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19 Cards in this Set
- Front
- Back
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Positive iotopic drug |
D igoxin Levosimendan Omecative mecarbil Istaroxime
Bipyridines
Beta-agonist |
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levosimendan |
- sensitizes the tropanin system to ca+2 - inhibit phosphodiesterase - cause some vasodilatation in addition to it’s intropic effect |
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Beta -agonist |
*Dobutamine has been most widely used in HF -given IV -produce an increase in cardiac output together with a decrease in ventricular filling pressure *Dopamine : - used in acute HF -and if there is a need to raise blood pressure |
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Digoxin |
- cardiac glycoside - 65-80% absorbed after oral administration - Widely distributed to tissue , including the CNS - Not extensively metabolized in humans - 2/3 is excreted uncharged by the kidneys - it’s renal clearance is proportional to creatinine clearance - half-life is 36-40 h in patient , with normal renal function - need to adjust digoxin dosage in patient with renal impairment - positive inotropic drug - Work by inhibiting the Na+/K+ ATPase
- increase in cardiac contractility |
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Istaroxime |
- Investigational steroid derivative - Increase contractility by inhibiting Na+/K+ ATPase
-also allows calcium to be stored in the SR so less arrhythmia toxicity than digoxin |
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Bipyridines (Inamrinone ,Milirinone) |
- inhibit phosphodiesterase isozyme 3 (pde-3) - active orally and parent rally but available only in parental forms - half-lives 3-6 h - 10-40% excreted in the urine - increase in cAMP - in heart >> increase contractility - in vessels >> cause vasodilatation - used only for acute HF or sever exacerbation of chronic HF - toxicity of inamrinone >> nausea , vomiting , arrhythmias , thrombocytopenia and liver enzyme change
- milirinone appears less likely to bone marrow and liver toxicity than inamrinone but it dose not cause arrhythmias |
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Natriuretic peptides analogs |
Nesiritide Vlaritide Caperitide Bosentan and tezosentan |
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Diuretics |
- furosemide is mostly used in HF - No direct effect on cardiac contractility - Reduce venous pressure and ventricular preload - reduction of salt and retention and edema and it’s symptoms - reduction of cardiac size >> lead to improve pump efficiency
- spironolactone and eplerenone >> the aldesterone antagonist diuretics >> decreasing and mortality |
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Used in HF Drug without positive iotropic effect |
Diuretics ACE inhibitors ARBs and aliskiren Vasodilators Beta blockers |
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ACE inhibitors (captopril) |
- reduce preload and after load - reduce salt and water retention - reduce the long-term remolding of the heart and vessels - reduce mortality and morbidity in patient with HF |
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Omecativ mercarbil |
- Alter the rate of transition of myosin from low-- action-binding state to strongly action-bound force generating state - still in development |
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Beta blockers |
- Used for chronic HF - only bisoprolol , carvedilol , metoprolol and nebivolol are used - reduce mortality and morbidity
- decrease remodeling of heart |
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Vasodilators |
- Effective also in acute HF - reduction in preload (through venodilation) - reduction in after load (through arteriolar dilation ) - hydrolazine / isosorbide dinitrate >> reduce damaging remodeling of the heart |
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Nesiritide |
- Synthetic from of the brain natriuretic peptide (BNP) - Increase cGMP in smooth muscle and reduce venous and arteriolar tone - it also causes diuresis - Short half-life > 18 minutes -The most common adverse effect >> excessive hypotension |
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losartan |
ARB-AT1 antagonist :
can be used when ACE inhibitors cause cough or angioedema |
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Alisikirin |
-rennin inhibitors
-similar to ACE inhibitors |
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Vlaritide |
-synthetic from of urodilation
- similar to BNP , under investigation |
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Caperitide : |
- synthetic from of atrial natriuertic peptide (ANP)
- similar to BNP , under investigation |
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Bosentan and tezosentan |
- Competitive inhibitors of endothelium
- But they are only approved for use in pulmonary hypertension , not heart failure |
