Flashcards in Drugs for congestive Cardiac Failure Deck (23):
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reduction in cardiac contractility
systolic dysfunction
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inadequate filling of ventricles during diastole
diastolic dysfunction
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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
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arteriolar vasodilators names & consequences
arteriolar vasodilators decrease after load
1. hydrallazine
2. calcium channel blockers: amlodipine &nifedipine
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venodilators
venodilators decrease preload
Ex) Nitrates: isosorbide dinitrate
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Nitrates effect on cardiac failure
they're ventilators which results in decreased preload
Ex) Nitrates: isosorbide dinitrate
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Hydrallazine & it's effect on heart failure
arteriolar vasodilators decrease after load
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Calcium channel blockers & their effect on heart failure
arteriolar vasodilators decrease after load
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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
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Drugs used to treat heart failure that control Na & water retention
1. diuretics: loop diuretics (ie furosemide)
2. Loop diuretics + K sparing diuretics
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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
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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
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ACE Inhibitors
1. captopril
2. Enalapril
vasodilators
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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
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When to use ACEI
1. chronic Heart failure
2. HTN
3. Diabetic Renal disease
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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
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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
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Toxicity/drug interaction with ACEI
1. dry cough (due to increase in bradykinin)
2. HYPERkalemia
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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
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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
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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
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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
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