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Pharmacology II > Drugs For Heart Failure > Flashcards

Drugs For Heart Failure Flashcards

1
Q

Occurs when cardiac output is inadequate to provide the oxygen needed by the body.

Common cause
CAD- Coronary arterial disease
HPN - Hypertension

2 Major Types:
Systolic Failure
Diastolic Failure

A

HEART FAILURE

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2
Q

Diuretics
Aldosterone receptor antagonists
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Beta blockers
Cardiac glycosides Vasodilators, neprilysin inhibitor
Resynchronization and cardioverter therapy

A

Chronic Systolic Heart Failure

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3
Q

Diuretics
Vasodilators
Beta agonists
Bipyridines
Natriuretic peptide
Left ventricular assist device

A

Acute Heart Failure

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4
Q

An important contributor to the contractile property of muscle & other cells. A protein that produces small contractile filaments within muscle cells.

A

ACTIN

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5
Q

A protein that produces thick, contractile filaments within muscle cells.
A molecular motor & converts chemical energy released from ATP into mechanical energy, thus generating force & movement.

A

MYOSIN

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6
Q

Coronary artery disease
Cardiac output below the normal range.

A

Heart Failure

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7
Q

with reduced cardiac output & significantly reduced ejection fraction, is typical of acute failure, especially resulting from myocardial infarction.

A

Systolic dysfunction

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8
Q

often occurs as a result of hypertrophy & stiffening of the myocardium.

A

Diastolic dysfunction

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9
Q

Primary signs & symptoms of all types of Heart Failure:

A

Tachycardia
Decreased exercise tolerance
Shortness of breath
Cardiomegaly
Peripheral edema
Pulmonary edema

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10
Q

Neurohumoral compensation:

A

•Sympathetic nervous system
•Renin-angiotensin-aldosterone hormonal response

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11
Q

Primary factors of Cardiac Performance:

A

Preload
Afterload
Contractility
Heart rate

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12
Q

Digitalis lanata
Other sources: Oleander, Lily of the valley, Milkweed

65-80% absorption
Half-life: 36-40 hours

A

CARDIAC GLYCOSIDES
Digoxin:

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13
Q

All therapeutically useful cardiac glycosides:
Inhibit Na+/K+-ATPase- the membrane bound transporter

Its inhibitory action is responsible of the therapeutic effect (positive inotrophy) as well as as its toxicity.

Increases cardiac contractility

A

CARDIAC GLYCOSIDES
DIGOXIN:

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14
Q

A _____compound that inhibits phosphodiesterase isozyme e (PDE-3).

Oral & parenteral use.
Half-life: 3-6 hours

It increase myocardial contractility by increasing inward calcium flux in the heart during the action potential.

Inhibition of phosphodiesterase results in an increase in cAMP & the increase in contractility & vasodilation.

A

BIPYRIDINES
MILRINONE

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15
Q

Selective beta 1 agonist - widely used in patient with heart failure.

Parenteral drug which produces an increase in cardiac output together with a decrease in in ventricular filling pressure.

Also used in acute heart failure & helpful if there is a need to raise blood pressure.

A

BETA-ADRENOCEPTOR AGONISTS
DOBUTAMINE

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16
Q

Increases contractility by inhibiting Na+/K+-ATPase but in addition, it appears to facilitate sequestration of Ca2+ by the SR.

A

INVESTIGATIONAL POSITIVE INOTROPIC DRUGS
DISTAROXIME

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17
Q

A drug that sensitizes the troponin system to calcium, also appears to inhibit phosphodiesterase & to cause some vasodilation in addition to its inotropic effects.

A

INVESTIGATIONAL POSITIVE INOTROPIC DRUGS
OLEVOSIMERDAN

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18
Q

Parenteral agent that activates cardiac myosin & prolongs systole without increasing oxygen consumption of the heart.

A

INVESTIGATIONAL POSITIVE INOTROPIC DRUGS
DOMECAMTIV MECARBIL

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19
Q

Drug of choice in heart failure
Reduces salt & water retention, edema & symptoms.
Have no effect on cardiac contractility

It reduces venous pressure & ventricular preload.

A

DIURETICS
FUROSEMIDE

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20
Q

The aldosterone antagonist diuretic with additional benefit of decreasing morbidity in patient with severe heart failure who are also receiving ACE inhibitors.

A

DIURETICS
SPIRONOLACTONE & EPLERENONE

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21
Q

Reduces peripheral resistance thereby reduces afterload.

Also reduces salt, & water retention & in that way reduces preload.

Also reduces long-term remodelling of the heart & vessels, an effect that may be responsible for the observed reduction in mortality & morbidity..

A

ACE inhibitors, ARBS, & Other Related Agents
CAPTOPRIL

22
Q

An angiotensin AT1 receptor which appears to have similar beneficial effects.

A

ACE inhibitors, ARBS, & Other Related Agents
LOSARTAN

23
Q

A renin inhibitor approved for HPN, was found to have no definitive benefit in clinical trials for heart failure.

A

ACE inhibitors, ARBS, & Other Related Agents
ALISKIREN

24
Q

Effective for the treatment of heart failure because they provide a reduction in preload or reduction in afterload or both.

