Heart failure Flashcards
Eplerenone
Aldosterone antagonists
Inhibit sodium absorption in the distal tubule by antagonising aldosterone, increasing sodium and water excretion and reducing potassium excretion; they are weak diuretics.
Aldosterone may contribute to the pathophysiology of heart failure; by reducing aldosterone activity, aldosterone antagonists improve outcome.
Finerenone
Aldosterone antagonist
Selective nonsteroidal mineralocorticoid receptor (MR) antagonist; thought to reduce inflammation and fibrosis caused by overactivation of the MR.
Spironolactone
Aldosterone antagonists
Inhibit sodium absorption in the distal tubule by antagonising aldosterone, increasing sodium and water excretion and reducing potassium excretion; they are weak diuretics.
Aldosterone may contribute to the pathophysiology of heart failure; by reducing aldosterone activity, aldosterone antagonists improve outcome.
Bumetanide
Loop diuretics
Inhibit reabsorption of sodium and chloride in the ascending limb of the loop of Henle. This site accounts for retention of approximately 20% of filtered sodium; therefore, these are potent diuretics.
Produce a rapid and intense diuresis and have a short duration of action (4–6 hours). They are effective over a wide dose range with a dose-related response.
Furosemide
Loop diuretics
Inhibit reabsorption of sodium and chloride in the ascending limb of the loop of Henle. This site accounts for retention of approximately 20% of filtered sodium; therefore, these are potent diuretics.
Produce a rapid and intense diuresis and have a short duration of action (4–6 hours). They are effective over a wide dose range with a dose-related response.
Dobutamine
Sympathomimetics
Inotropic agent; vasodilator
Sympathomimetics partially or completely mimic the agonistic actions of noradrenaline or adrenaline on the alpha and/or beta adrenoreceptors. The effect of a specific agent is determined by receptor specificity, compensatory reflexes evoked and dose.
Dopamine
Sympathomimetics
Vasodilator at low dose; vasoconstrictor at higher doses; positive inotrope and chronotrope at high dose.
Sympathomimetics partially or completely mimic the agonistic actions of noradrenaline or adrenaline on the alpha and/or beta adrenoreceptors. The effect of a specific agent is determined by receptor specificity, compensatory reflexes evoked and dose.
Metaraminol
Sympathomimetic
Peripheral vasoconstrictor that increases systolic and diastolic BP and is mildly inotropic. Direct agonist at alpha1 receptors and also increases endogenous noradrenaline.
Sympathomimetics partially or completely mimic the agonistic actions of noradrenaline or adrenaline on the alpha and/or beta adrenoreceptors. The effect of a specific agent is determined by receptor specificity, compensatory reflexes evoked and dose.
Noradrenaline
Sympathomimetic
Vasoconstrictor with few cardiac effects.
Sympathomimetics partially or completely mimic the agonistic actions of noradrenaline or adrenaline on the alpha and/or beta adrenoreceptors. The effect of a specific agent is determined by receptor specificity, compensatory reflexes evoked and dose
Adrenaline
Sympathomimetic
Nonselective adrenergic agonist. Positive inotrope and chronotrope (beta1 receptors); vasodilator at low dose (beta2 receptors); vasoconstrictor at high dose (alpha1 receptors). Bronchial smooth muscle relaxant (beta2 receptors). Stabilises mast cells.
Milrinone
Phosphodiesterase 3 inhibitor
Inotrope; increases force of myocardial contraction; systemic and pulmonary arterial vasodilator.
Sacubitril with valsartan
Neprilysin inhibitor with a sartan
The active metabolite of sacubitril inhibits neprilysin reducing degradation of natriuretic peptides. It also increases angiotensin II concentration which is blocked by valsartan. The combination produces vasodilation, increases glomerular filtration rate, reduces sympathetic tone and aldosterone release, and increases bradykinin levels.
Vericiguat
Soluble guanylate cyclase (sGC) stimulator that targets the nitric oxide‑sGC‑cyclic guanosine monophosphate pathway, which may improve myocardial and vascular function.
