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608 Pharmacology > Heart Failure Drugs > Flashcards

Heart Failure Drugs Flashcards

1
Q

preload

A

volume of blood in the ventricles at the end of diastole which stretches the ventricles

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2
Q

What drugs are used to reduce preload?

A

DIURETICS (and sometimes nitroprusside/nitroglycerin)

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3
Q

Loop diuretics MOA

A

inhibit the Na/K/Cl cotransporters in the thick ascending limb of the Loop of Henle

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4
Q

2 Examples of Loop Diuretics

A

1) Furosemide (Lasix)
2) Torsemide

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5
Q

Which is more potent - furosemide or torsemide?

A

torsemide (10-20x) - used more in end stage or refractory cases of heart failure

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6
Q

Thiazide diuretic MOA

A

inhibits the reabsorption of Na and Cl in the distal tubule

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7
Q

Main side effects of Diuretic Therapy?

A

dehydration and electrolyte abnormalities

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8
Q

Spironolactone

A

competitively antagonizes aldosterone by downregulating NaK pump and therefore blocking Na reabsorption in the distal convoluted tubule

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9
Q

Why is spironolactone considered a weak diuretic?

A

not that much sodium is really reabsorbed in the collecting duct and that’s its main MOA

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10
Q

Inotrope

A

agent which alters the force of heart muscle contractility

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11
Q

Negative Inotrope Definition and Two Categories

A

decreasing the force of muscular contractions
1) beta blockers
2) calcium channel blockers

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12
Q

Clinical Scenarios for Negative Inotropes

A

Hypertrophic Obstructive Cardiomyopathy, Stenoses, tachyarrhythmias

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13
Q

Positive Inotrope Definition and Three Examples

A

Increase the strength of muscular contraction; also reduces mitral regurgitation and pulmonary edema
1) Dobutamine
2) Pimobendan
3) Digoxin

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14
Q

5 Goals of Positive Inotrope

A

IMPROVE:
1. Contractility
2. Cardiac output
3. Blood pressure
4. Clinical signs
5. QOL

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15
Q

Which positive inotrope is given IV?

A

dobutamine

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16
Q

Pimobendan

A

the first line therapy for heart failure - an oral medication that does NOT cause significantly increased calcium!

17
Q

Dobutamine

A

a continuously administered IV medication (positive inotrope) for severe cases of heart failure

18
Q

Cardiac Output equation

A

heart rate times stroke volume

19
Q

Pimobendan MOA

A

inhibits phosphodiesterase III making it a balanced arterial and venous vasodilator, making the heart more SENSITIVE without increasing levels of calcium

20
Q

Phosphodiesterase Inhibtors

A

prevent conversion of cAMP to AMP; more cAMP means more contractility

21
Q

Afterload

A

the pressure the ventricle must overcome to circulate blood (left –> aorta or right –> pulmonary artery)

22
Q

Is afterload increased or decreased when blood pressure is high?

A

increased

23
Q

Is afterload increased or decreased during vasoconstriction?

A

increased

24
Q

Ideal systemic blood pressure?

A

110-130mmHg

25
Q

Systemic Afterload Reducers

A

work on the left side of the heart; Amlodipine, angiotensin receptor blockers (drugs that end in -sartin), and ACE inhibitors (Enalapril, Benazepril, etc)

26
Q

Ideal pulmonary pressure?

A

15-25mmHg

27
Q

Overlapping mechanisms which control blood pressure?

A

neuro, renal, vascular, hormonal

28
Q

Beta receptor on the heart?

A

b1

29
Q

Beta receptor on the lungs?

A

b2

30
Q

Nucleus solitarius

A

termination of afferent stimuli (from vagal and glossopharyngeal nerves of the autonomic nervous system) in the medulla

31
Q

baroreceptors

A

part of the autonomic nervous system and participate in the feedback loop which controls blood pressure

32
Q

In circulation, which is higher under normal conditions - epinephrine or norepinephrine?

A

epinephrine

33
Q

Amlodipine

A

calcium channel blocker

34
Q

Sildenafil

A

stimulates the nitric oxide pathway via inhibiting PDE5; treats pulmonary hypertension

35
Q

RAAS

A

Renin Angiotensin Aldosterone SYstem

36
Q

End products of RAAS?

A

aldosterone and angiotensin II

37
Q

How to block RAAS?

A

ACE inhibitors, angiotensin receptor blockers, spironolactone

38
Q

Side effects of ACE inhibitors?

A

azotemia

39
Q

Beta blockers are what drugs?

A

the -olols (like atenolol); helps chill out the sympathetic nervous system

608 Pharmacology (13 decks)

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