Inotropic Flashcards
1st line for CHF–inhibit LV remodeling post MI?
ACE inhibitors
Captopril Enalapril Lisinopril Ramipril Quinapril Fosinopril
Used in place of an ACEi when cough is an issue?
Angiotensin receptor blocker–ARB
Losartan Irbesartan Valsartan Candisartan Olmesartan Telmisartan
Dramatically decreases mortality in CHF pts by blocking high circulating levels of catecholamines?
B-blockers
Bisoprolol
Carvedilol
Metoprolol
Improve arterial distensability and reduce preload
Diuretics –decrease volume and preload
Add-on for class III and IV CHF, blocks aldosterone action and inhibits Na+ reabsorption in distal tubule?
Spironolactone
Eplerenone
What is the mechanism of action of digoxin, a cardiac glycoside?
Inhibits Na/K ATPase
Increases contractility d/t more Ca++
Increases vagal activity to heart–reduces SA firing rate–conduction through AV node
What are the uses of digoxin?
Improves LV function Decreases neurohormonal activation Increases vagal tone Normalizes arterial baroreceptors Decreases hospitalizations in CHF
What are the major issues with digoxin?
Very narrow therapeutic-toxic window–arrhythmias
Eliminated in kidneys–so dose according to renal function
Positive inotrope and chronotrope used with acutely decompensated pts–about half will die after 6 months?
Dobutamine
What is the mechanism of action of dobutamine?
B1 receptor agonist–postive inotrope and chronotrope
What are the side effects of dobutamine?
Can develop tachyphylaxis after 48 hrs
Used in acute setting of heart failure and is used for short term only?
Milrinone
What is the mechanism of action of milrinone?
Phosphodiesterase IIIa inhibitor–inhibits cAMP breakdown
What are the side effects of milrinone?
Increased hypotensive and atrial arrhythmia event acutely
