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Pharmacology II > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

what is a disorder due to reduced cardiac output

A

systolic dysfunction ( acute)

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2
Q

what are some compensatory mechanisms for heart failure

A

sympathetic nervous system and renin-angiotensin aldosterone response, and myocardial hypertrophy

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3
Q

what are the most common causes of heart failure

A

coronary disease and hypertension ( other causes are MI, valvular heart disease, and congenital heart disease)

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4
Q

what are some bfts of tx

A

reduced load on heart, decreased ec fluid volume, improved cardiac contractility, slower rate of cardiac remodeling

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5
Q

what happens under diastolic failure

A

loss of adequate relaxation -> reduced filling, reduced cardiac output

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6
Q

which is a disorder due to a result of hypertrophy and stiffening of the myocardium

A

diastolic dysfunction

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7
Q

the actions of this molecule include potent vasoconstrictor, enhances release of catecholamines, increases synthesis of aldosterone ( leads to Na and water retention), and will also induce cardiac hypertrophy

A

angiotensin II

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8
Q

this drug is used in pts with HF and/or atrial fibrillation ; pts who respond well to ACE inhibitors and/or diuretics do not need this drug; adverse effect is toxicity , cardiac arrhythmia , GI probs, anorexia, nausea, HA, fatigue, confusion, blurred vision, etc

A

digoxin

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9
Q

symptoms of this disorder include dyspnea, fatigue, and fluid retention

A

heart failure

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10
Q

what allow for the movement of actin and myosin filaments

A

interaction of activator CA with actin-troponin-tropomyosin system ( contraction occurs)

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11
Q

what happens under systolic failure

A

reduced contractility

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12
Q

where is activator Ca released from

A

SR ( amt released depends on the amt stored in the SR and on the amt of trigger Ca that enters the cell during the action potential)

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13
Q

adaptive mechanisms work to restore the cardiac output; but if they increase the work of the heart and contribute to further decline in performance , HF is

A

decompensated HF

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14
Q

decreased K levels increase toxicity in this drug

A

digoxin

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15
Q

this type of inotropic drug comes from the digitalis plant ; has low therapeutic index

A

cardiac glycosides ie. digoxin

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16
Q

reduction in physical activity, reduction in dietary intake of Na, treatment of comorbid conditions, medications, avoiding NSAIDS alcohol Ca channel blockers and high dose beta blockers and some antiarrhythmic drugs are used to manage

A

chronic HF

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17
Q

what is associated with remodeling of cardiac tissue -> loss of myocytes, hypertrophy, and fibrosis

A

chronic activation of sympathetic nervous system and release of aldosterone

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18
Q

what are the two goals tx of HF is aimed at

A

reducing symptoms and slowing progression, and managing acute epidoses of decompensated failure

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19
Q

this compensatory mechanism is when a fall in cardiac output decreases blood flow to the kidney; this prompts the release of renin and increased circulation of aldosterone; results in increased peripheral resistance and retention of Na and water -> blood volume increases and pulmonary edema results

A

activation of renin-angiotensin system

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20
Q

this is a system for controlling bp and electrolyte levels; monitors Na, K, vascular volume, and bp

A

renin-angiotensin-aldosterone system

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21
Q

what converts angiotensinogen to angiotensin I

A

renin

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22
Q

what happens to the heart as a result of compensatory mechanisms

A

heart becomes more spherical -> less efficient pump, prompts additional sympathetic activation

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23
Q

this is an impaired ability of the heart to adequately fill with and/or eject blood

A

heart failure

24
Q

for tx of HF: all of these drugs are examples of what- inotropic agents, beta blockers, diuretics, inhibitors of renin angiotensin system, and vasodilators

A

effective drug classes

25
Q

this compensatory mechanism is when the baroreceptors sense a decrease in bp; this stimulates beta receptors to increase HR and force of cxn; alpha 1 mediated vasoconstriction enhances venous return

A

increased sympathetic activity

26
Q

HF can be accompanied by ________

A

abnormal increases in blood volume and interstitial fluid ->pulmonary congestion/ and or peripheral edema

27
Q

this compensatory mechanism is when the heart increases in size ; becomes more globular and elongation of fibers results in weaker cxn

A

myocardial hypertrophy

28
Q

what causes a releaseof renin from the kidney

A

reduction in bp or fall in the delivery of Na to the nephron

29
Q

this is when the heart is unable to pump blood to meet the body’s needs ( progressive and lethal)

