Heart Failure Drug action sites Flashcards
What drugs are indicated for Stage A heart failure?
These are high risk patients
Should be placed on an Ace inhibitor or ARB
What drugs are indicated for Stage B heart failure if the patient is experiencing recent or remote MI, an Asymptomatic LVD, or hypertensive LVH
These are asymptomatic heart failure patients
Should receive ACE inhibitors or ARB with a Beta blocker
What drug combination works well for hypertensive african american patients?
Nitrates and hydralazine
What is the effect of phosphodiesterase inhibitors inamrinone and milrinone?
These guys increase cAMP concentration allowing for an increase in myocardial contractility.
What is the mechanism of action for the drug Digoxin?
Digoxin works by blocking the Na/K ATPase leading to an intracellular accumulation of sodium. This reduces the Na/Ca channel leading to increased Calcium influx and enhanced contraction!
What are the overall cardiac effects that Digoxin has?
Overall has a positive ionotropic effects
Direct increase in vagal tone
Increases coronary flow
Decreases renal artery resistance
What effects does Digoxin have that make it proarythmic?
Increases the PR interval and ST depression
(Hockey Stick).
Can be especially bad if there is hypokalemia.
How long is the half life of Digoxin?
How long does it take to reach a steady state?
The half life of Digoxin is 36-48 hours if renal function is normal.
Steady state is achieved around 7 days after maintenance therapy.
What can lead to a dioxin tolerance in 10% of the population?
10% of the population harbor the bacteria Eubacterium lentum!
This bacteria metabolizes digoxin.
What is the indication for the drug Digoxin?
Used in treatment of HF especially CHF with AF.
No longer first line through as it does not improve all-cause mortality.
What drug can be used to correct Digoxin intoxication?
Cholestyramine
and Digoxin immune Fab (Digibind)
How do the digoxin antidotes Cholestyramine and Digoxin immune Fab work?
These guys work by binding to bound and free digoxin (cardiac glycoside) where it can then be eliminated by the kidneys.
How do Phosphodiesterase inhibitors Inamrinone and milrinone work?
These work by decreasing cAMP degradation leading to increased contraction, increased relaxation and venous dilation!!!
Overall work to increase CO.
What is the indication for the drugs Inamrinone and Milrinone?
Approved for the short term circulation suppport in advanced CHF.
