Cardiovascular pharmacology X

Question 1

what is anrep?

Answer 1

1. relationship between afterload and contractility

2. if you increase afterload you can trigger the increase in contractility

Question 2

what is the Bowditch phenomenon?

Answer 2

1. relationship between HR and contractility

2. if you have an increase in HR, the increase in frequency is associated with increase in contraction

Question 3

ARBs block which pathophysiological process of heart failure?

Answer 3

1. aldosterone production
2. vasoconstriction
3. cardiac remodeling

Question 4

spironolactone blocks which pathophysiological process of heart failure?

Answer 4

1. sodium and water retention

2. cardiac remodeling

Question 5

the vasodilators block which pathophysiological process of heart failure?

Answer 5

1. SANS-mediated vasocontriction

2. elevated cardiac filling pressure

Question 6

beta blockers block which pathophysiological process of heart failure?

Answer 6

SANS-mediated renin secretion

Question 7

how do beta blockers control intrinsic myocardial contractility?

Answer 7

1. increase in cAMP
2. increase in calcium leading to
3. increased rate of contraction
4. increased peak force
5. increased rate of relaxation

Question 8

what are the four approaches to increasing intrinsic myocardial contractility?

Answer 8

1. increase cytosolic calcium
2. increase myocardial cAMP
3. agonism at B1 receptors
4. increase B1 receptor density

Question 9

which agents are useful for increasing cytosolic calcium?

Answer 9

cardiac glycosides

Question 10

what is an example of a cardiac glycoside used to increase intrinsic myocardial contractility? what is its function?

Answer 10

1. digitalis (digoxin)

2. increases cytosolic calcium

Question 11

which agents are useful for increasing myocardial cAMP?

Answer 11

phosphodiesterase inhibitors

Question 12

what are examples of phosphoidesterase inhibitors used to increase intrinsic myocardial contractility? what is their function?

Answer 12

1. amrinone, milrinone

2. increase myocardial cAMP

Question 13

which agents are useful for agonism at B1 receptors?

Answer 13

beta adrenergic agonists

Question 14

what are examples of beta adrenergic agonists used to increase intrinsic myocardial contractility? what is their function?

Answer 14

1. isuprel, dobutamine, dopamine, EPI, NE

2. B1 agonism

Question 15

which agents are useful for increasing B1 receptor density?

Answer 15

B1 adrenergic antagonists

Question 16

what are examples of B1 adrenergic antagonists used to increase intrinsic myocardial contractility?

Answer 16

1. metoprolol, carvedilol

2. increase B1 receptor density

Question 17

what is the MOA of digoxin?

Answer 17

1. blocks NaK ATPase at myocardial cell membrane
2. increased sodium concentration inside heart muscle
3. calcium will not leave because the NaCa exchanger will no longer need to function - increase in intracellular calcium

Question 18

what are the cardiac effects of digoxin?

Answer 18

1. positive inotropic - lower SANS, preload, afterload, HR
2. direct positive vagal effect - decrease AV conduction, increase PR interval, lower APD
3. increase coronary flow - lower hypertrophy
4. proarrhythmic

Question 19

what are the pharmacokinetics of digoxin?

Answer 19

1. 36-48 hour half life - steady state after 7 days

2. excreted by kidney