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Cardiorespiratory pharmacology > heart failure pharmacology > Flashcards

heart failure pharmacology Flashcards

1
Q

drugs effect heart function both..

A
  • directly - force of contraction/ rhythm

- indirectly - vsascualture by altering blood volume and composition

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2
Q

outline the first line of therapy

A
  • beta blockers in conjunction
  • ACE inhibitors
  • Diuretics
  • MRAs (K sparring)
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3
Q

outline the second line of therapy

A
  • digitalis (inhibits Na/K ATTase)
  • entresto (sacubitril + valsartan)
  • ivabridine (funny current blocker)
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4
Q

Outline the mechanism of beta-blockers

A
  • metoprolol & carvedilol
  • inhibit SNS innveration via blocking B1r
    reduces
  • chronotropy
  • isotropy (contractility)
  • dromotropy (conduction)
  • Lusitropy (relaxation)
  • minimal effect on vasculature
  • preservation of ATP/ reduces work load and energy requirement
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5
Q

Outline the mechanism of ACE inhibitors -

A
  • Benazepril & Captopril
  • produce vasodilation of vasculature by inhibiting formation of ag2
  • treat chronic HT
  • used in conjunction with diuretics
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6
Q

AT1r blockers work by? (ARBs)

A

The sartans - eprosartan & Valsartan

  • bind to AT1r on vessels
  • inhibits IP3 pathway involved in increasing ca levels and therefore contraction. of smooth muscle around vasculature
  • stimulates Ca release from L-T/ SR
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7
Q

Loop diuretics work how?

A

Bumetanide & Edecrin

  • most powerful
  • targets the NKCC2 channel in the loop of Henle (thick ascending limb)
  • transporter absorbs 25% of Na load
  • loss of na/water
  • hypoK, alkalosis
  • increased ca loss
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8
Q

Thiazides target the?

A
  • inhibit the Na/Cl symporter in DCT
  • 10% of Na reabsorbed so not very effective
  • increased ca absorption
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9
Q

K -sparring diuretics work by?

A
  • act as antagonists of the MR present on epithelial cells of the CD
  • increased water loss in urine
  • inhibits insertion of preformed Na channels within apical membrane and Na/K atpases + synthesis
  • weak natriuresis
  • prevents XS loss of K (no hypoK)
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10
Q

Natriuretic peptides work via?

ANP, BNP

A
  • elevating cGMP synthesis in smooth muscle of vessels leading to vasodilation
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11
Q

natriuretic peptides are produced in response to?

A
  • stretch
  • ag2
  • endothelia levels
  • SNS activity

nesirtide (recombinant BNP)

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12
Q

CV and renal action of NPs include?

A
  • natriuresis
  • diuresis
  • elevated GFR /filtration fraction
  • reduced circulating ag2
  • reduced circulating aldosterone
  • systemic VD
  • arterial hypotension
  • reduced venous pressure
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13
Q

sacubitril works how?

A
  • blocker of neprilysin
  • enzyme that degrades NP
  • effective when given in conjunction with ARB valsartan
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14
Q

what is the benefit of funny current inhibitors ?

A
  • funny current carried by hyperpol activated cyclic nucleotide gated Chanel (HCN)
  • inhibition slows AP firing rate
  • reduced HR and preservation of ATP in myocyte cells
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15
Q

what are the 2 types of nitro dilators?

A
  • those that release NO spontaneously (Na nitroprusside)
  • organic nitrates that require enzymatic processes to form NO
  • tolerance occurs with frequent dosing
  • work via elevating cGMP levels, up regulating K channels expression , stimulation of MLCP and inhibition of IP3 pathway
  • all aim to produce VD in smooth muscle
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16
Q

Name a cardiostimulatory drug

A
  • cardiac glycosides
  • sympathomimetics
  • PDE inhibitors
17
Q

name an example of a cardiac glycoside drug and explain how it works

A
  • digitalis compounds - digoxin
  • inhibitors of ATPase pump
  • rises Na levels in the cell
  • reduced external driving force on Na
  • so this leads to reduced ca efflux via the NCX channel (anti porter)
  • elevated intracellular levels of ca
  • increased contractility
  • increased EF and HR
18
Q

Name some negative side effects of digitalis compounds

A
  • arrhythmias
  • diastolic dysfunction
  • hypertrophy
  • fibrosis
19
Q

How do PDE inhibitors work? (in periphery)

A
  • inhibit PDE3 in the smooth muscle vessel cells
  • increased levels of cAMP via reduced degradation
  • stimulation of MLCP
  • inhibits MLCK
  • vasodilation
  • decreased systemic resistance
  • decreased arterial BP
20
Q

The effects of PDE5 on cardiopulmonary system?

A
  • increased cAMP
  • increased contractility and HR
  • increased SV and EF
  • decreased V preload
21
Q

Non- pharmacological approaches include

A
  • CRISPR cas 9 system
  • SERCA2A gene transfer via CUPID2 (often down regulated in HF)
  • increases lucitropy
  • pluripotent stem cell derived cardiomyocytes
  • cardiac assist devices - implantations of a LV assist device

Cardiorespiratory pharmacology (15 decks)

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