Pharm Unit 2 Cardiac Flashcards
positive inotropes
increase strength of heart muscle contraction
vasopressors
increase BP by contracting blood vessels
adrenergic neurons
norepinephrine
epinephrine
postganglionic neurons
B1 receptor location
heart
kidney
beta 2 receptor
kidney
peripheral
beta 1 receptor causes
increase HR and contractilioty
beta 2 receptor on kidney causes
renin release
- RAAS (incr Na+/H2O retention)
increases blood volume
increases blood pressure
beta 2 receptor peripheral causes
peripheral vasodialtion
- bronchodilation
- decrease GI motility
- glucagon release
- increase glucose
alpha 1 receptors
walls of blood vessels
eyes
bladder
alpha 1 receptor causes
vasoconstriction
pupil dilation
urinary retention
alpha 2 receptor
synaptic cleft
NE binds and decreases NE in synaptic cleft
cellular actions are driven by
Ca2+
higher Ca2+ means
faster
more foreceful contraction
faster relaxation
contractility
strength of contraction
preload
amount of blood returning to heart
afterload
peripheral resistance
(arterial)
force resisting myocardial fiber contraction at the start of systole
stroke volume determinants
contractility (EF)
afterload
ejection fraction
percentage of EDV ejected each contraction
normal: 55-60%
contractility
reasonably estimatd by Ejetion fraction
what lowers afterload
afterial vasodilation
increases in afterload causes
decreases in SV
severe LV dysfunction is impacted by what
afterload
increased afterload significantly decreases SV
frank-starling mechanism
describes relationship between preload and cardiac output
increased preload causes
increased SV
stroke volume calculation
SV = EDV-ESV
CO calulation
CO = (EDV-ESV) x HR
HFpEF
diastolic dysfunction (dec EDV)
cannot fully relax so will not fully fill
pump is still functioning: No change to EF
HFrEF
systolic dysfunciton (incr ESV)
loss of contractile strength
decreased EF due to inability to contract
inotrope receptors
beta agonists
increases contracility
vasopressor receptors
alpha 1 agonists
increases SVR
positive inotrope drugs
dobutamine
dopamine
milrinone
dobutamine
beta 1 agonist (highly selective)
– incr Ca2+ (incr contractility/HR)
beta 2 agonist (some selectivity)
– vasodilation (incr CO)
dobutamine indications
systolic heart failure (B1)
-schemic heart disease
acute heart failure (b2)
cardiogenic shock (b2)
dobutamine CI
chronic heart failure
(due to tolerance)
dobutamine SE
tachycardia
palpitations
arrhythmias
tolerance
PDE
breaks down cAMP
PDE inhibitors
prevent breakdown of cAMP
incr Ca2+
incr contraction
vasodilation
“inodilator”
common PDE inhibitor
milrinone
milrinone indication
acute heart failure
milrinone CI
chronic heart failure
(incr morbidity/mortality)
dopamine: low dose
<3 mcg/kg/min
vasodilation
incr naturesis (Na+/H2O elim)d
dopamine: mod dose
4-10 mcg/kg/min
beta 1 agonist (incr Ca2+)
incr CO
dopamine: high dose
> 10 mcg/kg/min
alpha 1
vasopressor (incr Ca2+)
vasoconstriction
incr BP
dopamine indications
severe hypotension
acute heart failure
shock (vasodlatory/cardiogenic)
severe bradycardia
dopamine SE
tachycardia
atrial/ventricular dysrhythmias
nausea/vomiting
ischemia of digits/organ systems
norepinephrine
potent a1 receptor agonist
- vasoconstriction
- incr BP
moderate beta 1 stimultor
- incr CO
- minimal HR change
norepinephrine indidcations
hypotension
shock-like state w/periph vasodilation
norepinephrine adverse effects
atrial/ventricular dysrhythmias
ischemia of digits/organs
which is safer: NE or dopamine?
