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Biomedical Pharmacology > Lecture 11 - The Heart > Flashcards

Lecture 11 - The Heart Flashcards

1
Q

What is heart failure?

A

The output of heart is insufficient to meet the demands of the body

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2
Q

When does Myocardial Ischaemia occur?

A

When blood flow to your heart is reduced

Not receiving enough oxygen

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3
Q

Where does Myocardial Ischaemia occur from?

A

Angina

Myocardial Infarction

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4
Q

What is disturbance in cardiac rhythm treated by?

A

Beta-receptor antagonist

Beta blockers

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5
Q

What can lead to dysrhythmia/ arrhythmia?

A

Angina

Myocardial infarction

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6
Q

What does Myocardial Ischaemia result from?

A

Blockage in coronary blood vessel

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7
Q

What is Angina?

A

Chest pain associated with Myocardial Ischaemia

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8
Q

How can Angina be classified?

A

Stable
Unstable
Prinzmetals (variant)

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9
Q

What is stable and unstable of angina be due?

A

Narrowing of blood vessels

Build up of atheromatous plaque = thrombosis

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10
Q

What is stable?

A

Less serious form of angina

At rest: individual will not experience any chest pain unless acted on oxygen demand of heart increases

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11
Q

What is unstable?

A

More severe
Continual pain
Whether engaging in exercise or at rest
Greater restriction on blood flow

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12
Q

Prinzmetal (variant)

A

Smooth muscle contraction in arterial side of circulation

Vasospasm

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13
Q

What is the pharmacological intervention for Angina?

A

Increase blood flow through coronary vessels

Decrease oxygen demand prophylactically

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14
Q

What are the compounds that treat Angina?

A

Organic nitrates
Potassium channel activators
Beta adrenoceptor antagonist
Calcium channel antagonist

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15
Q

What can lead to Angina?

A

Decrease oxygen supply

Increase oxygen demand

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16
Q

What is the effect of decreased oxygen supply?

A 
Decreased coronary blood flow 
Decrease vessel calibre
Increase heart rate 
Decrease perfusion pressure 
Increase ventricular wall tension
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17
Q

What is the effect of increased oxygen demand?

A

Increase heart rate
Increase Myocardial contractility
Increase ventricular well tension

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18
Q

What is nitric oxide taken through?

A

Sequence of events

Activation of guanylate cyclase —> GT to cyclic cGMP —> activation of protein kinase

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19
Q

Where does nitric oxide come from?

A

Endothelial cells

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20
Q

What is Increase in blood flow due to?

A

Vasodilation

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21
Q

What does reduced oxygen demand suggest?

A

Heart is contracting less forcefully

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22
Q

What does Frank-Starling mechanism of heart suggest?

A

The relationship between ventricular filling and force of contraction
Greater venous return = greater stretch of myocardium and resulting force of contraction is greater
Greater preload on heart

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23
Q

What are veins referred to as?

A

Capacitance vessels

Alter proportion of blood in circulation by altering diameter of veins

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24
Q

What does organic nitrates cause?

A

Both vasodilation on venous and arterial side of circulation
Easier for boood to flow
Reduce cardiac preload
Reduce oxygen demand

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25
Q

What are examples of organic nitrates?

A

Glyceryl trinitrate

Isosorbide mononitrate

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26
Q

What is Glyceryl trinitrate?

A

Absorbed quickly across mucosal membrane
Administration: spray/tablet under tongue/patch
Used when there is Angina attack

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27
Q

What is isosorbide mononitrate?

A

Taken orally
Absorbed in GIT
Longer lasting action

28
Q

What are the results from cardiovascular point of view?

A
  1. Increased blood flow and reduced oxygen demand
  2. Frank-Starling mechanism
  3. Dilation in blood vessel = venous side of circulation
  4. Organic nitrate - venodililation
  5. Organic nitrate - both vasodilation on venous and arterial circulation
  6. Relax vascular smooth muscle
  7. Venous capacitance vessel
  8. Coronary arteries
  9. Arterial resistance vessels
29
Q

Dipyridamole

A

Dilatory effect on major coronary blood vessel

30
Q

What does collateral arteries found in cardiovascular circulation allow?

A

Communication between parts of blood flow

31
Q

What does organic nitrate have?

A

Specific dilatory effect which can bring about dilation if collateral vessels

32
Q

How are organic nitrate administered?

A

Sublingual
Buccal
Transdermal
Oral

33
Q

What are the unwanted effects of organic nitrate?

A 
Venodilation 
Postural hypotension
Dizziness 
Syncope 
Reflex tachycardia
34
Q

What can arterial dilation cause?

