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heart failure agents
heart failure
55
Medical
Graduate
12/04/2011

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Term
angiotensin II effects
Definition
sustained adrenergic traffic ledasd to icnrased renin adn increased nagiotensin II. It raisesadlsoterone raising sodium retension. This leads to edema and pulmonary congestion in Heart fialure.
Term
downwrad spiral of herat faiulre
Definition
decreased CO activated norep and angiotensin II and endothelin, which causes vasocinstriaction and incrased afterload . Further redjuction of ejection fraciton adn CO. This spiral.

look at downward spiral graph on right: ionotropes shfit the curve back up. and vasoidilators shift it to the left.
Term
diuretics main fucntion
Definition
to decrease ecf volume/preload and curtial remodeling/foibrosis (ppironolactone).

control congestive symtpoms. dont decreasem ortality
Term
vasodilators over al lfunction
Definition
to dcrease preload/afterload
Term
b-adrenergic antagonists
Definition
reduce arrythmogenesis, curtail remodeling. reduce undsird ysmpathetic effects
Term
b-adrenergic antagonists
Definition
reduce arrythmogenesis, curtail remodeling. reduce undsird ysmpathetic effects
Term
inotropic agents
Definition
increse cardiac output
Term
review of nephron
Definition
fluid enters glomerulus passign through prox tubule, thorugh thin dsecending limb through ascending limb through distal convulated utuble otu to collecting duct.
Term
loop diuretics
Definition
blocks na/k/2cl- mines nkcc2, in thick ascending limb .

loop agents also hae dirrect effects on blood flow through several vascular beds, leading to relif of pulmonary congestion before diuresis occurs.
Term
furosamide
Definition
loop diuretic
Term
ethacryinc acid
Definition
loop diuretic, used only for sulfonamie allergies due to otoxicity
Term
loop diuretic side effects
Definition
enhace delivery of sodium and water to colelcting duct, leading to enhance k,h, mg2plus secretion, resulting in hypokalemic metabolic alkalosis an d hypomagnesemia.
Term
Thiazides moa
Definition
block symporter- NCC - nacl- . Less effective than loo pdiuretics, hwoever synergistic effect.
Term
thiazide adverse effects
Definition
enhance h and k secretion nthrough increased sodium deliver to moredistal sites. Causing hypokalemic metabolic alkalosis
Term
potassium sparing diuretics moa
Definition
act on collecting duct, priamrily of prinficple cel, antagonising aldosterone.
Term
potassium sparing diuretics moa
Definition
act on collecting duct, priamrily of prinficple cel, antagonising aldosterone.
Term
triamterone amiloride type and moa
Definition
potassium sparing diuretic. - block EnaC Na plus chanel.
Term
spironolactone type and moa
Definition
direct aldosterone antagonist (work at receptor). Thought to be effective more due to their ability to inhibit cardiac remodelling as opposted to diuretic ability
Term
epleronone moa and type
Definition
direct aldosterone antagonist (work at receptor). better tolerated than spironoclatone because mroe specific.
Term
principal cells function
Definition
primary site of potassium secretion.
Term
aldosterone
Definition
higher in patients with heart failrue due to lwoer adlosterne degradationi nliver, k plus stimulated secretion, or angiotensin II levels icnreased
Term
k plus sparing diuretic side effects
Definition
increased potassium! leading to possible rhythmic changes
Term
ACE inhibitors MOA
Definition
decrease afterload by lwoering peripheral resistance (increasign C.O and ejection fraction), reduce preload byreducing aldosterone secretion.

1. decrease conversion of angiotensin I to II.

2. Decreased aldosterone synthesis.

3. Decrease sympathetic activity by reducing NE.

4. Decreased logn term remodelling of heart and vessels due to decreases SNS and Aldosterone

venodilation in CHF.
Term
Ace inhibitors adverse effects
Definition
increased risk of hyperkalemia due to decreased aldosterone syntehsis.

increased renin and angiotensin I levels due to negative feedback
Decreased bradykinin degradation , which stimualted prostaglandin and NO leads to cough and angioneurotic ademea (swelling of nose, throat , glottic, tongue).

risk of hypotesion (as well as other drugs)
Term
Ace inhibitor types
Definition
all -pril drugs
Term
ACe inbhitor uses
Definition
for grades II-IV CHF, support actions of diuretics. Are able to decrease mortality due toheart failure.
Term
angiotensin II receptor blockers
Definition
block at1 and at2 recetpros. at1 receptors are g protein linked and use plc pathway to eleate free calcium.
at2 recpetors: icnrease cGMP formation.
Term
-sartan drugs
Definition
ARBs
Term
ARBs efficacy
Definition
almost as e fefctie as AcCE inhibitors, but not quite. Decreasem ortality. have less side effects ecause do nott effect bradykininw in anyway
Term
nitroprusside
Definition
used for acute setting. dilates both arterial and venous vessels, but must be given contiously via iV.
Term
hydralazine plus isorbide dintrate
Definition
helpful butless effective htan ace inhibitors. usually used as adjunct. esp useful in blacks.
Term
topcial nitrates
Definition
for use for chf in acute basis
Term
allskiren
Definition
renin blocker, use like ace inhibitor ,but no bradykinin effects
Term
b-antagonists
Definition
reduce mortality.

