Shared Flashcard Set

Details

Heart failure drugs
Dr. Williams Block 2
9
Pharmacology
Professional
10/31/2011

Additional Pharmacology Flashcards

 


 

Cards

Term
what is going on in heart failure?
Definition

preload and afterload are affected

 

contractility problem = backup = more fluid trying to go through the the pipe = inadequate CO

Term
ACEi (overview pg 250)
Definition

can decrease symptoms and increase symptoms

 

(increase bradykinin = vasodilation)

 

dilate arterial and decrease aldosterone = decrease afterload and preload (increase SV)

Term
beta blockers (overview)
Definition

studies have shown that carvedilol, metoprolol, and bisoprolol can decrease mortality in certain patients

 

worsening heart failure may occur initially; improvement may take months

 

decrease HR, decrease BP = decrease contractility

Term
spironolactone (overview)
Definition

study of patients on spir. found that they had decreased visits to the hospital for heart failure and decreased mortality

 

requires careful monitoring of serum potassium and renal function

 

decrease Blood volume = decrease preload and afterload

Term
some other drugs
Definition

1) angiotensin receptor blockers

 

2) hydralazine and isosorbide dinitrate (combination of an arterial dilator and a venous dilator) - African american

 

3) eplerenone approved for heart failure following acute myocardial infarction in certain cases

 

(CCB = decrease impuls to SA node= decrease HR)

Term
Cardiac dlycosides: digitalis
Definition

increased contractility = shift curve upwards (preload) - - DIRECT EFFECTS ON HEART

 

used mainly in heart failure and certain arrhythmias such as a. fib.

 

1) increases contractility - inhibits sarcolemmal Na,K-ATPase - binding enhanced by hypokalemia

- increase intracellular Na and decreased intracell K = = increased intracellular Ca++ (figure on pg 252)

 

2) vagal stimulation = decrease HR (tx for supraventricular tachyarrhythmias, such as a. fib)

 

3) decrease sympathetic NS activity at theraputic levels; increase SNS at higher doses

 

effects on heart can be direct or indirect: beneficial effect in atrial fib (decreased vent. rate), but arrhythmias and heart block possible at toxic levels

 

increased t1/2 with renal insufficiency

 

Adverse effects:

1) Cardiac toxicity = arrhythmias and/or heart block

2) GI = anorexia, nausea and vomiting, diarrhea

3) CNS - blurred vision, abnormal color vision (see Halos around lights - think van Gogh); confusion

4) manage K and monitor heart arrhythmia

 

Electorlyte disturbances: hypokalemia, hypercalcemia, hypomagnesemia

 

Drug interactions:

1) thiazide or loop = hypokalemia

2) quinidine = increase plasma digoxin concentration

3) verapamil or amiodarone = increase plasma dig. conc.

4) antacids, kaolin-pectin, cholestyramine = decreased plasma dig concentration

Term
dobutamine
Definition

Beta-1 agonist - used in acute pulm edema and no response to lasix

 

may increase CO with less reflex tachycardia than occurs with nonselective beta agonists such as isoproterneol

 

possible adverse effects:

1) excessive increase in HR

2) arrhythmias

Term
milrinone
Definition

ONLY IV for acute heart failure

 

decreases PWP, decrease vasc. R, increase CO

 

inhibits phosphodiesterase (type 3) = increase cAMP = increased contractility and vasodilation

 

adverse: arrythmias

Term
nesiritide
Definition

recombainant human B-type natriuretic peptide; hBNP

 

increase cGMP

 

approved for use in certain patients with actue decompensated heart failure

 

decreased PWP and dyspnea

 

increase action on particulate guanylate cyclase receptor = increased cGMP = Smooth muscle relaxation

 

adverse effects: hypotension; reports of renal damage and death

 

(remember - BNP is a test for heart failure)

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