A

Throbbing headache and flushing

35
Q

Asymmetric dosing

A

Take doses 6 hours apart rather than 12
Most prophylactic effect
Period where concentration of nitrate decreases over period of 24 gods
Reduce incidence of tolerance

36
Q

Potassium channel Activators

A

K+ channel opener
Increased membrane K+ permeability with K+ extrusion from cell
Vascular smooth muscle hyperpolarisation
Closure of L-type voltage-dependent Ca2+ channel
Inhibition of intracellular Ca2+ release
Reduced free intercellular Ca2+
Quiescence and protection of cells against hypoxia
Vasodilation

37
Q

B-adrenoceptor antagonist

A

Beta blockers
In Angina: reducing oxygen demand of heart
Beta blockers block beta 1 receptors
Beta 1 receptors present on cardiac tissue
When cardiac tissue blocked - reduction in heart rate and reduced force of contraction - lower Bp

38
Q

What does blockade of B1 receptors act to do?

A

Reduce heart rate
Reduce force of contraction
Lower blood pressure

39
Q

What is an example of drug that is cardioseletive?

A

Atenolol

40
Q

Lipophilic

A

Propanolol

41
Q

Hydrophilic

A

Atenolol

42
Q

What are unwanted effects of B-adrenoceptor antagonist?

A

Precipitation of heart failure/ impairment of blood supply to peripheral tissues
Lowering of HDL
Sleep disturbances
Sudden withdrawal syndrome

43
Q

What are 3 classes of calcium channel antagonist?

A

Phenylalkylamine (verapamil)
Dihydropyridine (nifedipine, amlodipine)
Benzothiazepine (diltiazem)

44
Q

What does the 3 classes of calcium channel antagonist do?

A

Block cellular entry of calcium through L-type channels

45
Q

What does cellular entry of Ca2+ blockade result in?

A

Arteriolar/arterial dilation

Reduction in heart rate and cardiac contractility

46
Q

What are the side effects of calcium channel antagonist?

A

Arteriolar dilation: headache, flushing and dizziness and ankle oedema
Reduced cardiac contractility
Verapamil: altered gut motility
Nifedipine: heart burn and nausea

47
Q

What does formation of clot include?

A

Fibrinogen

Activated fibrinogen fibrin

48
Q

What enzyme breaks down blood clots?

A

Streptokinase

49
Q

What is the streptokinase enzyme if bacteria origin capable of activating?

A

Plasminogen into plasmin

50
Q

What is plasmin involved in?

A

Breakdown of fibrinogen and fibrin

Dissolving the clot

51
Q

What does secondary prophylaxis include?

A 
Stop smoking
Exercise more 
Low dose aspirin or warfarin 
B-adrenoceptor antagonist
ACE inhibitors 
Calcium channel blockers 
Statins to lower cholesterol
52
Q

What does ACE inhibitors do?

A

Angiotensinogen is concerted into Angiotensin 1
Angiotensin 1 is converted into Angiotensin 2
Angiotensin 2: potent vasoconstrictor effect
Ace inhibitors can cause vasodilation - reduce stress on heart by reducing blood pressure

53
Q

What does peripheral oedema occur?

A

Swelling in ankles

54
Q

What are the symptoms associated with reduced cardiac output/ venous congestion?

A

Breathlessness
Peripheral oedema
Fatigue

55
Q

What is Digoxin?

A

Potent inotrope derived from natural sources

Affects how Ca2+ is handled on intracellular part of cardiomyocte

56
Q

What can diuretics lead to?

A

Hypokalamia (potassium levels are too low)

57
Q

What does diuretic influence?

A

Tubular reabsorption of sodium

Diuretics will increase urine flow at various stages from tubular and water follows by osmotic means

58
Q

What are examples of Loop Diuretics?

A

Furosemide
Bumetanide
Torasemide

59
Q

When is loop diuretics used?

A

Where oedema is an issue

Clinically used in treatment of salt and water overload

60
Q

What is salt and water overload associated with?

A 
Acute pulmonary oedema 
Chronic heart failure 
Ascites (liver cirrhosis)
Nephrotic syndrome
Renal failure
61
Q

where does Thiazide and related drugs act on?

A

Distal tubule

62
Q

What are examples of thiazides?

A

Bendrochlorothiazide

Hydrochlorothiazide

63
Q

What are other drugs of thiazide?

A

Chloralidone
Indapamide
Metolazone

64
Q

What does Thiazide mechanism inhibit?

A

Na+-Cl- cotransporter
Reduce Na+ reabsorption
Potassium loss
Excretion of Ca2+ and uric acid is decreased

65
Q

When is Cardiac glycosides good?

A

Heart failure associated with atrial fibrillation

Rapid heart rate

66
Q

How do you exacerbate heart failure?

A

Myocardial depression

Fluid retention

67
Q

What are primary Myocardial injury?

A

Secondary Myocardial effect
Neurohormone
Endothelium

Biomedical Pharmacology (19 decks)

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