Lecture 4 - Heart Failure Drugs 2 Flashcards
List examples of B-blockers
Metoprolol, carvedilol
How are B-blockers usually administered to HF patients?
Low doses (0.1 x) gradually increased over weeks cause some but little hemodynamic depression
- reduces heart rate and oxygen consumption
- cardiac output is increased after several months
*chance of irregular heart beat reduced
When are B-blockers most effecting in HF patients?
post-MI
**Mortality reduced post-MI
Benefits of B-blockers?
- decrease adverse effects of high catecholamine levels on the heart
- decreased cardiomyocyte apoptosis (cell death)
- decreased cardiac remodeling (decreased mitogenic activity)
*mechanism is not completely understood but clinical benefits are clear!
How does Carvedilol (B blocker) work?
- blocks B and alpha receptors
- alpha blockage helps to relax (dilate) arteries
- the heart does not have to work as hard to eject blood
- decreases afterload
- B adrenergic receptor blockade slows the heart and decreases force of contraction
How does Metoprolol (B blocker) work?
- similar benefits to carvedilol
- selectively blocks B1 adrenergic receptors
____ is a B1 selective B blocker
Metoprolol
In what kinds of patients should you avoid/caution B blockers with?
-asthma, COPD, peripheral vascular disease, insulin dependent diabetes, the very physically active
B blockers are good if what certain other diseases are present (i.e. they will treat both the HF and the other condition)
- hypertension
- glaucoma
- certain arrhythmia
- myocardial infarction
- angina
Carvedilol interacts with _____ and will worsen breathing problems due to narrowing of airways
ventolin
Carvedilol and Metoprolol - interact with _____ (anti-hypertensive) and may cause irregular heartbeat
verapamil
B blockers and ____ medications could cause arrhythmia
antiretroviral
B blockers and ____ are dangerous since it is has additive effects of lowering blood pressure
alcohol
What are inotropes?
Agents which alter the force of contraction of the heart
Do we want positive or negative inotropes to treat HF?
positive
List 2 positive inotropes used in HF
digoxin
dobutamine