S3 Week 3 Pharmacology

Front 1

Therapuetic tree for treatment of heart failure:

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Front 2

Heart hypertrophy effect on ejection fraction:

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As the heart hypertrophies, the chambers get smaller leading to a decreased ejection fraction.

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Eplerenone

Front 4

Use of ACE inhibitors in heart failure:

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Use of aldosterone antagonists in HF:

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Use of diurectics in heart failure:

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Use of vasodilators/venodilators in heart failure:

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Use of beta blockers in heart failure:

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Back 10

Reduces compensatory salt retention

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Back 11

Reduces compensatory salt retention

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Back 12

Lupus like syndrome

Front 13

ACC guidelines for beta blocker use in heart failure:

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Afterload decrease

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Positive inotropic agent use in heart failure:

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MOA of Digoxin:

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Front 17

Therapeutic indications for use of digoxin:

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Front 18

Digoxin toxicity and electrolyte levels:

Back 18

Digoxin binds to Na/K pump and blocks the outflow of Na+ while blocking inflow of K+
When you have low serum potassium, you have less competition with digoxin for binding spots on the Na/K pumps, which can lead to digoxin toxicity.

Front 19

Digoxin effect on action potential:

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- Lowered action potential makes SA node more irritable; makes arrhythmias more likely
- Increased intracellular calcium causes earlier phase 4 upstroke; increased automaticity!

Front 20

Effects of digoxin on an EKG:

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- A decrease in QT interval means a decreased ventricular refractory period.
- An increased PR interval means slower AV nodal conduction.
- Inverted T wave has something to do with K+ changes
- DAD = ectopic or abnormal ventricular beats

Front 21

Bigeminy on an EKG resulting from digoxin toxicity:

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Note the abnormal T wave and the abnormal ventricular beats that are coming from a ventricular electrical source and not the AV node.

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Back 22

Shortens ventricular refractory period

Front 23

Adverse effects of digoxin:

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Contraindications to digoxin therapy?

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Ventricular fibrillation
Ventricular arrhythmias/tachycardia
Wolff-Parkinson-White syndrome
AV block or Bradycardia
Hypokalemia (correct 1st )

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MOA of Dobutamine:

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Dopamine:

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Adverse effects of beta-1 agonists:

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Digoxin

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Phosphodiesterase Inhibitors MOA:

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Treatments for Stage A or B heart failure:

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Treatments for stage C or D heart failure:

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MOA of Nesiritide:

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Therapeutic tree for treating pulmonary hypertension:

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Overview of therapeutics for pulmonary hypertension:

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*Calcium channel blockers will not help if the vessels are incapable of reacting to vasodilators.

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Use of Calcium channel blockers in PH:

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PAH Patients are infused with NO or adenosine-if they react by vasodilating (about 20% patient), then they are administered CCB’s. Evidence suggests CCBs significantly reduce PAH in vasoreactive patients BUT not in other PAH patients.

Front 36

PDE5 inhibitors in treatment of PH:

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Endothelin receptor antagonists in treatment of PH:

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Use of prostacyclins in pulmonary hypertension:

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Treatment algorithm for pulmonary hypertension:

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Antiarrhythmic indications:

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