A

VASODILATORS

25
Q

A synthetic form of the endogenous peptide brain natriuretic peptide (BNP).
Approved for use in acute cardiac failure.
A recombinant product with increase cGMP in smooth muscle cells & reduces venous & arteriolar tone in experimental preparations.

Short half-life: 18 min.

A

VASODILATORS
NESIRITIDE

26
Q

Most patients with chronic heart failure responds to these drugs.
They precipitate acute decompensation of cardiac function.
Mechanisms includes attenuation of the adverse effects of high concentrations of catecholamines (including apoptosis), up-regulation of beta receptors, decreased heart rate, & reduced remodelling through inhibition of the mitogenic activity of catecholamines.

A

Beta BLOCKERS
BISOPROLOL, CARVEDILOL, METOPROLOL, NEBIVOLOL

27
Q

MANAGEMENT OF CHRONIC HEART FAILURE:
Treatment of patients at high risk (stages A & B) should be focused on control of hypertension, arrhythmias, hyperlipidemia & diabetes.

SODIUM REMOVAL
•Dietary salt restriction
•Diuretics
•Thiazide diuretics
•Loop diuretics
•Spironolactone
•Eplerenone

A

NA

28
Q

Drug of choice in patients with left ventricular dysfunction without edema.
First-line therapy for chronic heart failure
By reducing preload & afterload in asymptomatic patients, ACE inhibitors (enalapril) slow the progress of ventricular dilation & thus slow the downward spiral of the heart failure

A

ACE inhibitors

29
Q

Are used to patients who cannot tolerate ACE inhibitors

A

ARBS

30
Q

for patients with high filling pressures with dyspnea, helpful in reducing filling pressure & the symptoms of pulmonary congestion.

A

VASODILATORS
Venodilators
· ISOSORBIDE Dinitrate

31
Q

used in patients whom fatigue due to low left ventricular output is the primary symptoms, & helpful in increasing forward cardiac output.

A

VASODILATORS
Arteriolar dilator
HYDRALAZINE

32
Q

Bisoprolol, Carvedilol, Metoprolol, Nebivolol
Therapy using these drugs are based on the hypothesis that excessive tachycardia & adverse effects of high catecholamine levels on the heart contribute to the downward course of heart failure.

A

Beta BLOCKERS & Ion Channel Blockers

33
Q

Indicated for patients with heart failure & atrial fibrillation. Given only when diuretics & ACE inhibitors failed to control the symptoms.

A

DIGITALIS

34
Q

Occurs frequently in patients chronic failure associated with:
Increased exertion Increased emotion
Excess salt intake Nonadherence to therapy or
Increased metabolic demand occasioned by fever, anemia, etc.

A

NA

35
Q

Treatment-intravenous treatment of the following:
Diuretics
Dopamine or Dobutamine
Levosimendan
Vasodilators
Conivaptan

A

NA

36
Q

Cardiovascular agents that is classified chemically as glycoside

A

Digoxin

37
Q

Primary signs and symptoms of all types of heart failure:

A

Fatigue, increased heart rate, shortness of breath, cardiomegaly

38
Q

Interactions with digoxin may occur with

A

Antacids, cholestyramine, diuretics calcium

39
Q

These drugs are used for the treatment of heart failure in patients who cannot tolerate ACE inhibitors

A

ARBs

40
Q

Heart failure:
l. A syndrome with many causes that may involve one or both ventricles.
Il. Coronary artery disease is one of the most common cause of heart failure
II. If the heart does not pump enough blood to supply the body and tissues, it will lead to heart failure
IV. When heart rate or stroke volume increases cardiac output decreases

A

T or F

41
Q

Common cause of heart failure

A

Hypertension, Coronary arterial disease (CAD)

42
Q

A selective beta 1 agonist available and use parenterally to produce an increase in cardiac output together with a decrease in ventricular filling pressure

A

Dobutamine

43
Q

This drug is indicated for patients with heart failure and atrial fibrillation and given only when diuretics and ACE inhibitors failed to control the symptoms

A

Digitalis glycosides

44
Q

Initial stretching of cardiac myocytes prior to contraction which is related to ventricular filling

A

Preload

45
Q

The drug of choice for treatment of heart failure

A

Furosemide

46
Q

A bipyridine compound that inhibits PDE-3

A

Milrinone

47
Q

The following drugs are used in heart failure without positive inotropic effects

A

Dobutamine, Milrinone

48
Q

The following statements are true about cardiac glycosides:
1. In heart failure, cardiac glycosides act by decreasing the force of the
cardiac contractility.
2. Cardiac glycosides lowers norepinephrine levels which are elevated in heart failure and are toxic to the failing heart.
3. All therapeutically useful cardiac glycosides inhibit sodium-potassium ATPase.
4. Cardiac glycosides increases cardiac contractility.

A

“T or F”

49
Q

Drugs that can interact or affected digoxin level, the reason they have to be administered far apart

A

Cholestyramine, Neomycin, Macrolides, Verapamil

50
Q

Management of chronic heart failure includes:

A

Sodium removal
Control of hypertension
Loop diuretics
Control of diabetes

Pharmacology II (8 decks)

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