Pharmacological Treatment Of Heart Failure

Front 1

Describe the mechanisms involved in the physiological control of blood pressure?

Back 1

The arterioles, the post capillary venules (capacitance vv) and the heart. The kidney contributes to longer term maintenance of blood pressure by regulating the volume of the intravascular fluid.
Smooth muscle tone controlled by mediators secreted by sympathetic nerves and vascular endothelium and by circulating hormones.

Front 2

two acting effects of beta blockers as vasodilators (indirect acting arterial dilators)

Back 2

1)cardiac effects: decreases Heart rate and decreases Stroke Volume = decreases Cardiac Output
2) renal effect: blocks the B1-receptors on the juxtaglomerular apparatus, leading to inhibited Renin release therefore preventing actions of angiotensin II (actions = vasoconstrictor, stimulates release of Aldesterone = sodium retention = H20 retention = increased MAP)

Front 3

What is an example of a Beta Blocker?

Back 3

Propanolol

Front 4

What are the side effects of Beta Blockers as vasodilators?

Back 4

1) cold extremities
2) fadigue (due to reduced cardiac output)
3) bronchoconstriction (B2 receptor agonist effect)

- in the long term, cardiac output returns to normal but results in baroreceptors resetting at a lower level.

Front 5

What is a positive inotrope?

Back 5

Increases cardiac contractility, Increases cardiac output

Front 6

what is a negative inotrope?

Back 6

Decreases cardiac contractility, Decreases preload

Front 7

What is a diuretic?

Back 7

Decreases the preload (volume overload)

Front 8

What is a vasodilator do for cardiac disease?

Back 8

Decreases preload, afterload or both

Front 9

How is an anti-arrythmic useful in cardiac disease?

Back 9

Increases cardiac output.

Front 10

How do positive intotropes increase cardiac contractility?

Back 10

They increase intracellular calcium. They all have potential to cause propblems because they increase cardiac workload.

Front 11

what are the two most common glycosides?

Back 11

Digoxin and Digitoxin

Front 12

How do the glycosides work?

Back 12

They work by binding to and inhibiting the Na/K ATPase pump on the cardiac myocyte--> increasing intracellular sodium concentraitions--> reducing the exchange of calcium out of the cell for Na. increase in intracellular Ca increases contractility

Front 13

How does Hydralazine act as an arterial dilator?

Back 13

True mechanism is unknown thought it works similar to an alpha blocker

Front 14

How does an alpha blocker work as an arterial dilator?

Back 14

Acts indirectly as a vasodilator (arterial dilator).
It decreases a-receptor induced vasoconstriction by binding to the a-receptor and prevents Noradrenalin from binding. Without NA binding, dilation occurs.

Front 15

What the the active effects of Hydralazine as a vasodilator?

Back 15

1) reduces afterload, therefore reduces regurgitation, therefore promotes forward aortic flow.
2) increases venous oxygen tension
3) decreases pulmonary oedema

Front 16

Why should you use diuretics with Hydralazine?

Back 16

it causes hypotension which may stimulate RAAS. RAAS with increase MAP and therefore increase preload and afterload (increase strain on the heart)

Front 17

What tissues do the L-type calcium channels exist within?

Back 17

cardiac, vascular smooth muscle, pacemaker tissue.

Front 18

How do the calcium channel blockers work as vasodilators?

Back 18

They bind to the inside of the L-type calcium channels and render them inactive. The more active the channel, they more that channel is targeted by the blockers (use dependance)

Front 19

How do beta blockers effect the heart and vasculature?

Back 19

1) heart SA and AV nodes - activity is slowed
2) cardiac myocytes - reduce contractility
3) vasculature - dilation of systemic arteries and arterioles

Front 20

What are the 3 types of calcium channel blockers and what do that have a bigger effect on (cardiac vs vessels)?

Back 20

1) Verapamil - heart selective
2) Diltiazem - heart and vessel selective
3) Amodipine - vascular selective

Front 21

What are the roles of cAMP in a cardiac myocyte?

Back 21

cAMP phosphorylates the Calcium channels so they can open wider when stimulated via action potential (positive inotrope)

Front 22

What are the roles of cAMP in a vascular smooth muscle?

Back 22

cAMP inactivates Myosin Light Chain Kinase, therefore inactivating myosin (which relies on an active MLCK for phosphorylation to activate myosin)

Front 23

What is an example of a commonly used ACE Inhibitor?

Back 23

Enalapril

Front 24

What is an example of a commonly used Angiotensin II Receptor Blocker?

Back 24

Losartan

Front 25

What are three roles propranolol (a common Beta blocker) can be used for?

Back 25

- negative inotrope
- vasodilator (for hypertension)
- anti arythmic

Front 26

What class of drugs can be used as anti-arrythmics?

Back 26

negative inotropes

- the sodium channel blocker Quinidine can also be used

Front 27

How do calculate pulse pressure?

Back 27

systolic pressure - diastolic pressure = Pulse Pressure

Front 28

How do you calculate Mean Arterial Pressure?

Back 28

Diastolic pressure + 1/3 pulse pressure = MAP

Front 29

How do you calculate Cardiac Output?

Back 29

Stroke Volume (ml) x Heart rate (beats per min)

Front 30

How do you calculate Stroke Volume?

Back 30

End Diastolic volume-end systolic

Front 31

How do you calculate ejection fraction?

Back 31

Stroke Volume / end diastolic volume

Front 32

Which muscle cell contains troponin?

Back 32

Cardiac muscle

Front 33

Which muscle contains calmodulin?

Back 33

Vascular smooth muscle

Front 34

WHich cell has a better developed sarcoplasmic reticulum (between cardiac and smooth muscle cells)?

Back 34

cardiac myocyte cell

Front 35

Which cells have t-tubules (cardiac vs smooth muscle)?

Back 35

cardiac

Front 36

Why are smooth muscles able to contain a basal tone?

Back 36

Smooth muscle stimulation results in a maintained isometric force, but contractions are extremly slow. Smooth muscle cells maintain large forces almost continually at extremely low energy costs. Thus there is a basal degree of vascular smooth muscle contraction. Spontaneous depolarisation leads to action potentials that produce this basal tone.