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Drugs > L19- Cardiac Failure and Angina > Flashcards

L19- Cardiac Failure and Angina Flashcards

1
Q

Which rceptors are primarily respinsable for the sympathetic increase of heart contractions?

A

Beta-1 receptors

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2
Q

What are the additional effects of beta blockers?

A

Blooc can flow through the coronary vessels during diastole, B blockers prolong diastole so theat more O2 can get to heart.

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3
Q

hat are the principal and secondary effecs of beta blockers in relieving angina of effort?

A

Principal- reduction in cardiac work, reducing O2 demand.

Secondary- making diastole longer, improving blood flow to cardiac muscle

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4
Q

Which 2 drugs can be used for angina, bind to the alpha subunit of the L type Ca channel?

A

Verapamil = use dependent block

Nifedipine = NOT use dependent block

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5
Q

What can verapamil treat?

A

dysrhythmias and angina and hypertension

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6
Q

How does the use dependence determine the mechanisms of ca blockers in angina treatment?

A

verapamil = use dependent. more potent on the heart than vasuclar smooth muscle. so reduces cardiac output

nifedipine= not use dependent. more potent on vascular smooth muscle than heart. so causes vasodilation.

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7
Q

Which drugs reduce risk of thrombosis?

A

Anti- coagulents eg heparin and aspirin

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8
Q

Which drugs relieve symptoms of angina?

A

beta blockers

organic nitrates

calcium antagonists

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9
Q

Which drugs relieve pain after an MI?

A

Opioids eg morphine

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10
Q

What;s a symptom of heart failure?

A

Oedema. Build up of fluid at the extremities. eg fat ankles

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11
Q

WHat is hypertrophy?

A

When the muscle thickness increases in the heart and the ventricles can’t fill as well.

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12
Q

WHat is dilated cardiomyopathy?

A

When the chambers become enlarged, filling more than normal and can’t pump as much

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13
Q

What are 3 causes of heart failure?

A
  1. chronic hypertension
  2. ischaemia
  3. heart valve disorders
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14
Q

What’s wrong with the compensatory mechanisms the body uses to deal with short term heart failure?

A

Blood pressure rises

Salt and water are retained

vasoconstriction

these end up causing more work for the heart and just make it aaall worse!!

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15
Q

What is a classification system for chronic heart failure?

A

left- left side failing

right- right side failing

forward- failure for pushing blood out heart

backward- failure for blood going back into the heart

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16
Q

What type of heart failure causes:

  1. problems in the lungs
  2. oedema in the rest of the body?
A
  1. lef-sided backwards
  2. right-sided backwards
17
Q

What are the symptoms for:

  1. forward failure?
  2. backwards failure?
A
  1. tiredness, preipheral cyanosis, salt and water retention
  2. breathlessness, engorgement of liver, oedema of legs and ankles
18
Q

What are 3 strategies for treating congestive heart failure?

A
  1. reduce cardiac work
  2. reduce pulmonary congestion and peripheral oedema
  3. increase cardiac output
19
Q

How do you reduce cardiac workload?

A
  1. rest
  2. ACE inhibitor (reduce preload and afterload)
  3. Organic nitrate
20
Q

How do you reduce oedema in tissue and lungs?

A
  1. diet- reduce salt
  2. Thiazide diuretics
  3. loop diuretics
21
Q

How do you increase cardiac output?

A

With a positive inotropic agent.

eg Digoxin.

Improved quality of life but not survival

22
Q

Where does digoxin come from?

A

Fox Gloves.

Digitalis lanata (digit finger)

23
Q

What are the 4 parts in digoxin?

A

a glycone- determines pharmodynamic properties

lactone

steroid- lipid soluble

sugar residues - water soluble

24
Q

Which drug has a positive inotropic effect on the heart without increasing oxygen demands?

A

Digoxin

25
Q

What is the mechanism of digoxin?

A

Not understood. believed to involve the sodium potassium pump

26
Q

What does digoxin do at pharmaceutical doses and toxic doses?

A

pharma- increases vagus nerve activity

toxic- increases sympathetic tone, causing arrhythmias. and inhibits na k atpase

27
Q

When is digoxin used?

A
  1. To treat heart failure with atrial fibrillation and dysrhythmias
  2. Heart failure when diuretics and ACE inhibitors used and still have symptoms.
28
Q

What;s the problemo with digoxin?

A

Low therapeutic index. small window. causes nausea and blurred vision.

29
Q

How is digoxin toxicity treated?

A

Withdrawing it and trying to control the arrhythmias. Propranalol or phenytoin for the arhythmias,. KCl for hypokalaemia.

30
Q

Name three other treatments for congestive heart failure?

A
  1. Phosphodiesterase inhibitors (PDE) ed milrinone
  2. B1- AGONIST eg dobutamine
  3. B1 ANTAGONIST WHEN BROUGHT IN SLOWLY eg carvedilol and metoprolol

(as well as digoxin)

Drugs (16 decks)

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