Heart Failure Flashcards
Cardinal manifestations of heart failure
Dyspnea
Fatigue
Fluid retention
Treatment is directed at two somewhat different goals
Reducing symptoms and slowing progression as much as possible during relatively stable periods
Managing acute episodes of decompensated failure
Drugs use for chronic heart failure
Diuretics Aldosterone receptor antagonists Angiotensin-converting enzyme inhibitors Angiotensin receptor blockers Beta blockers Cardiac glycosides Vasodilators
Drugs for heart failure
diuretics vasodilators beta agonists bipyridines natriuretic peptide
General therapeutic principles
Reduction of the congestive state
Controlled blood pressure
Maintenance of atrial contraction and prevention of tachycardia
Treatment and prevention of myocardial ischemia
Detection and treatment of sleep apnea
Genus name for the family of plants that provide most of the medically used cardiac glycosides
DIGOXIN
T/F All of the cardiac glycosides/cardenolides combine steroid nucleus linked to a lactone ring at the 17 position and a series of sugars at carbon 3 of the nucleus
T
T/F Digitalis Lack an easily ionizable group
T
Prototype of digitalis
digoxin
T/F 65-80% absorbed after oral administration
T
T/F Digitalis are extensively metabolized and widely distributed to tissues
False: Digitalis are not extensively metabolized and all acardiac glycosiddes are widely distributed to tissues
half lide of digitalis in normal renal fundtion
36-40 hours
T/F Cardiac glycosides inhibit Na/K ATPase
T
T/F Inhibitory action of digitalis is responsible for therapeutic effect (positive inotropy) only
false: Inhibitory action is responsible for both therapeutic effect and toxicity
T/F cardiac gycosides increase contraction of the cardiac sacromere
T
T/F digitalis increses the free calcium concentration
T
2 steps when there is an increase in the free calcium concentration by digitalis
1st: Na/K ATPase inhibition
2nd: Reduction of calcium expulsion from the cells by sodium-calcium exchanger
The most common cardiac manifestations of Digitalis toxicity include
Atrioventricular junctional rhythm
Premature ventricular depolarizations
Bigeminal rhythm
second-degree atrioventricular blockade
T/F Digitalis can cause virtually ANY arrythmia.
T
Most common site of digitalis toxicity outside the heart
GI tract
GI tract manifestation of digitalis toxicity
anorexia
nausea
vomit
diarrhea
CNS manifestation of digitalis toxicity
Disorientation and hallucinations (especially in the elderly), visual disturbances, aberrations of color perception
T/F Gynecomastia is a common effect reported in men
F: Gynecomastia is a rare effect reported in men
Interaction of potassium and digitalis
First, they inhibit each other’s binding to Na⁺/K⁺-ATPase
Second, abnormal cardiac automaticity is inhibited by hyperkalemia
A positive inotropic drug for heart failure that increases contractility by inhibiting Na/K ATPase and is an invetigational steroid derviative
Istaroxime
Positive inotropic drugs used in heart failure
PHOSPODIESTERASE INHIBITORS BETA ADRENOCEPTOR AGONISTS DIURETICS ACE INHIBITORS, ARBS, AND RELATED AGENTS VASODILATORS BETA- ADRENOCEPTOR BLOCKERS
