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Pharmacology > Lecture 17: Drugs for Heart Failure > Flashcards

Lecture 17: Drugs for Heart Failure Flashcards

1
Q

What class/type are the following drugs: furosemide, spirnolactone, hydrochlrothiazide

A

Diuretics

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2
Q

What class/type are the following drugs: enalapril, benazepril, lisinopril, ramipril

A

ACEI

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3
Q

What class/type is the following drug: pimobendan

A

Calcium sensitizer

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4
Q

What class/type is the following drug: Digoxin

A

Digitalis

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5
Q

What class/type are the following drugs: dobutamine and dopamine

A

Sympathomimetics

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6
Q

What class type/are the following drugs: atenolol, metoprolol, propanolol

A

Beta blockers

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7
Q

What class/type is the following drug: carvedilol

A

Alpha and beta blocker

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8
Q

What class/type is the following drug: diltiazem

A

Calcium channel blockers

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9
Q

Describe the steps in cardiac muscle contraction

A

Na+ channels open, depolarize and open voltage gated calcium channels that then release more calcium from sarcoplasmic reticulum. Results in myosin-actin interaction causing contraction

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10
Q

What are the 4 factors that affect cardiac performance

A
  1. Preload
  2. After load
  3. Contractility
  4. Heart rate
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11
Q

How does and increase preload affect contractility and cardiac output

A

Increase both

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12
Q

What is afterload

A

Peripheral resistance in the left ventricle

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13
Q

Afterload regulates __pressure

A

Diastolic

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14
Q

What regulates afterload

A

SNS tone which is regulated by contractility

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15
Q

How does increase in contractility affect SNS and diastolic pressure

A

Increase both

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16
Q

What regulates heart contractility

A

Filling pressure, distention of heart and SNS tone

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17
Q

How does vagal tone regulate HR

A

Regulates HR at much lower rate by controlling SA node

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18
Q

What are the 2 regulatory response systems to heart failure

A
  1. SNS activation
  2. RAAS activation
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19
Q

Failure of __ dysfunction is characterized by high cardiac filling pressure which leads to venous ____ and ___ accumulation

A

Systolic, congestion and tissue fluid accumulation

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20
Q

Poor contractility is often results from chronic ___

A

Cardiac overload

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21
Q

What are the signs of left sided heart failure

A

Pulmonary venous congestion and edema often resulting in cough, tachypnea, dyspnea, pulmonary crackles, etc.

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22
Q

What are the signs of right sided heart failure

A

Systemic venous hypertension resulting in jugular vein distension, pleural effusion, ascites

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23
Q

How is acute heart failure characterized

A

Cardiogenic pulmonary edema, with or without pleural and/or abdominal effusion and poor cardiac output

