Cardio Lecture 23--Pharm Treatment Of Heart Failure

Front 1

What is the problem in LOHF?

Back 1

Inability of heart to maintain CO--Early compensated(elevated venous filling pressure to increase VR yields asymptomatic) and Late Decompensated(heart can't meet metabolic demands and so symptomatic)

Front 2

What are the chronic LOHF causes?

Back 2

Hypertension, acute myocardial infarction, and idiopathic dilated CM

Front 3

What do lusitropic drugs do?

Back 3

Affect diastolic function and relaxation

Front 4

What is the status of diastolic HF?

Back 4

Ventricles hypertrophy because there is increased afterload--this causes the heart to get too thick and be unable to relax properly to allow in atrial blood--so it backs up

Front 5

Which has a change in EF, diastolic or systolic HF?

Back 5

Systolic--diastolic EF stays the same even though SV goes down because the thick heart muscle is able to eject the same fraction

Front 6

An S4 sound indicates what? Why?

Back 6

Diastolic HF--Heart is very rigid and not relaxing and when it tries to push the blood out, you get a 4th heart sound

Front 7

An S3 sound indicates what? Why?

Back 7

Systolic Hf--EDV is increased and so there is an increase in residual blood in the heart, leading to the 3rd heart sound

Front 8

Diastolic HF

Back 8

Thick walled ventricle that squeezes fine

Front 9

Systolic HF

Back 9

Thin walled ventricle that can't squeeze well and makes an S3

Front 10

What are the 4 compensatory mechanisms for LOCHF?

Back 10

Starling adjustment, baroreceptor reflex, renal mechanism, and myocardial hypertophy

Front 11

What is the cardiac reserve?

Back 11

Upgrade from normal operating point to max function

Front 12

What are some negative inotropic agents?

Back 12

ACh, vagal stimulation, anoxia, fatigue

Front 13

What are some positive inotropic agents?

Back 13

Epi and Norepi

Front 14

What does calcium bind in the myocyte?

Back 14

TROPONIN C

Front 15

What is the difference between isometric contraction and isotonic contraction?

Back 15

Isometric--flexing muscle doesn't do any work(increases tone but not mass)
Isotonic--muscle does work and increases in mass(increasing afterload causes the heart to do this type of work)

Front 16

What is the abdominojugular test?

Back 16

Push on the liver and see if the IJV pops out

Front 17

What are the pharm approaches to low output HF?

Back 17

Decrease preload = decrease veinous return with diuretics and venodilators--decrease Afterload = vasodilators and RA antagonists

Front 18

What is the order of treatment for HF?

Back 18

Diuretics and Aldosterone inhibitors--ACE inhibitors and Beta blockers(SELECTIVE so not propanolol) and vasodilators--Inotropic agents to increase contractility

Front 19

What are three diuretics?

Back 19

Thiazides, loop diuretics, and Triamterene

Front 20

What are three bad actions of Aldosterone?

Back 20

Retain Na+ and water--Excrete K+ and Mg++--Cause collagen deposition leading to fibrosis

Front 21

Spironolactone

Back 21

ALDOSTERONE INHIBITOR(competitive antagonist)
increases Na+ and Water absorption
AE: Anti adrenergic and mimics steroids to cause hormonal changes

Front 22

Eplerenone

Back 22

ALDOSTERONE ANTAGONIST
Similar to spironolactone but more specific to mineralcorticoid receptors
Shorter half life than spironolactone

Front 23

What effect do ACE inhibitors have on the vessels?

Back 23

They cause arteriovenous vasodilation--increase CO and increase exercise tolerance

Front 24

True/False: ACE inhibitors increase vasodilation and also HR

Back 24

FALSE--they don't increase HR

Front 25

Look at notes because all you did was drug slides

Back 25

Do it

Front 26

Catopril

Back 26

1st gen ACE inhibitor
Not tolerated by patients with sulfa drug allergy

Front 27

Enalapril

Back 27

2nd Gen ACE Inhibitor
Prodrug so action is delayed

Front 28

Lisinopril

Back 28

3rd Gen ACE Inhibitor
Direct acting

Front 29

Fosinopril

Back 29

ACE inhibitor that isn't metabolized in the liver so it can be used in liver failure patients but it is excreted in the kidneys so be careful

Front 30

What is the most common ACE inhibitor side effect? Why?

Back 30

Dry cough because you are inhibiting Kininase II

Front 31

Losartan and Valsartan

Back 31

1st gen AT1 inhibitors

Front 32

Ibersartan and Candesartan

Back 32

2nd Gen AT1 inhibitors

Front 33

What three drugs can be used for HF that are beta blockers?

Back 33

Metoprolol, Carvedilol, and Bisoprolol

Front 34

What are the venodilators?

Back 34

Nitrates: isosorbide dinitrate and nitroglycerin

Front 35

What are afterload decreasing drugs?

Back 35

HYDRALAZINE

Front 36

Dobutamine

Back 36

Beta 1 stimulator

Front 37

Isoproterenol

Back 37

Beta 1/2 stimulator

Front 38

Dopamine

Back 38

B1 stimulator and D1 stimulator(vasorelaxation

Front 39

Amrinone, Milnorone, Vesnarinone

Back 39

PDE Inhibitors--improve cAMP so in the heart causes contraction and in the VSM it causes relaxation