Drugs Used For Treatment Of Heart Failure I: Drugs Decreasing The Load On The Heart. Drugs Of Acute Cardiac Failure. Pharmacology Of Chronic Heart Failure.

Question 1

Which factors determine cardiac performance?

Answer 1

HR
Preload
After load
Contractility

Question 2

What are the symptoms of heart failure?

Answer 2

Dyspnea
Fatigue
Fluid retention
Serum bio markers

Question 3

What are the underlying causes of cardiac failure?

Answer 3

MI
IHD
Valvular heart disease
Cardiomyopathies
Congenital heart disease

Question 4

What are the treatment options for cardiac failure?

Answer 4

1. Prevention and non-pharmacological treatment
2. Drug treatment
3. Invasive therapy

Question 5

What are the drugs used to control congestive heart failure?

Answer 5

Beta blockers
Diuretics - venous vasodilators
RAAS inhibitors - arteriolar vasodilators
Cardiac glycosides and other positive inotropic agents

Question 6

Why are beta blockers used in the control of CHF?

Answer 6

They decrease the overcompensatory mechanisms of the sympathetic system

Question 7

Why are diuretics used in the treatment of CHF?

Answer 7

They decrease pre load

Question 8

What is pre-load?

Answer 8

Preload is the amount of sarcomere stretch at the end of diastole

Question 9

What is after load?

Answer 9

After load is the amount of pressure the heart has to work against in order to eject blood during systole

Question 10

Why are RAAS inhibitors used in CHF treatment?

Answer 10

They inhibit afterload

Question 11

Why are positive inotropic agents used in the treatment of CHF?

Answer 11

They improve the cardiac contractility and pumping function

Question 12

What is the mechanism of action of Ivabradine?

Answer 12

Ivabradine selectively inhibits the I funny ion channel in a dose dependent manner.

Question 13

What is the result of Ivabradine?

Answer 13

Blocking the I funny ion channel reduces cardiac pacemaker activity, selectively slowing the HR and allowing more time for blood flow to the myocardium.

Question 14

What are the names of the drugs that reduce the heart rate?

Answer 14

Ranolazine

Ivabradine

Question 15

What is the mechanism of action of Ranolazine?

Answer 15

Ranolazine inhibits the late inward sodium channel (INa) in heart muscle in a variety of voltage gated sodium channels.

Question 16

What is the result of Ranolazine?

Answer 16

Inhibiting the late inward sodium current leads to reductions in intracellular calcium levels, leading to reduced tension in the heart wall, leading to reduced oxygen requirements for the muscle.

Question 17

What are the side effects of Ranolazine?

Answer 17

The drug increases the QT interval in those with liver dysfunction; thus it is contraindicated in those with mixed to moderate liver disease.