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AU 15 - Pharmacology Exam 3 > Heart Failure and Angina > Flashcards

Heart Failure and Angina Flashcards

1
Q

What is heart failure?

A

Condition in which the heart can’t pump enough blood to meet the body’s needs
Sometimes because the heart doesn’t fill with enough blood, sometimes because the heart can’t pump with enough force, sometimes both

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2
Q

What are the two types of heart failures? How often does each occur?

A

Systolic (50%)

Diastolic (50%)

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3
Q

Systolic Heart failure

A

Weakened heart muscle can’t squeeze as well
Can’t get blood through the body
Ventricles are enlarged and pump out less than 40-50% of blood (normally pumps 60%)

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4
Q

Diastolic heart failure

A

Stiff heart muscle can’t relax normally
Stiff ventricles fill with less blood than normal
Ventricles pump out about 60% of the blood, but the amount of blood is lower

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5
Q

What are the classifications of Heart failure?

A 
Class I (mild)
Class II (mild)
Class III (moderate)
Class IV (severe)
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6
Q

Excitation-Contraction coupling

A

Contraction is the result of Ca influx from depolarization causing the release of more Ca from the SR
Liberated Ca binds to troponin leading to a change in the interaction between actin and tropomyosin, exposing myosin
Myosin pulls on the actin as it hydrolyzes ATP, contracting the muscle

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7
Q

Depolarization of the cardiac myocyte leads to what?

A

Opening of the voltage-gated Ca++ channels

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8
Q

Ryanodine receptor

A

This is the receptor on the membrane of the SR, and when Ca binds to it, it releases more Ca into the cell

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9
Q

What factors contribute to how well the heart pumps blood?

A

1) Sensitivity of contractile proteins to Ca
2) Amount of Ca that is released
3) Amount of Ca stored in the SR
4) Amount of Ca that enters the cell upon depolarization
5) Activity of the Na/Ca exchanger
6) Intracellular Na concentration and activity of the Na/K ATPase

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10
Q

Ionotropic drugs

A

Alter the force or energy of muscular contractions

There are both positive and negative ionotropic drugs

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11
Q

Negative ionotropes

A

Weaken the force of muscular contractions

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12
Q

Positive ionotropes

A

Increase the strength of muscular contractions

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13
Q

Chronotropic drugs

A

May change the heart rate by affecting the nerves controlling the heart, or by changing the rhythm produced by the SA node

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14
Q

Positive chronotropes

A

Increase the heart rate

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15
Q

Negative chronotropes

A

Decrease the heart rate

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16
Q

What are the different types of ionotropes used to treat heart failure?

A

Cardiac glycosides
B-adrenergic receptor agonists
Bipyridines

17
Q

Cardiac glycosides

A

Digoxin is the only one used in the US
Blocks Na/K ATPase pump
-internal Na increases
-slows the Na/Ca exchanger, slowing the removal of Ca

18
Q

What are the theraputic effects of cardiac glycosides/digoxin?

A

Increase the contractility

  • increase ventricular ejection and decrease end diastolic and systolic cardiac size
  • Increase CO and increase renal perfusion
  • The above effects lead to a decrease in sympathetic and renal responses
19
Q

What drugs without positive ionotropic effects can be used to treat heart failure?

A 
B-adrenergic receptor antagonists
Diuretics
ACE inhibitors and angiotensin receptor antagonists
Aldosterone receptor antagonists
Direct vasodilators
20
Q

What are the suggested mechanisms of B-adrenergic antagonists used to treat heart failure?

A

Attenuation of adverse effects of catacholamines
Up-regulation of B-receptors (possibly through decreased desensitization)
Decreased HR
Decreased catacholamine-mediated remodeling

21
Q

Most patients (91%) of patients with heart disease also have what?

A

Periodontitis

22
Q

Angina

A

Pain or discomfort in the chest that happens when some part of the heart does not receive enough oxygen from the blood

23
Q

What are the different types of angina?

A

Classical/Typical/Stable/Exertional Angina
Prinzmetal/Variant Angina
Unstable Angina

24
Q

Classical/Typical/Stable/Exertional Angina

A

Due to fixed and stable plaque

25
Q

Prinzmetal/Variant Angina

A

Due to spasm of the coronary artery

26
Q

Unstable Angina

A

Due to unstable plaque

27
Q

What drugs can be used to treat Anginas?

A 
Nitrates/Nitrites
B-adrenergic receptor blockers
Calcium channel bloackers
Aspirin, antiplatelet, and anticoagulant drugs
Ranolazine
28
Q

Nitrates and nitrites used to treat angina are what?

A

Esters of nitrous or nitric acid

29
Q

All of the organic nitrates/nitrites used to treat angina are prodrugs that spontaneously produce what?

A

Nitric oxide - produce vasodilation

30
Q

Nitroglycerin

A

Apply under the tongue for acute episodes of angina; can also be absorbed in GI tract or skin
Therapeutic effect is apparent within 1-3 minutes of sublingual tablets, 30-60 minutes of applying ointment or patch, and 1-2 minutes via IV

31
Q

Longer acting nitrates are effective when?

A

Effective when taken orally

32
Q

What are adverse effect(s) of nitroglycerin and other nitrates?

A

Headache

33
Q

High doses of organic nitrates can cause what?

A

Postural hypotension
Facial flushing
Tachycardia

34
Q

What effect can viagra have when taken with nitrates?

A

Potentiates the action of nitrates - leading to dangerous hypotension

35
Q

How do B-blockers help treat angina?

A

Decrease HR and O2 demand in the SA node
Decrease contractility and O2 demand in the ventricle myocardium
Decrease BP and O2 demand in arterioles

36
Q

How do Ca-channel blockers help treat angina?

A

Decrease HR and O2 demand in the SA node
Decrease contractility and O2 demand in the ventricular myocardium
Increase vasodilation and O2 supply in the coronary arteries
Decrease BP and O2 demand in the arterioles

AU 15 - Pharmacology Exam 3 (6 decks)

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