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Pharmacology #3 > Heart Failure and Angina > Flashcards

Heart Failure and Angina Flashcards

1
Q

What is heart failure?

A

This is a condition in which the heart can’t pump enough blood to meet the body’s needs.
This can be due to the heart not being filled properly or else the heart can’t contract with enough force to get the blood to where it needs to go

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2
Q

Diastolic heart failure is what?

A

The heart isn’t filled properly

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3
Q

Systolic heart failure is what?

A

The heart can’t contract forcefully enough to get blood out to the rest of the body

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4
Q

There are several classes of heart failure from mild to severe. It’s all dependent on how it impacts your physical activity.

A

Great. Class I means no limitation of physical activity. Class IV means you can’t carry out any physical activity without discomfort

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5
Q

Remember excitation-contraction coupling? Well, do you? Prove it. Tell me about it.

A

Depolarization happens and an influx of calcium occurs. That influx of calcium causes the release of more calcium from the sarcoplasmic reticulum. The liberated calcium binds to troponin, which leads to a change in the interaction between actin and tropomyosin, thereby exposing the sites on the actin filament for myosin to grab onto and pull. Boom- contraction.

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6
Q

Depolarization of a cardiac myocyte leads to what?

A

Opening of the voltage gated calcium channels.

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7
Q

Calcium influx from the voltage gated calcium channels do what?

A

They activate the ryanodine receptors on the sarcoplasmic reticulum, which leads to more calcium release.

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8
Q

There is this actin, myosin, troponin and tropomyosin thing going on. Where does calcium bind and what happens?

A

Calcium binds to troponin, exposing the the myosin binding site on the actin.

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9
Q

What fuels the moment of the actin-myosin complex?

A

ATP hydrolysis

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10
Q

There are several things that contribute to how well the heart pumps blood. List a few of them. Or 6.

A
  1. the sensitivity of contractile proteins to Ca++
  2. The amount of Ca++ that is released
  3. The amount of Ca++ that is stored in the sarcoplasmic reticulum
  4. The amount of Ca++ that enters the cell upon depolarization
  5. the activity of the Na+/Ca++ exchanger
  6. Intracellular Na+ concentration and the activity of the Na+/K+ ATPase (which affects Ca++ via #5)
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11
Q

What do inotropic drugs do in general?
Negative inotropes do what?
Positive inotropes do what?

A

They alter the force or energy of muscular contractions.

Negative inotropes weaken the force of muscular contractions whereas positive inotropes increase the force

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12
Q

Chronotropic drugs do what? Positive and negative chronotropic drugs do what?

A

They may change the heart rate by affection the nerves controlling the heart or by changing the rhythm produced by the sinoatrial node.
Positive ones increase heart rate and negative ones decrease heart rate

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13
Q

What does digoxin do?

A

It has effects on the electrical properties of the cardiac tissue

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14
Q

Digoxin blocks what? What effects does that have?

A

the activity of the Na+/K+ ATPase.
Internal sodium increases. This slows the Na+/Ca++ exchanger which slows the removal of Ca++
This leads to increased heart contractility

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15
Q

T/F-Positive inotropic drugs to treat heart failure would include B1-adrenergic receptor agonists.

A

True

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16
Q

Heart failure is often treated with drugs that don’t have positive inotropic effects. Whats an example of a class of drugs that do this?

A

Beta-adrenergic receptor antagonists.

There are several suggested mechanisms as to why this works but we’re not a 100% sure.

17
Q

T/F anyone with congestive heart failure will be treated with diuretics?

A

Indeed they will

18
Q

Drugs without positive inotropic effects that treat heart failure include

A

ACE inhibitors
Aldosterone receptor antagonists
Direct vasodilators

19
Q

91% of patients with heart disease also have

A

periodontitis

20
Q

What is angina?

A

Its pain or discomfort in the chest that happens when some part of the heart doesn’t receive enough oxygen from the blood

21
Q

What is a stable angina due to?

A

It’s predictable and is due to fixed and stable plaque

22
Q

What is variant angina?

A

It is due to a spasm of the coronary artery

23
Q

What is an unstable angina?

A

It is due to an unstable plaque +/- thrombus

24
Q

Nitrates are often used to treat what?

A

Angina

25
Q

So if blood vessels are occluded and blood isn’t getting to part of the heart and the proposed treatment is giving someone a nitrate, what do you think is going to happen?

A

Vasodilation. Open up the blood vessel so blood can pass through.

26
Q

All nitrates used to treat angina are prodrugs that spontaneously produce what?

A

Nitric oxide- vasodilation

27
Q

How does NO work?

A

Nitric oxide hooks up with soluble guanylyl cyclase which takes GTP to cyclic GMP. cGMP activates protein kinase G which helps to smooth muscle relaxation.

28
Q

If someone has acute episodes of angina, what should you do? Why?

A

Apply some nitroglycerin under the tongue. It’s rapidly absorbed from the oral mucosa and well absorbed from GI tract and through the skin. It works fast.

29
Q

Longer acting nitrates are more effective when taken orally.

A

excellent

30
Q

What are some adverse side effects of taking nitro?

A

Headache
Postural hypotension
facial flushing
tachycardia

31
Q

Beta-adrenergic receptor blockers are used to treat angina.

A

Decreases contractility and heart rate. The way this works is that it decreases the amount of work the heart is doing. If the heart is doing less work then it needs less blood to function. This helps prevent angina.

32
Q

T/F Calcium channel blockers are also used to treat angina. Why?

A

True. Calcium channel blockers act as cardiac depressants. This decreases the work the heart is doing as well as decreasing the oxygen requirement.
Calcium also has another pathway where it complexes with calmodulin. Through that pathway NO is released, thereby inducing vasodilation, which is also great for angina. Calcium channel blocks are both cardiac depressants as well as vasodilators

33
Q

Which drugs for angina are vasodilators and which are cardiac depressants?

A

Vasodilators:
Nitrates and Calcium blockers

Cardia depressants:
Calcium blockers and beta-blockers

Pharmacology #3 (7 decks)

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