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Pharmacology B > Lecture 3 - Heart Failure Drugs 1 > Flashcards

Lecture 3 - Heart Failure Drugs 1 Flashcards

1
Q

Define Heart Failure

A

an abnormality of cardiac structure or function leading to the failure of the heart to deliver oxygen at a rate that fulfills the requirements of the tissues in the body

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2
Q

Most patients with heart failure have what other condition?

A

high blood pressure

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3
Q

Most patients with heart failure have what characteristics about their heart?

A

enlarged heart muscle and chamber

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4
Q

look at slide 6

A

kay

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5
Q

Heart failure is defined as having an Ejection Fraction (EF) as less than ?%

A

less than 50%

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6
Q

What is the formula for EF?

A

EF % = amount of blood pumped out of the ventricle / total amount of blood in the ventricle

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7
Q

Systole = ventricles ______

A

contracting

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8
Q

Diastole = ventricles _____

A

relaxing

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9
Q

Cardiomycocytes respond to action potential by ______ of the membrane

A

depolarization

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10
Q

Starts by shortening of _____ proteins and ends with relaxation and return to resting state

A

contractile

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11
Q

Cardiomyocytes are ______ in intercalated discs that respond to stimuli as a unit

A

interconnected

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12
Q

What is an echocardiography?

A
  • send sound waves into the body which are reflected at the interfaces between tissue
  • return time tells us the depth of the reflecting surface
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13
Q

Force of muscle contraction is related to the amount of cytosolic ____

A

Ca2+

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14
Q

Initially, heart failure is not perceived by the patient due to ______

A

compensation

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15
Q

As failure increases, _____ mechanisms keep increasing

A

compensatory

*But at some point, no longer able to improve condition - decompensated HF

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16
Q

List some risk factors and co-morbidities that contribute to the development of HF

A
  • age
  • smoking
  • obesity
  • hypertension
  • coronary artery
  • disease
  • diabetes
  • dyslipidemia
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17
Q

What are some heart failure symptoms?

A
  • dyspnea
  • edema
  • fatigue
  • cough
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18
Q

List 3 ways that the body corrects slight decreases in blood pressure

*note this happens in early heart failure and the patient may not even be aware that they are experiencing heart failure due to the compensatory mechanisms

A

1) increased sodium retention (slow benefit)
- with water retention this increases blood volume
2) activation of RAAS
- angiotensin - constricts arteries/veins (fast benefit)
- aldosterone - sodium retention (slow benefit)
3) sympathetic nerve activation
- increased HR (fast benefit)
- increased contractility (fast benefit)

*pic on slide 16 explains this well :)

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19
Q

____ in heart failure (decompensated) these things worsen the condition

A

Late

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20
Q

How does “overly increased plasma volume and constriction of veins” worsen the condition in late heart failure?

A
  • increased venous return stretches already overstretched ventricles
  • heart no longer able to increase force of contraction
  • heart size enlarges (dilates) and muscle thickens (hypertrophy)
  • venous pressure increases - edema - peripheral and pulmonary
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21
Q

How does “overly increased constriction of arteries” worsen the condition late in heart failure?

A
  • greatly increased peripheral resistance hard for heart to empty against
  • increased resistance to outflow more than heart can now overcome
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22
Q

How does “cardiac overstimulation” worsen the condition late in heart failure?

A
  • now little response - heart has failed
  • overstimulation of B-adrenergic receptors
  • down regulation of these receptors
  • increased fibrosis
  • increased apoptosis (cell death)
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23
Q

How do the compensatory mechanisms of early heart failure worsen the condition in late heart failure?

A
  • Patient no longer able to compensate and overt signs of heart failure appear
  • But now heart must deal with large increases in RAAS, SNS and blood volume
24
Q

Describe Left Side Failure

A
  • blood backs up into lungs and periphery
  • pulmonary (edema)
  • life threatening
  • sitting up helps (more blood in lower veins)

*may prevent right side pumping and blood backs up into veins

25
Q

Describe Right Side Failure

A

-blood backs up into periphery

peripheral edema

26
Q

Main Symptoms of Heart Failure

A
  • Shortness of breath
  • Shortness of breath at night
  • Need to sit or stand to breath easily
  • Reduced exercise tolerance
  • Fatigue
  • Ankle swelling
  • Peripheral edema
  • pulmonary Edema
27
Q

Main Signs of Heart Failure

A
  • Sweating
  • Increased HR
  • Elevated jugular venous pressure
  • Hepato-jugular reflux
  • Rapid breathing
  • Cardiac murmur
28
Q

Clear relationship between ??

