Oxygen Supply
Function of:
(2)

A
  1. Arterial O2 content
  2. Coronary blood flow
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17
Q
  1. Arterial O2 content
A
  • decreased anemia and hypoxia
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18
Q
  1. Coronary blood flow
A
  • decreased atherosclerosis and vasospasm
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19
Q

Myocardial Oxygen Supply is a function of

A

Heart Rate
Cardiac myocytes supplied with blood during diastole
increased Heart rate = dcereased time in diastole

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20
Q

Myocardial Oxygen Demand (MVO2)
MVO2Determinants
(3)

A
  1. Heart rate
  2. Myocardial contractility
  3. Myocardial wall stress
    * Preload
    * Afterload
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21
Q

Surrogate marker for MVO2

A

Double Product= HR X SBP

22
Q

SYMPATHETIC Nervous System
b1 adrenoreceptors
(5)

A
  • increased force of contraction
    (positive inotropic effect)
  • increased heart rate (positive
    chronotropic effect)
  • increased automaticity
  • Repolarization
  • Reduced cardiac efficiency
23
Q

PARASYMPATHETIC Nervous System
Muscarinic (M2) receptors
(3)

A
  • Cardiac slowing
  • decreased automaticity
  • Inhibition of AV node
    conduction
24
Q
  • Organic nitrates-
A

increased myocardial O2 supply

25
Q
  • Calcium channel blockers-
A

increased myocardial O2 supply and decreased O2 demand

26
Q
  • b-adrenocepter antagonists-
A

decreased myocardial O2 demand

27
Q
  • Ranolazine-
A

improves angina w/o changing BP or HR

28
Q
  • Ivabradine-
A

not approved for angina in U.S.

29
Q

Antianginal medications
Organic nitrates
* Forms:
(4)

A
  • Organic nitrates
    -Nitroglycerin
  • Isosorbide dinitrate/mononitrate
  • Sodium Nitroprusside
30
Q

Antianginal medications
Organic nitrates
* Major side effects
(5)

A
  • Headache
  • Syncope/hypotension
  • Tachycardia
  • Tolerance
  • Methemoglobinemia
31
Q

Antianginal medications
Organic nitrates
* Contraindicated with

A

PDE-5 Inhibitors

32
Q

Antianginal medications
Organic nitrates- Available products

A
  • SL tablets
  • Spray
  • Intravenous
  • Ointment
  • Patch
  • Capsules
  • LA tablets
  • Isosorbide mononitrate (ISMN)
  • Isosorbide dinitrate (ISDN)
33
Q

Immediate relief

A
  • SL tablets
  • Spray
  • Intravenous
  • Ointment
34
Q

Prevention

A
  • Patch
  • Capsules
  • LA tablets
  • Isosorbide mononitrate (ISMN)
  • Isosorbide dinitrate (ISDN)
35
Q

Antianginal medications
Organic nitrates
Isosorbide Mononitrate
* Brand name: (2)
* MOA:
* Use: (2)

A

Imdur, Ismo
Stimulate production of intracellular cGMP
Angina and heart failure

36
Q

Antianginal medications
Organic nitrates
Isosorbide Mononitrate
ADRs:
(4)

A
  • Headache (common), flushing, dizziness, postural hypotension
37
Q

Antianginal medications
Organic nitrates
Isosorbide Mononitrate
Drug-Drug interactions:

A
  • Increased effects with other vasodilator type medications
38
Q

Antianginal medications
Organic nitrates- Dental Implications
* Monitor …
* — protocol
* After supine positioning,
* Use — with caution
* — available for acute angina attack

A

vital signs
Stress reduction
have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension
vasoconstrictors
Sublingual nitroglycerin

39
Q

Antianginal Medications
Calcium Channel Blockers
MOA:

A

Block calcium from entering cell through voltage
sensitive “slow” L-type channels
* Slow conduction in SA and AV node (non-dihydropyridine)
*  heart rate
* AV block
* Vasodilatation of arterioles
* Decrease arterial pressure and wall tension
* Decrease myocardial contractility
* Increase flow through areas of fixed coronary obstruction

40
Q

Antianginal Medications
Calcium channel blockers
Amlodpine
* Brand name:
* MOA:
* Use: (3)

A

Norvasc
Dihydropyridine calcium channel blocker
Angina, hypertension, also vasospastic angina

41
Q

Antianginal Medications
Calcium channel blockers
Amlodpine
ADRs:
(6)

A
  • Edema (common), dizziness, lightheadedness, hypotension, flushing,
    gingival enlargement (rare- but more common than non-DHP)
42
Q

Antianginal Medications
Calcium channel blockers
Amlodpine
Drug-Drug interactions:
(2)

A
  • Hypotension with sedatives, opioids, general and inhaled anesthetics
  • NSAIDS reduce blood pressure lowering effect
43
Q

Antianginal Medications
Calcium channel blockers- Dental Implications
* Monitor …
* Consider …
* — appointments
* After supine positioning,
* Use (2) with caution
* Place on frequent recall to monitor for —

A

vital signs
stress reduction protocol
Shorter
have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension
vasoconstrictors and inhaled anesthetics
gingival hyperplasia

44
Q

Antianginal medications
β-adrenoceptor blockers
* Block sympathetic stimulation to the heart
(4)

A
  • Decrease heart rate
  • Decrease automaticity
  • block NE’s effects on Ca2+ channels
  • Slow conduction through AV node (increase
    refractory period)
45
Q

Antianginal medications
β-adrenoceptor blockers
Prevent

A

ischemia
* Decrease myocardial oxygen demand
* decrease HR, decrease contractility, decrease SBP

46
Q

Antianginal medications
β-adrenoceptor blockers
* Prefer —acting b1 selective agents for angina

47
Q

Antianginal medications
β-adrenoceptor blockers
Dental implications
* Monitor …
* — protocol
* — appointments
* After supine positioning,
* Use (2) with caution
* Use – effective dose of local anesthetics

A

vital signs (heart rate should be low)
Stress reduction
Shorter
have patient sit upright for at least 2
minutes before standing to avoid orthostatic hypotension
vasoconstrictors and inhaled anesthetics
lowest

48
Q

Antianginal Medications
Ranolazine
* MOA:
(2)

A
  • inhibits late inward sodium current (Ina) in ischemic myocardium  reduced
    myocardial wall tension and O2 consumption
  • At higher concentrations inhibits rapid delayed rectifier potassium current (Ikr) 
    prolonged action potential and QT interval
49
Q

Antianginal Medications
Ranolazine
* Brand name:
* MOA:
* Use:

A

Ranexa
Inhibition of late inward sodium current (Ina)
Angina

50
Q

Antianginal Medications
Ranolazine
* ADRs:
(6)

A
  • Bradycardia, hypotension, dizziness, QT prolongation, TdP, xerostomia
51
Q

Antianginal Medications
Ranolazine
* Drug-Drug interactions:
(1)

A
  • Many due to CYP 450 3A4 metabolism
52
Q

Antianginal Medications
Ranolazine
Dental implications:
(2)

A
  • Assess salivary flow as a factor in caries, periodontal disease, and candidiasis
  • Use vasoconstrictors and inhaled anesthetics with caution

Pharmacology (13 decks)

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