NE
causes less arrythmias
epinephrine
balanced (nonselective) b1, b2, a1 agnonist (Cardiac stimulator)
incr contractility
incr HR
incr SVR
which drug is a cardiac stimulator
epinephrine
epinephrine indications
cardiac arrest
shock
bronchospasm/anaphylaxis
symptomatic bradycardia
epinephrine SE
atrial/ventricular dysrhythmias
ischemia of digits/organs
cardiac toxicity (high/prolonged doses)
severe hypertension (cerebral hemorrhage)
phenylephrine
potent alpha 1 agnoist
incr SVR
incr BP
minimal HR/contractility change
phenylephrine indications
vasodilatory hypotension
vagal / drug induced hypotension
phenylephrine SE
reflex bradycardia
ischemia of digits/organs
tissue necrosis (extravasation)
severe hypertension
digoxin
blocks Na+/K+ atpase
which inhibits NCX
- Ca2+ stays IN cell
incr Ca2+
incr contraction force
digoxin indications
atrial flutter/afib
HFrEF
digoxin therapeutic window
narrow
0.5-2.0 ng/ml
<1.0 in HF
digoxin low dose
increases parasympathetic tone
digoxin SE (toxicity)
GI upset
altered color perception (halo vis)
malaise
bradycardia
AV block
VTAC
fibrillation
cardiovascular mortality risk _____ for every _____ incr in BP
cardiovascular mortality risk doubles with each 20/10 mmHg BP increase
hypertension
Systolic >130
and/or
Diastolic > 80
2 ways to decrease blood pressure
decrease CO
decrease SVR
3 ways to decrease CO
decrease BV
decrease HR
decrease SV
5 anatomic sites of BP control
arteries (SVR)
veins
heart (CO/HR/SV)
kidney (BV)
CNS
RAAS antagonists
ACE inhibitoprs
ARBS
neprilysin inhibitor + ARB
aldosterone antagonist (K+ sparing diuretic)
aldosterone
promotes Na+/H2O retention
increases BV
incr BP
can cause myocardial/renal/vascular fibrosis
angiontensin II
vasoconstriction
incr aldosterone
Na+/H2O retention
incr NE release
ACE breaks down
bradykinin
bradykinin function
vasodilation
ACE inhibitors mechanism
incr bradykinin = vasodilation
decr antiontensin II = vasodilation
ACE inhibitor indications
HF
CAD
hypertension
chronic renal disease w/proteinuria
ACE inhibitor SE
incr K+
acute renal failure
dry cough
angioedema
hypotension (volume/Na+ depleted pts)
ACE inhibitor CI
pregnancy
renal insufficiency pts
renal artery stenosis
ACE inhibitors drugs
end in -pril
Benazepril
capropril
quinapril
etc
ARBS mechanism
block angiotensin II receptors
= vasodilation
decr aldosterone
decr Na+/H2O retention
decr BV
decr BP
ARBS indications
HF
CAD
hypertension
chronic renal diseas w/proteinuria
alt to ACE inhibitors for pts w/dry cough
ARBS CI
renal failure pts
pregnancy
ARBS SE
incr K+
acute renal failture
hypotension (volume/Na+ depleted pts)
ARBS drugs
end in -Sartan
candesartan
losartan
etcf
Neprilysin Inhibitor Plus ARB
neprilysisn breaks down bradykinin
vasodilation
decr BP
neprilysin inhibitor plus ARB drug
sacubitril/valsartan (enstrest)
neprilysin inhibitor plus ARB indication
heart failure
neprilysin/ARB SE
hyperkalemia
cough
angioedema
renal function deterioration
hypotension
neprilysin/ARB CI
pregnancy
bilateral renal artery stenosis
neprilysin/ARBs should not be used within ____ hrs of ACE inhibitors
36 hrs
increased risk of angioedema
aldosterone antagonists indications
hyperaldosteronism
hypertension (resistant HTN)
HF
MI w/LV dysfunction
aldosterone antagonist SE
renal dysfunction
hyperkalemia
endocrine abnormalities
- dynecomastia
- breast pain
- menstrual irregularities
- impotence