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Cardiovascular > L28-heart Failure 2 > Flashcards

L28-heart Failure 2 Flashcards

1
Q

What are the compensatory responses in heart failure

A

1-inc sympathetic activity
2-activated RAAS
3-myocardial hypertrophy,dilatation and remodeling

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2
Q

What are the 3 mediators for neurohormonal activation

A

NE
AgII
Aldosterone

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3
Q

What do the natriuretic peptides do(physiological response)

A 
Vasodilation
Dec blood pressure
Dec aldosterone levels
Naturesis
Diuresis
Antifibrotic effects
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4
Q

What does the RAAS do(pathophysilogical response)

A 
Activates Angiotensin 2 which acts on the AT1 receptor to:
Vasoconstriction 
Inc blood pressure
Inc sympathetic tone
Inc aldosterone 
Inc sodium
Fibrosis
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5
Q

What are the 2 main goals in treatment of heart failure

A

Relieve symptoms

To slow down disease progression,improve survival and dec the long term mortality

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6
Q

What type of drugs can relieve symptoms

A 
▪️Inotropic drugs:
1-sympathomimetics
2-PDE inhibitors
3-cardiac glycosides 
▪️Diuretics
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7
Q

What type of drugs can be given to dec long term mortality and slow down disease progression

A

Beta blockers
ACEI and ARBs
aldosterone antagonist
ARNI

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8
Q

Describe sympathomimetic inotropes

A

B adrenoreceptor activation which inc myocyte cAMP and inc intracellular Ca

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9
Q

Examples for non selective b1 and b2 drugs

A

Isoprenaline and isoproterenol

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10
Q

Example of sympathomimetic inotropes(selective) and what does it do

A

Dobutamine

B1 less tachycardia

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11
Q

Example of sympathomimetic inotropes for D1,D2,b1 and a1 receptors and what does it do

A

Dopamine
D1:renal VD
Presynpatic D2:peripheral VD by inhibtion of NE release

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12
Q

When are sympathomimetic drugs given

A

Given IV to acutely ill hospitalized patients in order to provide a short term inc in cardiac contractility

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13
Q

What are phosphodiestrase inhibitors

A

Do no cause down regulation of b receptor number

Inc intracellular cAMP which is associated with inc patient mortality

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14
Q

Examples for PDI

A

Milrinone

Enkximone

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15
Q

How do milrinone and enoximone relieve hf

A

▪️Inc cAMP by inhibtion of phosphodiestrase 3 which breaks down cAMP
▪️Activation of protein kinase which causes phosphorylation of ca2+ channels and inc ca2+ flow
▪️Which will cause positive inotropism and relaxation of resistance in vessels
▪️Which will inc CO and dec preload and afterload relieving heart failure

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16
Q

What are cardiac glycosides used for and give an example

A

For uncontrolled hf
For atrial fibrillations
Not first line
Digitoxin

17
Q

What is the mechanism of action for digitalis

A

Leads to partial inhibtion of Na+/k+ atpase enzyme
▪️Inhibition of of atpase to inc intracellular calcium and inc in intracellular Na+
▪️inc release of Ca2+ from SR
▪️inc vagal activity centrally
▪️inc force of contractility

18
Q

What are the extra cardiac adverse effects of digoxin

A

GIT: anorexia, nausea, vomiting
CNS:headache,fatigue,confusion,blurred vision,altered color perception, haloes on dark objects

19
Q

Cardiac adverse effects of digoxin

A

1-arrhythmias from excessive intracellular calcium
2-A-C block and complete heart block(excessive vagal activity)
Narrow therapeutic index
All toxicities inc by hypokalemia

20
Q

What are the 3 types of diuretics

A

Thiazide
Loop
PS

21
Q

Therapeutic effects of thiazide and loop

A

Reduce preload
Reduced blood vol
Reduce cardiac size
No role in progression of disease

22
Q

Describe the therapeutic effects of PS

A

Reduce mortality
Reduction in aldosterone action
For severe Hf

23
Q

For mild Hf

A

Thiazide

24
Q

For marked fluid retention and edema of lungs and limbs

A

Loop

25
Q

Adjunct,inc diuresis and corrects electrolyte imbalance

A

PS

26
Q

What are the 3 humoral compensatory mediators for cardiac remodeling,fibrosis and apoptosis

A

Angiotensin 2
Aldosterone
NE

27
Q

Only drugs that can relieve morbidity(not just for symptomatic relief)

A

ACEIs
Sprinolactone
B-blockers

28
Q

Blockade of renin angiotensin system

A

ACEI
ARBs
aldosterone

29
Q

Benefits of ACEIs in hf

A 
Dec preload and afterload
Improve signs and symptoms 
Dec remodeling 
Dec mortality 
Reduce aldosterone production
30
Q

What do beta blockers do in hf

A

Dec apoptosis and fibrosis(remodeling)

Dec hr and oxygen need

31
Q

Beta blocker agents

A

Carvedilol
Metoprolol
Nebivolol
Bisoprolol

32
Q

What is ARNI

A

Angiotensin receptor neprilysin inhibitor

Sacubitril/valsartan is combination product

33
Q

What does sacubitril

A

Pro drug that acts as a neprilysin inhibitor thus preventing breakdown of natriuetic peptides

34
Q

What does valsartan do

A

An ARB
works on blocking the RAAS system
Blocks effect of excess angiotensin 2 since neprilysin breaks down angiotensin 2

35
Q

What cant sacubritil be used be

A

With an ACEI due to inc risk of angioedema

Only used together or dosed in a short timeframe

36
Q

Substances broken down by neprilysin

A

Bardykinin and angiotensin 2 and ANP

37
Q

What does ARNI inhibit

A

AT1 receptor and neprilysin

Cardiovascular (36 decks)

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