ORGANOTROPIC AGENTS - Drugs used for treatment of heart failure Flashcards
Normally involved in the pathogenesis of heart failure
- A cardiac lesion that impairs cardiac output
- An increase in peripheral vascular resistance
- An increase in sodium and water retention
Not Normally involved in the pathogenesis of heart failure
A decrease in preload
All of the following are compensatory mechanisms that occur during the pathogenesis of congestive heart failure
- An increase in ventricular end-diastolic volume
- An increase in the concentration of plasma catecholamines
- Increased activity of the renin-angiotensin-aldosterone system
The following are not compensatory mechanisms that occur during the pathogenesis of congestive heart failure
An increase in vagal tone
All of the following are recommended at the initial stages of treating patients with heart failure
- Reduced salt intake
- ACE inhibitors
- Diuretics
The following are not recommended at the initial stages of treating patients with heart failure
Verapamil
The following agents belong to cardiac glycosides
- Digoxin
- Strophantin K
- Digitoxin
The following agent do not belong to cardiac glycosides
Amrinone
The non-glycoside positive inotropic drug is
Dobutamine
Sugar molecules in the structure of glycosides influence
Pharmacokinetic properties
Aglycone is essential for
Cardiotonic action
Derivative of the plant Foxglove (Digitalis)
Digoxin
True or False. They inhibit the Na+/K+-ATPase and thereby increase intracellular Ca++ in myocardial cells
TRUE
True or False. They cause a decrease in vagal tone
FALSE
True or False. Children tolerate higher doses of digitalis than do adults
TRUE
True or False. The most frequent cause of digitalis intoxication is concurrent administration of diuretics that deplete K+
TRUE
True or False. An important action of digitalis is to increase vagal tone.
TRUE
True or False. Digoxin is thought to increase intracellular concentrations of calcium in myocardial cells by indirectly slowing the action of the sodium-calcium exchanger.
TRUE
Compare the half-life of digoxin and the half-life of digitoxin
Digitoxin is greater than digoxin
True or False about cardiac glycosides. They inhibit the activity of the Na+/K+-ATPase
TRUE
True or False about cardiac glycosides. They decrease intracellular concentrations of calcium in myocytes
FALSE
True or False about cardiac glycosides. They increase vagal tone
TRUE
True or False about cardiac glycosides. They have a very low therapeutic index
TRUE
True or False about cardiac glycosides. Digoxin is a mild inotrope
TRUE
True or False about cardiac glycosides. Digoxin increases vagal tone
TRUE
True or False about cardiac glycosides. Digoxin has a longer half-life than digitoxin
FALSE
True or False about cardiac glycosides. Digoxin acts by inhibiting the Na+/K+ ATPase
TRUE
The most cardiac manifestation of glycosides intoxication is
- Atrioventricular junctional rhythm
- Second-degree atrioventricular blockade
- Ventricular tachycardia
The manifestations of glycosides intoxication are
- Visual changes
- Ventricular tachyarrhythmias
- Gastrointestinal disturbances
For digitalis-induced arrhythmias the following drug is favored
Lidocaine
In very severe digitalis intoxication the best choice is to use
Digibind (Digoxin immune fab)
True or False about cardiac glycoside-induced ventricular tachyarrhythmias. Lidocaine is a drug of choice in treatment
TRUE
True or False about cardiac glycoside-induced ventricular tachyarrhythmias. Digibind should be used in life-threatening cases
TRUE
True or False about cardiac glycoside-induced ventricular tachyarrhythmias. They occur more frequently in patients with hyperkalemia than in those with hypokalemia
FALSE
True or False about cardiac glycoside-induced ventricular tachyarrhythmias. They are more likely to occur in patients with a severely damaged heart
TRUE
This drug is a selective beta-1 agonist
Dobutamine
Tolerance to this inotropic drug develops after a few days
Dobutamine
This drug inhibits breakdown of cAMP in vascular smooth muscle
Amrinone
This drug is useful for treating heart failure because it increases the inotropic state and reduces afterload
Amrinone
This drug acts by inhibiting type III cyclic nucleotide phosphodiesterase
Milrinone
True or False about inhibitors of type III phosphodiesterase. They raise cAMP concentrations in cardiac myocytes
TRUE
True or False about inhibitors of type III phosphodiesterase. They reduce afterload
TRUE
True or False about inhibitors of type III phosphodiesterase. They show significant cross-tolerance with beta-receptor agonists
FALSE
True or False about inhibitors of type III phosphodiesterase. They are associated with a significant risk for cardiac arrhythmias
TRUE
The following drugs are used in the treatment of severe congestive heart failure
- Digoxin
- Dobutamine
- Dopamine
The following drug are not used in the treatment of severe congestive heart failure
Verapamil
Drugs most commonly used in chronic heart failure are
- Cardiac glycosides
- Diuretics
- Angiotensin-converting enzyme inhibitors
True or False about angiotensin converting enzyme (ACE) inhibitors. They act by inhibiting the ability of renin to convert angiotensinogen to angiotensin I.
FALSE
True or False about angiotensin converting enzyme (ACE) inhibitors. Enalapril is a prodrug that is converted to an active metabolite
TRUE
True or False about angiotensin converting enzyme (ACE) inhibitors. They reduce secretion of aldosterone
TRUE
True or False about angiotensin converting enzyme (ACE) inhibitors. They can produce hyperkalemia in combination with a potassium-sparing diuretic
TRUE
The following effects of ACE inhibitors may be useful in treating heart failure
- They decrease afterload
- They reduce reactive myocardial hypertrophy
- They increase myocardial beta-1 adrenergic receptor density
The following effect of ACE inhibitors may be not useful in treating heart failure
They increase circulating catecholamine levels
True or False about the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of
heart failure. They improve hemodynamics by decreasing afterload
TRUE
True or False about the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of
heart failure. They can increase plasma cholesterol levels
FALSE
True or False about the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of
heart failure. They may slow the progression of heart failure by preventing myocardial and vascular remodeling
TRUE
True or False about the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of
heart failure. They are effective first-line agents in the treatment of chronic heart failure
TRUE
