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Pharmacology Block 1 > Drugs for Congestive Cardiac Failure > Flashcards

Drugs for Congestive Cardiac Failure Flashcards

1
Q

what is heart failure?

what functions of the heart get affected?

A

Heart unable to provide adequate perfusion of peripheral organs to meet their metabolic requirements

  1. Reduction in cardiac output
  2. Systolic dysfunction- reduction in cardiac contractility
  3. Diastolic dysfunction- inadequate filling of ventricles during diastole
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2
Q

In acute heart failure, the short aim is to do what?

In acute heart failure, the short aim is to do what?

A
  • stabilize, providing symptomatic treatment by IV
  • not short, only long term and is through:
    • relieving symptoms
    • improving hemodynamics
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3
Q

Heart failure is usually accompanied by an increase in what?

A
  1. Sympathetic nervous system (SNS)
  2. Chronic up-regulation of the renin-angiotensin-aldosterone system (RAAS) and effects of aldosterone on heart, vessels and kidney
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4
Q

In a failing heart, the loss of contractile function leads to what?

Activation of SNS serves as a compensatory mechanism to maintain adequate cardiac output how?

A

a decline in CO and a decrease in arterial BP, Baroreceptors sense the hemodynamic changes and initiate countermeasures to maintain support of the circulatory system.

  1. Increasing myocardial contractility and heart rate (β1-adrenergic receptors)
  2. Increasing vasomotor tone (α1-adrenergic receptors) to maintain systemic blood pressure
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5
Q

what are the Consequences of hyperadrenergic state in the long term?

A
  1. irreversible myocyte damage
  2. cell death
  3. fibrosis
  4. increase in Left Ventricular afterload: because of the augmentation in peripheral vasomotor tone
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6
Q

Baroreceptor mediated activation of the SNS leads to release of what?

A

renin and then formation of Angiotensin 2

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7
Q

Angiotensin II acts through what receptors?

What is the overall effect of Angiotensin 2?

why is it important in Cardiac Heart Failure?

A

Angiotensin 1 and Angiotensin 2 receptors

vasoconstriction and stimulates aldosterone production

because it is the target of chronic CHF therapy

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8
Q

What is the goal during heart failure?

A
  • Alleviation of symptoms
  • Arrest ventricular remodeling, Prevent sudden death
  • Reduce cardiac work
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9
Q

what drug therapy can be given in cardiac heart failure?

A
  1. Diuretics
  2. Vasodilators
  3. Beta blockers
  4. Digoxin
  5. Other Cardiac Inotropes – Dobutamine, Milrinone
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10
Q

when are diuretics useful?

what do they do?

what are the most commonly used?

in mild cases what is used?

A
  • useful in reducing the symptoms of volume overload
  1. decreasing the extra cellular volume
  2. decreasing the venous return
  • furosemide and bumetanide
  • thiazides
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11
Q

what is the adverse effects of diuretics?

how is it overcome?

give an example of a drug that helps in overcoming the problem?

A
  • Loop diuretics and thiazides cause hypokalemia.
  • Potassium sparing diuretics help in reducing hypokalemia due to these diuretics.
  • Spironolactone
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12
Q

what are the ACE inhibitor drugs?

What is the effect of these drugs?

A
  • Captopril, Lisinopril, Enalapril, Ramipril, Quinapril.
    1. Blockade of Angiotensin Converting Enzyme (ACE)
    2. Decreased AT-II
    3. Decreased aldosterone
    4. Decreased fluid retention
    5. Vasodilation
    6. Reduction in arterial resistance (afterload)
    7. Reduction in venous tension (preload)
    8. Slows cardiac remodeling
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13
Q

what are the adverse effects of ACE inhibitors?

A

cough, postural hypotension, hyperkalemia, angioedema

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14
Q

what are the Angiotensin Receptor AT-1 blockers (ARB) drugs?

what are these type of drugs?

A

Losartan, Irbesartan, Candesartan

Competitive antagonists of Angiotensin II (AT-1).