A

heart failure

30
Q

long term use of these drugs has been found to increase mortality ; used short term as IV fusion for acute failure or severe chronic failure

A

inotropic drugs ( phosphodiesterate inhibitors)

31
Q

Dobutamine is the most common of these drugs and is given by IV infusion ; risk of angina or arrhythmias with this drug

A

beta adrenergic agonists ( inotropic drugs)

32
Q

this class of drugs relieves pulmonary congestion and peripheral edema ; causes decreased plasma volume and decreased venous return to the heart; reduction in plasma volume also reduces blood pressure

A

diuretics

33
Q

these type of diuretics are mild ; loose efficacy if pt creatinine clearance is low

A

thiazide diuretics

34
Q

what is the most common type of diuretic used for Heart failure

A

loop diuretics ie. furosemide

35
Q

Pts with heart disease have increased levels of _______

A

aldosterone

36
Q

What do Antagonists prevent

A

salt retention, myocardial hypertrophy, and hypokalemia ( pts should not take K supplements)

37
Q

Which aldosterone antagonists is reserved for advanced cases ? ; Causes GI disturbances, lethargy and confusion, decreased libido, menstrual irregularities

A

spironalactone

38
Q

Which aldosterone antagonist is the drug choice over spironalactone due to its lower side effects

A

eplenerone

39
Q

Heart failure leads to the activation of what system

A

renin angiotensin system

40
Q

Via what two mechanisms is the renin angiotension system activated

A
  1. increased renin secretion in response to decreased renal perfusion pressured produced by the faiing heart
  2. increased renin secretion as a response to sympathetic stimulation and activation of beta receptors
41
Q

T or F: Angiotension I is a potent vasoconstrictor

A

F: Angiotensin II is a potent vasoconstrictor

42
Q

Stimulation of Aldosterone release causes ______ and _________ retention

A

salt and water

43
Q

How do ACE inhibitors work

A
  1. Angiotensin Converting Enzyme cleaves angiotension I to angiotension II
  2. ACE inhibitors block the enzyme
  3. Decrease the rate of bradykinin inactivation ( bradykinin is a potent vasodilator )
44
Q

What actions do ACE inhibitors have on the heart

A
  1. decrease vascular resistance , venous tone, and bp
  2. reduce preload and afterload ( increased cardiac output)
45
Q

These class of drugs are considered as a single agent therapy in pts who have mild dyspnea on exertion with no signs of edema; indicated in pts with all stages of L ventricular failure; can be used in combo with diuretics, beta blockers, digoxin, and aldosterone antagonists ; good after heart attack

A

ACE inhibitors

46
Q

Pharmacokinetics of thes class of drugs: food decreases absorption; most are pro drugs; Ramipirl and Fosinopril have longer half lives and are dosed once a day

A

Ace inhibitors

47
Q

Adverse effects of this class of drugs includes postural hypotension; persistent dry cough ; not to be used in pregnant women

A

ACE inhibitors

48
Q

These class of drugs are competitive antagonists of the angiotension receptor; do not affect bradykinin levels ; can substitute for ACE inhibitors if pt cant tolerate

A

Angiotension receptor blockers

49
Q

What are the actions that Angiotension receptor blockers have on the cardiovascular system

A

lower BP; used as substitute for ACE inhibitor in pts with severe cough or angioedema

50
Q

These class of drugs are most effective when taken orally ; once daily dosing; losartan is converted to active compound in liver metabolism ; plasma protein bound

A

Angiotension receptor blockers

51
Q

Adverse effects of this class of drugs are similar to ACE inhibitors ; includes postural hypotension; but NO persistent dry cough ; not to be used in pregnant women

A

Angiotension receptor blockers

52
Q

T or F: dilation of veins leads to an increase in cardiac output

A

F: leads to a decrease

53
Q

T or F: dilation of arteries reduce systemic resistance and decrease afterload

A

T

54
Q

Which drugs should be avoided in pts with heart failure

A

Ca channel blockers

55
Q

this class of drugs decreases chronic activation of the sympathetic nervous system ; decreases HR, inhibits renin release, and decreases cardiac remodeling; get initial worsening of symptoms ( negative inotropic activity )

A

beta blockers

56
Q

What are the two approved beta blockers to be used in heart failure

A

carvedilol and metoprolol

Pharmacology II (31 decks)

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