Drugs for congestive Cardiac Failure Flashcards Preview

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Flashcards in Drugs for congestive Cardiac Failure Deck (23):
1

reduction in cardiac contractility

systolic dysfunction

2

inadequate filling of ventricles during diastole

diastolic dysfunction

3

consequences of hyperadrenergic state

Long term: leads to irreversible myocyte damage, cell death & fibrosis
1. The augmentation in peripheral vasomotor tone increases LV afterload
2. this places added stress upon the LV and an increase in myocardial O2 demand (ventricular remodeling)

The frequency and severity of cardiac arrhythmias are enhanced in the failing heart

4

arteriolar vasodilators names & consequences

arteriolar vasodilators decrease after load
1. hydrallazine
2. calcium channel blockers: amlodipine &nifedipine

5

venodilators

venodilators decrease preload
Ex) Nitrates: isosorbide dinitrate

6

Nitrates effect on cardiac failure

they're ventilators which results in decreased preload
Ex) Nitrates: isosorbide dinitrate

7

Hydrallazine & it's effect on heart failure

arteriolar vasodilators decrease after load

8

Calcium channel blockers & their effect on heart failure

arteriolar vasodilators decrease after load

9

Nonselective vasodilators & their action

NOnselective vasodilators decrease both preload & after load
1. ACE inhibitors: capropril, Enalapril
2. Angiotensin receptor blockers: Losartan
3. Na nitroprusside
4. Bidil- Hydrallazine + Isosorbide dinitrate

10

Drugs used to treat heart failure that control Na & water retention

1. diuretics: loop diuretics (ie furosemide)
2. Loop diuretics + K sparing diuretics

11

Drugs used to treat HF that increase cardiac contractility (have positive ionotropic effects)

aka positive ionotropic drugs
1. Digitalis glycosides: digoxin
2. beta adrenergic agonists: dopamine, dobutamine
3. Bypyridines (PDE inhibitors): inamrinone

12

Drugs used to treat HF that reduce cardiac and vascular remodeling to improve the survival

1. ACE inhibitors
2. Angiotensin receptor blockers
3. beta blockers: carvedilol, bisoprolol, metoprolol

13

ACE Inhibitors

1. captopril
2. Enalapril

vasodilators

14

ACEI MOA & effects

MOA: inhibits ACE-->reduces formation of angiotensin II

Effects:
1. decreases preload
2. decreases after load
3. decreases aldosterone secretion
4. increases CO
5. decreases cardiac remodeling

15

When to use ACEI

1. chronic Heart failure
2. HTN
3. Diabetic Renal disease

16

When to use captopril & side effects?

It's an ACEI; MOA: inhibits ACE-->reduces formation of angiotensin II
USE:
1. chronic Heart failure
2. HTN
3. Diabetic Renal disease

Side Effects:
1. dry cough (due to increase in bradykinin)
2. hyperkalemia

17

When to use enalapril & side effects?

It's an ACEI; MOA: inhibits ACE-->reduces formation of angiotensin II
USE:
1. chronic Heart failure
2. HTN
3. Diabetic Renal disease

Side Effects:
1. dry cough (due to increase in bradykinin)
2. hyperkalemia

18

Toxicity/drug interaction with ACEI

1. dry cough (due to increase in bradykinin)
2. HYPERkalemia

19

Angiotensin Receptor Blockers (ARB)
examples & uses

1. Losartan
2. Candesartan

Use:
same as ACEI, used in patients who are intolerant to ACEI
1. chronic Heart failure
2. HTN
3. Diabetic Renal disease

20

Angiotensin Receptor Blockers (ARB)
a) MOA
b) Effects
c) Side effects
d) USES

a) MOA: antagonize all effects of angiotensin II on AT1 receptors

b) Effects: same as ACEI
1. decreases preload
2. decreases after load
3. decreases aldosterone secretion
4. increases CO
5. decreases cardiac remodeling

c) side effects
1. NO COUGH (unlike ACEI)
2. HYPERkalemia

d) Use:
same as ACEI, used in patients who are intolerant to ACEI
1. chronic Heart failure
2. HTN
3. Diabetic Renal disease

21

Losartan

a) what is it
b) MOA
c) effects
d) use
e) side effects

a) Angiotensin Receptor Blockers (ARB)
b) MOA: antagonize all effects of angiotensin II on AT1 receptors

c) Effects: same as ACEI
1. decreases preload
2. decreases after load
3. decreases aldosterone secretion
4. increases CO
5. decreases cardiac remodeling

d) Use:
same as ACEI, used in patients who are intolerant to ACEI
1. chronic Heart failure
2. HTN
3. Diabetic Renal disease

e) side effects
1. NO COUGH (unlike ACEI)
2. HYPERkalemia

22

Candesartan

a) what is it
b) MOA
c) effects
d) use
e) side effects

a) Angiotensin Receptor Blockers (ARB)
b) MOA: antagonize all effects of angiotensin II on AT1 receptors

c) Effects: same as ACEI
1. decreases preload
2. decreases after load
3. decreases aldosterone secretion
4. increases CO
5. decreases cardiac remodeling

d) Use:
same as ACEI, used in patients who are intolerant to ACEI
1. chronic Heart failure
2. HTN
3. Diabetic Renal disease

e) side effects
1. NO COUGH (unlike ACEI)
2. HYPERkalemia

23

Na Nitroprusside

arteriolar & venodilator