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18 Cards in this Set
- Front
- Back
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Chronic Heart Failure is a syndrome characterized by:
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progressive (time) cardiac dysfunction
breathlessness tiredness neurohormonal disturbances oedema sudden death |
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Drugs for heart failure
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Diuretics
vasodilators ACE Inhibitors Angiotensin II receptor blockers positive ionotropic drugs |
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General treatment to improve symptoms
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Diuretics
Digoxin Ace inhibitors |
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General treatment to improve survival
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ACE inhibitors (first line)
Beta-blockers spironolactone |
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Digoxin
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Rapid onset of action (
Low Oral activity (1 - 2 days) hydrophilic low affinity for serum proteins |
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Digitoxin
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Long duration
Slow onset (5 - 7 days) good absorption strong binding |
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Mechanism of action of Digoxin and Digitoxin
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Inhibition of Na/K ATPase pump --> increase Ca in SR 00> increased Ca release via CICR
increased force and excitability decease AV conduction and rate |
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Side Effects of Digoxin and Digitoxin
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GI (related to vagal effects)
Anorexia abdominal pain vomiting diarrhoea atrial tachcardias AV dissociation |
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Receptor sympathomimetics
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Dobuamine (Beta-1 > Beta-2 > Alpha-1)
Dopamine (Beta-1 = Beta-2 > Alpha-1) |
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Uses of dobutamine and Dopamine
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Acute heart failure
cardiogenic shock acute renal failure |
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Adrenaline:
Receptor selectivity Use Actions |
Beta-1 = Beta-2 > Alpha-1 = Alpha-2
Anaphylatic shock cardiogenic shock cardiac arrest low dose - cardiac stimulation and vasodilation high doses - cardiac simulation and vasoconstriction |
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Noradrenaline
Receptor selectivity Use Actions |
Beta-1 = Alpha-1 > Beta-2 = Alpha-2
Severe hypertension septic shock reflex bradycardia masks direct simulatory effects on sinoatrial node |
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Nitrates
Example mechanism Side Effects |
Glycerol trinitrate
NO --> cGMP --> vasodilation Headache, dizziness |
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Classes of diuretics:
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Loop agents
Thiazide K-sparing Osmotic |
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Loop Agents:
Example side effects |
Frusemide
Hypovolemia, hypokalemia |
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Thiazides
Example side effects |
hydrochlorothiazide
potassium loss, hypotension |
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ACE inhibitors
Example Mechanism side effects |
Captopril, Analpril
inhibitor of aldosterone production vasodilation Cough hypotension hyperkalemia |
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ARBs
Example Side effect |
Losartan
better tolerated than ACE inhibitors (no cough) Less vasodilation than ACE inhibitors birth defects? |
