Advances in cardiovascular treatment Flashcards
(26 cards)
Give an example of an SGLT2 inhibitor and its MOA
What indication is it used in
Dapagliflozin
Type II
Standard treatment for patients with heart failure with reduced ejection fraction
What are the cardiovascular benefits of SGLT2 inhibitors
Improved glycemic control
Reduction in body mass and blood pressure
Natriuresis and reduction in circulating volume
What are natriuretic peptides?
Give examples
Where is it released?
What effect does it produce?
A family of peptides that promote natriuresis, diuresis and arterial relaxation (= increase in urinary sodium output)
Atrial Natriuretic Peptide (ANP)
Brain Natriuretic Peptide (BNP)
C- type Natriuretic Peptide (CNP)
What is Neprilysin?
What is Omapatrilat?
What are its effects?
A combined ACE inhibitor and neprilysin inhibitor
Reduces the pathological effects of excess RAAS system and potentiates the beneficial effects of increased natriuretic peptide effects
What are the risk factors/negative effects of Omapatrilat?
Natriuretic peptide agonists
Increase the beneficial effects of increasing natriuretic peptide signalling
It increases natriuresis and diuresis
Lowers arterial tone
*Stomach acids break down peptides so it can’t be administered orally
Only available in intravenous form
reduce breakdown or stimulate NP receptors
Zilebesiran (ALN-AGT)
New therapy to reduce angiotensin levels
In phase 2 clinical trials
Give an example of a combined angiotensin receptor blockade and neprilysin inhibitor (ARNI)?
Entresto
Angiotensin receptor blocker (Valsartan) + neprilysin inhibitor (Sacubitril)
What are the effects of a combined angiotensin receptor blockade and neprilysin inhibitor (ARNI)?
Reduces pathological effects of excess RAAS system whilst potentiating the beneficial effects of increased natriuretic peptides.
Has a good safety profile
Selective cardiac myosin activator
Omecamtiv mecarbil
increases myocardial systolic function by:
Activating myocardial ATPase and improving energy utilisation
enhances the myosin cross-bridge formation and duration
Improves cardiac muscle contractions
Ivarbradine
I (f) channel inhibitor
inhibitors of the I (f) channel (funny current channel) in the sinus node
slows the heart rate
*for severe heart failure and on other treatments (in trials)
Firibastat
Brain amino peptidase A inhibitor
Phase 3 clinical trials
Describe calcium channel blocker
Describe angiotensin receptor antagonists
How can peripheral resistance be reduced to reduce exertion of the heart?
What are new cardiovascular drugs that reduce exertion on the heart for heart failure?
What are SGLT2 inhibitors?
SGLT2 inhibitors prevent reabsorption of filtered glucose in the kidney, increasing urinary glucose excretion & reducing blood glucose levels
Inhibitos glucose reabsorption
*treatment for patients with heart failure and reduced ejection fraction.
What are the cardiac benefits of SGLT2 inhibitors?
Improved glycemic control
Reduction in body mass
Natriuresis and reduction in circulating volume
Cardiac remodelling
Explain left sided heart failure
Explain right sided heart failure
What are some of the side effects/risks of the current cardiovascular therapies?
ACEi/ARBs, beta-blockers and mineralocorticoid antagonists
Side effects/risks:
Hypotension
Impact on Kidneys/electrolytes
What are some of the limitations of the current statins and fibrates?
Statins and fibrates are linked to mucscle aches, and can - in severe cases - cause muscle damage
Rhabdomyolysis
They are both rarely linked to liver damage
PCSK9 inhibitors are expensive