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15
Q

what are the 3 types of Vasodilators?

Give an example drug of each.

A

Venodilators - Isosorbide dinitrate

Arteriolar dilators - Hydralazine

Both arteriolar & venodilators - Sodium nitroprusside

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16
Q

What will venodilators do?

when are they used?

A
  • Reduce preload
  • used in Acute and chronic heart failure & angina
17
Q

What will arteriolar dilators do?

when are they used?

A
  • Reduce BP and afterload
  • Use of Hydralazine plus nitrates (BiDil) have reduced mortality
18
Q

when are Both arteriolar & venodilators used?

A

hypertensive emergencies

19
Q

what do inotropes do?

give 3 examples of these.

A
  • Increase force of contraction by increasing intracellular cardiac Ca++ concentration
    1. Digitalis (cardiac glycoside)
    2. Dobutamine (β-adrenergic agonist)
    3. Amrinone, milrinone (PDE inhibitor)
20
Q

What is the mode of action of Digoxin?

What will it do?

A
  • Inhibition of Na/K ATPase pump increase intracellular sodium concentration – eventually increase cytosolic calcium
  • Enhances vagal tone (cardiac parasympathomimetic effect): slows sinus heart rate and atrioventricular conduction

*

21
Q

when is digoxin used?

A
  1. to reduce rapid ventricular rate in atrial flutter and atrial fibrillation
  2. Severe LV systolic dysfunction (CCF)
22
Q

what will digoxin toxicity cause in CNS?

what will digoxin toxicity cause in GI system?

what will digoxin toxicity cause in cardiovascular system?

A
  • Malaise, confusion, depression, vertigo, vision
  • Anorexia, nausea, intestinal cramping, diarrhea
  • Palpitations, syncope, arrhythmias, bradycardia, AV node block, tachycardia
    • LOOK for BIGEMINY in EKG (premature ventricular contractions)
23
Q

What Factors may help increase digoxin toxicity?

What drugs may help increase digoxin toxicity?

A
  1. hypokalemia: Because potassium competes with digoxin for binding sites on the Na+/K+-ATPase,
  2. Hypercalcemia: enhances digitalis toxicity as it increases in intracellular calcium
  3. Hypomagnesemia: sensitizes the heart to digitalis-induced arrhythmias.
  • K+-depleting diuretics
  • Quinidine, Amiodarone and verapamil can increase the plasma levels of digoxin
24
Q

How do you Manage Digoxin toxicity?

A
  • K+ supplementation
  • For digoxin induced arrythmias: lidocaine, Phenytoin or propranolol can be used.
  • Severe toxicity treated with Digibind, an anti-digoxin antibody.
25
Q

what is dobutamine?

When is it used?

A

a beta 1 agonist producing a positive inotropic response

useful in acute cardiac failure with marked systolic dysfunction

26
Q

what are the PDE inhibitors?

how do they work?

what is their effect?

These inhibitors are selective for what enzymes?

A
  • Inamrinone & Milrinone
  • Acts by inhibiting the enzyme Phosphodiesterase (PDE) and increasing of intracellular concentrations of cAMP, causing Ca2+ to enter the cell
  • Increase myocardial contractility by increasing the Ca influx during AP
  • Selective for PDE isoenzyme-3 of cardiac smooth muscle
27
Q

what is (BNP)-Niseritide?

what do they do?

when are they used?

what adverse reaction can they cause?

A
  • a recombinant human Brain Natriuretic Peptide (BNP) approved for treatment of acute decompensated CHF.
  • binds to receptors in the vasculature, kidney, and other organs, producing potent vasodilation by increasing levels of cGMP
  • in HF as it causes a reduction in preload and afterload and diuresis
  • hypotension
28
Q

What is the benefit Beta blockers have in heart failure?

what are the 2 important beta blockers for heart failure?

they have this benefit…

A
  • slowing of heart rate and decrease myocardial oxygen consumption, reduced remodeling
  • Carvedilol, Metoprolol
  • reduce mortality

Pharmacology Block 1 (10 decks)

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