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Biomedical Pharmacology > Lecture 11 - The Heart > Flashcards

Lecture 11 - The Heart Flashcards

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1
Q

What is heart failure?

A

The output of heart is insufficient to meet the demands of the body

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2
Q

When does Myocardial Ischaemia occur?

A

When blood flow to your heart is reduced

Not receiving enough oxygen

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3
Q

Where does Myocardial Ischaemia occur from?

A

Angina

Myocardial Infarction

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4
Q

What is disturbance in cardiac rhythm treated by?

A

Beta-receptor antagonist

Beta blockers

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5
Q

What can lead to dysrhythmia/ arrhythmia?

A

Angina

Myocardial infarction

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6
Q

What does Myocardial Ischaemia result from?

A

Blockage in coronary blood vessel

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7
Q

What is Angina?

A

Chest pain associated with Myocardial Ischaemia

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8
Q

How can Angina be classified?

A

Stable
Unstable
Prinzmetals (variant)

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9
Q

What is stable and unstable of angina be due?

A

Narrowing of blood vessels

Build up of atheromatous plaque = thrombosis

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10
Q

What is stable?

A

Less serious form of angina

At rest: individual will not experience any chest pain unless acted on oxygen demand of heart increases

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11
Q

What is unstable?

A

More severe
Continual pain
Whether engaging in exercise or at rest
Greater restriction on blood flow

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12
Q

Prinzmetal (variant)

A

Smooth muscle contraction in arterial side of circulation

Vasospasm

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13
Q

What is the pharmacological intervention for Angina?

A

Increase blood flow through coronary vessels

Decrease oxygen demand prophylactically

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14
Q

What are the compounds that treat Angina?

A

Organic nitrates
Potassium channel activators
Beta adrenoceptor antagonist
Calcium channel antagonist

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15
Q

What can lead to Angina?

A

Decrease oxygen supply

Increase oxygen demand

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16
Q

What is the effect of decreased oxygen supply?

A 
Decreased coronary blood flow 
Decrease vessel calibre
Increase heart rate 
Decrease perfusion pressure 
Increase ventricular wall tension
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17
Q

What is the effect of increased oxygen demand?

A

Increase heart rate
Increase Myocardial contractility
Increase ventricular well tension

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18
Q

What is nitric oxide taken through?

A

Sequence of events

Activation of guanylate cyclase —> GT to cyclic cGMP —> activation of protein kinase

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19
Q

Where does nitric oxide come from?

A

Endothelial cells

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20
Q

What is Increase in blood flow due to?

A

Vasodilation

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21
Q

What does reduced oxygen demand suggest?

A

Heart is contracting less forcefully

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22
Q

What does Frank-Starling mechanism of heart suggest?

A

The relationship between ventricular filling and force of contraction
Greater venous return = greater stretch of myocardium and resulting force of contraction is greater
Greater preload on heart

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23
Q

What are veins referred to as?

A

Capacitance vessels

Alter proportion of blood in circulation by altering diameter of veins

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24
Q

What does organic nitrates cause?

A

Both vasodilation on venous and arterial side of circulation
Easier for boood to flow
Reduce cardiac preload
Reduce oxygen demand