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24
Q

In acute heart failure, what is the therapy aimed at

A

Rapidly clearing pulmonary, improved oxygenation and optimizing cardiac output

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25
Hypertrophic cardiomyopathy impairs ___filling
Ventricular
26
How is the ejection fraction from the LV impacted in hypertrophic cardiomyopathy
Heart will want to maintain 65% ejection fraction, it will maintain 65% but will be smaller volume due to decreased total volume in HCM
27
What are the goals of the drugs to treat hypertrophic cardiomyopathy
Avoid elevated HR, increase filling time, reduce ischemia, improve cardiac relaxation
28
What drugs may be effective in tx of hypertrophic cardiomyopathy
ACEI and furosemide
29
What is cardiac tamponade a result of
Hole in the ventricle that is causing blood to go into pericardial sac instead of aorta
30
How do you treat cardiac tamponade
Pericardiocentesis with or without subsequent pericardiectomy
31
What is the main goal of diuretic therapy
Control edema and effusion in HF
32
What does furosemide do to treat HF
Reduces Na+ reabsorption and therefore decreases fluid retention, also synthesizes prostaglandins which vasodilate reservoir veins, decrease filling pressure of heart
33
When is furosemide most commonly used
1. Animals with cardiogenic edema or effusion, usually acute HF 2. Exercise induced pulmonary hemorrhage
34
How is furosemide used to treat acute heart failure vs chronic heart failure
Acute heart failure: aggressive furosemide indicated for acute pulmonary edema Chronic heart failure: should not be monotherapy
35
What are the adverse effects of furosemide
Excessive fluid and electrolyte losses Loss of Na+ thicken blood, increases peripheral resistance and BP. Decreases contractility of LV
36
What type of diuretic is spironolactone
K sparing diuretic
37
What is spironolactone used for
Adjunct therapy for chronic refractory heart failure
38
When is spironolactone contraindicated
Hyperkalemic patients
39
What does spironolactone antagonize
Aldosterone, which controls K+ excretion in CD
40
What are the adverse effects of spironolactone
Excess K+ (effects membrane potential) and GI disturbances
41
What are thiazide diuretics recommended for
1. Dogs and cats that have become refractory to furosemide 2. Hyperkalemic periodic paralysis in horses
42
How does ACE inhibitors work
Block conversion of inactive Angiotensin I to active angiotensin II, therefore decrease actions of RAAS
43
ACEI degrade ___ contributing to vasodilatory effect
Bradykinins
44
Most ACEi’s are prodrugs that are converted to their active form in the ___. How is the conversion location important
Liver, important to consider for liver dysfunction that might inhibit this conversion
45
How do ACEi impact CV remodeling changes
Oppose remodeling changes by decreasing BP/afterload which cause hypertrophy
46
When are ACEi’s used
Chronic heart failure, expected DCM, chronic valvular insufficiency and HCM First choice agent in management of systemic arterial hypertension in dogs Cats with hypertension Chronic renal disease
47
What is the drug of choice for systemic arterial hypertension in dogs
ACE inhibitors
48
What are some adverse effects of ACEi’s
Hypotension, GI upset, renal function deterioration, Hyperkalemic
49
Which ACEi is labeled use for dogs
Enalapril
50
How does pimobendan work
1. Increases myocardial contractility by increasing myofilament sensitivity to Ca2+ 2. Inhibits PDE III, so increase cAMP—> activates pKA which activates L-type Ca2+ channels and increases myocardial contractions
51
When is pimobendan indicated
Labeled use in dogs (ELDU cats) with HF from DCM of chronic mitral valves disease
52
How does digoxin work
Competitively binds and inhibits Na+/K+ ATPase, decrease Na+ extracellular transport and causes accumulation of Ca2+ intracellularly, increased Ca2+ available to contractile proteins
53
What arrhythmias is digoxin useful for
Supraventricular tachyarrythmias
54
What mediates supraventricular tachyarrythmias
Increased PNS tone to the SA band AV nodes and atria
55
Digoxin improves arterial ___ sensitivity to increase vagal activity in HF
Baroreceptor
56
When is digoxin primarily used
Atrial fibrillations with concurrent HF secondary to DCM or MVD
57
When is digoxin contraindicated
Hypertrophic cardiomyopathy
58
What is the dose for digoxin
0.25mg/dog- should never exceed this
59
How does renal dysfunction and decrease muscle mass affect digoxin
Both can lead to increase toxicity since the drug is processed through the renal system and binds to skeletal muscle
60
Elimination of digoxin is mainly __
Renal
61
What are the adverse effects of digoxin
Cardiac toxicity, sinus bradycardia, ectopic ventricular beats, AV block, ventricular fibrillation
62
Why should digoxin not be given with a drug that causes hypokalemia
Digoxin inhibits Na+/K+ ATPase so decrease K+ intracellularly don’t want to exacerbate
63
Why should digoxin not be given with a B-antagonist
B-antagonist will decrease HR, SA and AV node activity. Digoxin increases PNS tone to AV and SA node which decrease HR
64
Digoxin should not be given with __channel blockers
Calcium
65
Why should digoxin not be given with quinidine
Decrease plasma protein binding and increase toxicity
66
What does dopamine do at low levels
Stimulate D1 receptors and cause vasodilation in kidney
67
What does dopamine do at medium doses
Stimulates B receptors, producing positive inotropic effect
68
What does dopamine do at high doses
Stimulates alpha1 receptors causing vasoconstriction
69
What does dobutamine do
Stimulates b1 receptors increases contractility
70
When is dobutamine and dopamine indicated
Myocardial failure, short term treatment
71
Why is the use of catecholamines for heart failure limited
Downregulation of B receptors
72
What are the adverse effects of dopamine and dobutamine
Arrhythmias, increased myocardial O2 demand, tachycardia, tachyphylaxis, necrosis, seizures
73
What drugs are often used to decrease HR and myocardial O2 consumption
B-blockers (atenolol, propanolol, metoprolol)
74
What do calcium entry blockers do
Cause coronary and systemic vasodilation, enhanced myocardial relaxation and sometimes reduced cardiac contractility
75
Concurrent use of B-blocker with ___ is avoided
Diltiazem
76
ACEi inhibitors are increasingly being used in management of HF from ___
HCM
77
Certain ___ may be useful in long term management of CDM, CVD by reducing effects of chronic SNS activation
Beta blockers- carvedilol and metoprolol
78
What is the standard drug therapy for heart failure
1. Diuretics (furosemide) 2. ACEI 3. Pimobendan

Pharmacology (14 decks)

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