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Drugs: From molecules to man > Drugs for Heart Failure > Flashcards

Drugs for Heart Failure Flashcards

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Organic Chemistry 101 flashcards
1
Q

define cardiac failure

A

the inability ‘of the heart to meet the body’s oxygen demands (can be chronic or acute)

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2
Q

what is forward failure?

A

the inability to pump blood out of the heart

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3
Q

is forward failure systolic or diastolic?

A

systolic

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4
Q

what are the symptoms of forward heart failure? (3)

A
  • easily tired
  • peripheral cyanosis (under perfusion of skin- goes purple)
  • salt and water retention (under perfusion of the kidney)
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5
Q

what is backward failure?

A

inability to fill the heart

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6
Q

is backward failure systolic or diastolic?

A

diastolic

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7
Q

what are the symptoms of backward failure? (give 3)

A
  • pulmonary hypertension
  • reduced lung compliance
  • breathlessness
  • engorgement of liver
  • oedema of legs and ankles
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8
Q

What are the 5 primary treatment strategies for cardiac failure?

A
  • rest
  • ACE inhibitor
  • Beta-blocker
  • diet
  • diuretics
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9
Q

what do ACE inhibitors do for cardiac failure?

A

reduce cardiac preload and afterload

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10
Q

what do beta-blockers do for cardiac failure?

A

reduce sympathetic activation, slowing heart rate and allowing better ventricular filling

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11
Q

give 3 exaples of beta blockers used for cardiac failure

A

Carvedilol, Metoprolol and Bisoprolol

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12
Q

what are the 4 secondary treatments for cardiac failure?

A
  • Positive inotropic agent
  • aldosterone antagonists
  • ATII receptor blocker (ARB)
  • Isosorbide dinitrate/ Hydralazine
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13
Q

Give the main example of a positive inotropic agent

A

Digoxin

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14
Q

what does digoxin do?

A

increases force of contraction

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15
Q

as well as treating cardiac failure, what else can digoxin treat?

A

atrial fibrillation

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16
Q

What do aldosterone agonists do?

A

block activation of the renin-angiotensin- aldosterone system (RAAS)

17
Q

what do AT11 receptor blockers (ARBs) do?

A

blocks RAAS

18
Q

what’s different about the side effects of ACE inhibitors and ARBs?

A

ARBs don’t cause a cough as a side effect

19
Q

where is Digoxin obtained from?

A

Digitalis lanata

20
Q

What does Digoxin contain?

A
  • Aglycone (determines its pharmacodynamic properties)
  • lactone (gives it intermediate solubility)
  • a steroid nucleus (lipid soluble)
  • sugar residues (water soluble, determines pharmacokinetic properties)
21
Q

How does digoxin molecularly affect the heart?

A

Inhibits Na/K ATPase, increasing the conentration of Na+ and inhibiting Ca2+ efflux
also increases sarcoplasmic reticular Ca2+- more calcium

22
Q

How does digoxin physiologically affect the heart?

A

more calcium= more muscle contraction at a greater force

23
Q

How does Digoxin affect cardiac rate/rhythm at pharmatherapeutic doses?

A

increases vagus activity, slowing SA node firing and slowing AVN conduction velocity. Overall ventricular contraction rate decreases

24
Q

How does Digoxin affect cardiac rate/rhythm at toxic doeses?

A

increases sympathetic tone which can cause Arrhythmias by inhibiting nA/k atpASE. This increases after depolarisation causing ectopic beats

25
Q

What’s the therapeutic index of Digoxin?

A

2:1

26
Q

what are the symptoms of Digoxin poisoning/ toxicity? (4)

A

Nausea, Vomiting, disturbance of vision, Ventricular tachyarrhythmias

27
Q

How can digoxin poisoning be treated? (2)

A
  • stop digoxin administration

- an antidysrhythmic agent

28
Q

which of the secondary treatments is Digoxin?

A

positive iontropic agent

29
Q

The A-HeFT clinical trial showed that isosorbide dinitrate is useful in the treatment of heart failure in black patients when combined with…

A

Hydralazine

30
Q

which of the secondary treatments is spirolactone?

A

an aldosterone antagonist

31
Q

what happens to someone with hypertrophic cardiomyopathy?

A

thickening and stiffening of the ventriclular walls (the ventricles won’t fill so well during ventricular diastole)

32
Q

What is bumetanide?

A

a loop diuretic used to treat heart failure by reducing peripheral and pulmonary oedema

33
Q

which adrenoreceptors does carvedilol work on?

A

alpha

34
Q

what’s frusemide?

A

a loop diuretic used to treat heart failure by reducing peripheral and pulmonary oedema

35
Q

which adrenoreceptors does bisoprolol work on?

A

beta-1

36
Q

what’s lisinopril?

A

ACE inhibitor used to treat cardiac failure by reducing heart workload

37
Q

what’s captopril?

A

ACE inhibitor used to treat cardiac failure by reducing cardiac workload

38
Q

what’s bendroflumezide?

A

a thiazide- like diuretic used to treat cardiac failure by reducing peripheral and pulmonary oedema

39
Q

what adrenoreceptor does metoprolol target?

A

beta-1

Drugs: From molecules to man (10 decks)

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