A

severity of symptoms and survival

29
Q

Poor relationship between ??

A

severity of symptoms and ventricular function

*patients with mild symptoms may still have a relatively high absolute risk of hospitalization and death

30
Q

Stage A heart failure vs. Stage D heart failure:

which is worse

A

Stage D

*slide 23

31
Q

Most common cause of HF is ?

A

coronary artery disease

32
Q

HF has a complex pathophys involving activation of 2 key neurohormonal systems: ?

A
  • RAAS

- SNS

33
Q

What are the 5 drug classes for treating HF?

A

1) Inhibitors of RAAS
- ACEi (enalapril)
- ARB (losartan)
2) B-adrenergic receptor blockers
- metoprolol
- carvedilol
3) Ionotropes
- digoxin
- dobutamine
4) Diuretics
- furosemide, metolazone
- aldosterone antagonist (spironolactone)
5) Others
- vasodilators (not covered in this course)

34
Q

ACE inhibitors decrease formation of ??

A

angiotensin 2

35
Q

Why would you want to decrease angiotensin 2 (by using an ACEi in HF?)

A

*want to decrease the compensatory mechanisms

  • compensation to heart failure involves the RAAS
  • in the long term, vasoconstriction and blood volume retention become a problem
36
Q

Give an example of an ACE inhibitor

A

enalapril

37
Q

What effects will ACE inhibitors cause?

A

1-decreased constriction in arteries and veins
-decreased preload and after load (heart works less)
2-decreased aldosterone by decreased angiotensin 2
-decreased blood volume (and decreased venous return)
3-decreased remodeling
-decreased thickening of heart tissue

38
Q

___ are considered first line for HF

A

ACE inhibitors

39
Q

When are ACEi started?

A

-soon after diagnosis of HF

40
Q

Describe the benefits ACEi provide to patients with HF

A
  • excellent single therapy
  • improve clinical signs and symptoms
  • significantly decrease morbidity and mortality
  • reduces death caused by:
    • progressive heart failure
    • cardiac arrhythmia
    • myocardial infarction
    • stroke
41
Q

Enalapril has many benefits including: ?

A
  • survivial
  • symptoms/QOL/exercise tolerance
  • hospitalizations/ER visits
  • ejection fraction and hemodynamics

*Effective in slowing the course of heart failure

42
Q

____ should be the first line drug in heart failure after edema has been taken care of if present

A

Enalapril (ACEi)

43
Q

Enalapril generally used in combo with ??

A

furosemide *to treat edema

44
Q

Can ACEi be used in pregnancy?

A

NOOO

-causes birth defects (and some parents just don’t want this for their children)

45
Q

ACEi can cause ____ due to aldosterone decrease (can cause abnormal heart rate and cardiac arrest)

A

hyperkalemia

46
Q

ACEi can cause a dry ____

A

cough

47
Q

ACEi are metabolically neutral so there will be no effect on _____ or ____ ______

A

lipids or blood glucose

48
Q

What intervention is required when ACEi are given with spironolactone?

A

dose adjustments are necessary to avoid hyperkalemia

49
Q

What other drugs can cause increased potassium levels (hyperkalemia) when given with enalapril?

A
  • Ibuprofen/Indomethacin: chronic use of NSAIDs
  • Losartan (ARBs)
  • Alka-Seltzer (antacid)
  • Trimethoprim (antibiotic)
50
Q

Give an example of an ARB

A

Losartan

51
Q

Ultimate action of ARBs is similar to ____ but without the effects of increasing _____

A

ACEi

bradykinin

52
Q

With ARBs there will be no ____ like there is with ACEi

A

cough

53
Q

ARBs have similar complications and drug-drug interactions to those seen with ____

A

ACEi

54
Q

an ARB (losartan) combined with enalapril or spironolactone increases the risk of _____

A

hyperkalemia

55
Q

Efficacy of losartan is reduced by ???

A

grapefruit juice

Pharmacology B (21 decks)

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