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25
What are examples of organic nitrates?
Glyceryl trinitrate | Isosorbide mononitrate
26
What is Glyceryl trinitrate?
Absorbed quickly across mucosal membrane Administration: spray/tablet under tongue/patch Used when there is Angina attack
27
What is isosorbide mononitrate?
Taken orally Absorbed in GIT Longer lasting action
28
What are the results from cardiovascular point of view?
1. Increased blood flow and reduced oxygen demand 2. Frank-Starling mechanism 3. Dilation in blood vessel = venous side of circulation 4. Organic nitrate - venodililation 5. Organic nitrate - both vasodilation on venous and arterial circulation 6. Relax vascular smooth muscle 7. Venous capacitance vessel 8. Coronary arteries 9. Arterial resistance vessels
29
Dipyridamole
Dilatory effect on major coronary blood vessel
30
What does collateral arteries found in cardiovascular circulation allow?
Communication between parts of blood flow
31
What does organic nitrate have?
Specific dilatory effect which can bring about dilation if collateral vessels
32
How are organic nitrate administered?
Sublingual Buccal Transdermal Oral
33
What are the unwanted effects of organic nitrate?
``` Venodilation Postural hypotension Dizziness Syncope Reflex tachycardia ```
34
What can arterial dilation cause?
Throbbing headache and flushing
35
Asymmetric dosing
Take doses 6 hours apart rather than 12 Most prophylactic effect Period where concentration of nitrate decreases over period of 24 gods Reduce incidence of tolerance
36
Potassium channel Activators
K+ channel opener Increased membrane K+ permeability with K+ extrusion from cell Vascular smooth muscle hyperpolarisation Closure of L-type voltage-dependent Ca2+ channel Inhibition of intracellular Ca2+ release Reduced free intercellular Ca2+ Quiescence and protection of cells against hypoxia Vasodilation
37
B-adrenoceptor antagonist
Beta blockers In Angina: reducing oxygen demand of heart Beta blockers block beta 1 receptors Beta 1 receptors present on cardiac tissue When cardiac tissue blocked - reduction in heart rate and reduced force of contraction - lower Bp
38
What does blockade of B1 receptors act to do?
Reduce heart rate Reduce force of contraction Lower blood pressure
39
What is an example of drug that is cardioseletive?
Atenolol
40
Lipophilic
Propanolol
41
Hydrophilic
Atenolol
42
What are unwanted effects of B-adrenoceptor antagonist?
Precipitation of heart failure/ impairment of blood supply to peripheral tissues Lowering of HDL Sleep disturbances Sudden withdrawal syndrome
43
What are 3 classes of calcium channel antagonist?
Phenylalkylamine (verapamil) Dihydropyridine (nifedipine, amlodipine) Benzothiazepine (diltiazem)
44
What does the 3 classes of calcium channel antagonist do?
Block cellular entry of calcium through L-type channels
45
What does cellular entry of Ca2+ blockade result in?
Arteriolar/arterial dilation | Reduction in heart rate and cardiac contractility
46
What are the side effects of calcium channel antagonist?
Arteriolar dilation: headache, flushing and dizziness and ankle oedema Reduced cardiac contractility Verapamil: altered gut motility Nifedipine: heart burn and nausea
47
What does formation of clot include?
Fibrinogen | Activated fibrinogen fibrin
48
What enzyme breaks down blood clots?
Streptokinase
49
What is the streptokinase enzyme if bacteria origin capable of activating?
Plasminogen into plasmin
50
What is plasmin involved in?
Breakdown of fibrinogen and fibrin | Dissolving the clot
51
What does secondary prophylaxis include?
``` Stop smoking Exercise more Low dose aspirin or warfarin B-adrenoceptor antagonist ACE inhibitors Calcium channel blockers Statins to lower cholesterol ```
52
What does ACE inhibitors do?
Angiotensinogen is concerted into Angiotensin 1 Angiotensin 1 is converted into Angiotensin 2 Angiotensin 2: potent vasoconstrictor effect Ace inhibitors can cause vasodilation - reduce stress on heart by reducing blood pressure
53
What does peripheral oedema occur?
Swelling in ankles
54
What are the symptoms associated with reduced cardiac output/ venous congestion?
Breathlessness Peripheral oedema Fatigue
55
What is Digoxin?
Potent inotrope derived from natural sources | Affects how Ca2+ is handled on intracellular part of cardiomyocte
56
What can diuretics lead to?
Hypokalamia (potassium levels are too low)
57
What does diuretic influence?
Tubular reabsorption of sodium | Diuretics will increase urine flow at various stages from tubular and water follows by osmotic means
58
What are examples of Loop Diuretics?
Furosemide Bumetanide Torasemide
59
When is loop diuretics used?
Where oedema is an issue | Clinically used in treatment of salt and water overload
60
What is salt and water overload associated with?
``` Acute pulmonary oedema Chronic heart failure Ascites (liver cirrhosis) Nephrotic syndrome Renal failure ```
61
where does Thiazide and related drugs act on?
Distal tubule
62
What are examples of thiazides?
Bendrochlorothiazide | Hydrochlorothiazide
63
What are other drugs of thiazide?
Chloralidone Indapamide Metolazone
64
What does Thiazide mechanism inhibit?
Na+-Cl- cotransporter Reduce Na+ reabsorption Potassium loss Excretion of Ca2+ and uric acid is decreased
65
When is Cardiac glycosides good?
Heart failure associated with atrial fibrillation | Rapid heart rate
66
How do you exacerbate heart failure?
Myocardial depression | Fluid retention
67
What are primary Myocardial injury?
Secondary Myocardial effect Neurohormone Endothelium

Biomedical Pharmacology (19 decks)

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