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MBBS CPRS > CPRS 71: Positive Inotropic Drugs > Flashcards

CPRS 71: Positive Inotropic Drugs Flashcards

1
Q

What are positive inotropic drugs

A

Drugs to increase the heart contraction force

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2
Q

Name 2 Beta Adrenergic Receptor Stimulants

A

Dobutamine

Dopamine

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3
Q

How does Beta Adrenergic Receptor Stimulants work

A

Increase cAMP level
PKA Activation
Increase calcium entry
Increase Calcium ions in cells for contraction

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4
Q

Dobutamine (Negative enantiomer) is an agonist for ________ receptors. (Positive enantiomer) is an agonist for _________ receptors.

A

Alpha

Alpha

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5
Q

Why is dobutamine only a mild vasodilator

A

Effect of negative enantiomer is offset by positive enantiomer plus beta 2 receptor stimulation.

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6
Q

Dobutamine is a __________ beta receptor stimulant.

A

non-selective

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7
Q

At low doses, dopamine will activate ______ receptors. At intermediate doses, dopamine will activate _______ receptors. At high doses, dopamine will activate _________ receptors.

A

Beta 2
Beta 1
Alpha

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8
Q

At high doses, dopamine will activate alpha receptors, this will lead to _____________. This increases the _______ of the heart and leads to __________.

A

Vasoconstriction
Afterload
Decrease in cardiac output

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9
Q

What are the adverse effects of beta adrenergic receptor stimulants

A

Pro-angina (Increase heart rate, B1)

Pro-arrhythmic (Increase Ca concentration, B2)

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10
Q

What is the advantage of Beta adrenergic receptor stimulants

A

Short duration of action

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11
Q

Name 2 PDE Inhibitors

A

Milrinone

Enoximone

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12
Q

What’s the mechanism of PDE inhibtiors

A 
Inhibit PDE
Reduce Breakdown of cAMP to AMP
Increase level of cAMP
Increase PKA level 
Increase Ca2+ ions, increase contraction
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13
Q

Name the 2 adverse effects of PDE inhibitors

A

Pro-arrhythmic (Increase Ca 2+ concentration)

Hypotension

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14
Q

Name 1 advantage of PDE inhibitors

A

Vasodilation

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15
Q

Name 1 Cardiac Glycoside

A

Digoxin

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16
Q

What is the mechanism of Cardiac Glycosides- Digoxin

A

Inhibit the Na/K ATPase, less Na+ pumped out
Shift Na/Ca exchanger to pump out Na and pump Ca in
Increase Ca storage for muscle contraction

17
Q

Name the 2 adverse effects of Cardiac Glycosides

A

Pro-arrhythmic (increase Ca2+)

Narrow Safety Margin- Not the 1st line therapy

18
Q

What is the major limitation of Cardiac Glycosides

A

Effect opposed by increase potassium level

19
Q

Name 1 Calcium Sensitizer

A

Levosimendan

20
Q

How does Calcium Sensitizer- Levosimendan, work?

A

Stabilize the binding between Troponin C and Calcium ions.

Increases the contractility of cardiac muscle without increase in Calcium concentration.

21
Q

What is the composition of LCZ696

A

Valsartan 50%

Sacubitril 50%

22
Q

What is LCZ696 used to treat

A

Chronic Heart Failure

23
Q

What is the function of Valsartan

A

Angiotensin receptor inhibitor

Prevent the rise in blood pressure

24
Q

What is the function of Sacubitril

A

Neprilysin Inhibitor

25
Q

What is the function of Neprilysin Inhibitor

A

Reduce the breakdown of natriuretic peptides, bradykinin and substance P
Also reduce breakdown of Angiotensin II

26
Q

What will the accumulation of Natriuretic Peptides lead to

A

Diuresis
Natriuresis
Vasodilatation

27
Q

What will the accumulation of Bradykinin and Substance P lead to

A

Vasodilation

28
Q

What will the accumulation of Angiotensin II lead to

A

Vasoconstriction

That’s why need Valsartan as Angiotensin Receptor Blocker

29
Q

What is the precaution of using LCZ696

A

Not to use it in combination with ACE inhibitor

30
Q

Name 2 Adverse Effects of LCZ696

A 
Increase hypotension (vasodilation)
Increase angioedema (Increase bradykinin and Substance P)

MBBS CPRS (44 decks)

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