beneficial action; lower adverse effects ofh igh catecholamiens (icnludinga poptosis). upregulation of beta-1 receptors- for increased catech resposniveness.

reduced remodeling.

decreased heart rate adn arrythmogenesis
Term
-prolols
Definition
b-antagonists
Term
carvedilol composition
Definition
racemid mixture of nonselective beta blocekr and alpha 1 antagoninst
Term
carvedilol short term effects and logn term
Definition
short term: vasodilation without lwoering of C.O. long term: prevents detioration of myocardial function and reverse adrenergically mediated myocardial dysfunction. Unlike metaprolol has no effects on beta 1 receptor numbers.
Term
carvedilo ladverse efects
Definition
symptomatic hypotensioa nd bradycardia, alelviated by starting with very low doses
Term
nitortopic agents general moa
Definition
icnrease intracellular calcium levels , adrenergic agonists also do simliar things
Term
digatlis MOA/ cardiac glycosides
Definition
inhibition of sodium potasisum atpase. leading to decreased calcium kicking out via na/ca2plsu channel. Binding of digtalis is inhibited by potassium.

increaased itnracelluar free clacium promotes cardiac contraciltity viat he cardiac torpnoin system.

Movest the cardiac output curve verticallly upwards.

doesnt decrease moratliy, and doenst work syngerstically wtih acei nhbiitors
Term
digistalis toxicity
Definition
early breif prolognation fo AP , folwoed by protracted pe riod of shortening, which elads to shortened artial/ventricualr refractoriness. this is due to cholineric innervation stiulation.

It also reduces resting membrane potenial (lessn egative due to blockign ofh te atpase. It also sensitizes myocardium to sypathetic trnsmitters. digitalis can cause v irutally an ydegree of arrythmia
Term
cardiac glycosides farm actions
Definition
increases C.O. , decreases heart size, decreases venosu pressure, and decrease EDV,produce diuresis, adn decrease blood v olume.

consequences: decreases symapthetic output (direct and reflex and incresed vagal activity- decresed herat rate nad icn reased vasodialtion.

increased renal perfusion.

inhibiton of renal sodium/potassium atpase promoting sodium exretion and iuresis.

improving renlal perfusion nd reduced renin oputput.
Term
three variants of glycosides cardiac
Definition
ouabin, digoxin and digitoxin. Oubain not vyr lipid solube so used epremtianlly . digoxin only one really sued clinically
Term
Isatorixime
Definition
ivnestigational steroid driate increased cardiac contratiliy via na/ka apte but also faciliates calcium sequesteration making it lessa rrythmogenic htan digoxin
Term
pharmacokinetics of digoxin are complciated
Definition
needst o be itnroduced with care
Term
levosidmendan
Definition
calcium sensiizer- increase calcium binding to troponin.
Term
BIpyridines
Definition
phosphodiesterase inhibitors. Icnreases Camp and photrphosylaciton/activaiton fo l tyep calcium channels. Incresing calcium fluxx in heart and contractility. Also inhibition of myosin light chain phsorphyrlation leading to vasodilation.
Term
phosphidesterase inhibitorsu se
Definition
long term usei s not warranted due to increased arrythmias, thrombocytopenias and liver toxicity.
Term
beta adrenergic agonists main effects
Definition
rsult in icnrease calciu m influx and alterin calcium kienticsi n SR, resulting in phosphorylation of troponin.
Term
dopamine effects
Definition
depepdnant upon infusion rate. at low levels acivated d1 and d2, at higherl evels also acivated beta 1, at highest rates actives alpha1 whichi s udnesirable because of its vasoconstrictive effects.
Term
dobuatmine compositioand action
Definition
racmic mixture of beta1 more htan beta 2 agonists , with an alpha1 agonist. Overall see mostly b1 adrenergic repsonse.
Term
acute vs chronic heart failure
Definition
acute- ie. after mi, or shock. maintain pbp and icnrease cardiac output.

Chronic- congestive hear faiulare. Control ECF expansion, icnrease CO an d decrease periph resitance. INcrease excercise tolerance nad preent cardiac hypertrophy and remodleigng
Term
triamterone
Definition
ptoassium sparing diuretic
Term
amiloride
Definition
potssium sparing iuretic
Term
hydralazine and isodorbide dinatrate
Definition
vasodilators
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