PAT 202: PHARMACOTHERPAY OF CARDIAC DISEASES ASYNCHRNOUS PPT NOTES (THINK CAD, HTN, MI, HF, & /STROKE) PART ONE

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first some review knowledge

1. what class of drug is morphine

opiods

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first some review knowledge

2. what class medications are dilitzem and amlodipine

CCB

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first some review knowledge

3. what class medication is nitroglyceirn

vasodilators

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first some review knowledge

4. what class medication is metaprolol

B2 adrenergic receptor blockers

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first some review knowledge

5. what class of medication is enalapril

ACE inhibitors

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first some review knowledge

6. what class medication is sacubitril and valsartan the combination drug

neprilsyl inhibtor arb

think TOL for losartan which was our arb we learned about last year

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first some review knowledge

7. which class medication is digoxin

cardiac glycosides

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first some review knowledge

8. what class medication is amiodarone

antidysarythmias

or

antiarrythmias

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first some review knowledge

9. what class medication clopidogrel and tiacagrelor

antiplatelets

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first some review knowledge

10. what class medication is asa

COX inhibitors

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first some review knowledge

11. what class medication is alteplase

thrombolytics

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first some review knowledge

12. what class medication is heparin and warfarin

anticogulants

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first some review knowledge

13. what class medication is protamine sulfate and vitamin k

protamine sulfate is antidoate for heparin

vitamin k is antidoite for warfarin therapy

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first some review knowledge

14. what class medication is enaxaparin

low molecular weight heparin

think

-Parin like

daleParin the other low moleular weight heparin

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first some review knowledge

15. what class medication is dabigtram

direct thrombin inhibitor

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first some review knowledge

16. what class medication is furosemide

loop direutic

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first some review knowledge

17. what class medication is hydrochlorothiazde

thizide diuretic

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first some review knowledge

18. what class medication spironolactone

mineracoroticocoid

receptor

antagonist

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

the heart mechanically as a pump has what 3 main mechanical mechanisms its WORK can be described by (telling us information as to if the heart is working too hard, too little, not working at all, is diseased or damaged, or under a state of stress and etc)

1) CO

2) SV

3) HR

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

CO

SV

HR

tell us what about the heart

tell us about the cardiac performance of the heart

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

Cardiac performance depends greatly on what

a. CO

b. HR

c. SV

d. afterload

A. CO

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is cardiac output

CO is the amount of blood ejected out of the ventricles per MINUTE

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

CO depends mainly on what 2 products

CO = a X b

STROKE VOLUME

&

HEART RATE

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is stroke volume

stroke volume is the amount of blood in (ml NOT L) ejected out of the ventriucles during systole (in a heart beat basically)

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is heart rate

heart rate is the amount of times the heart beats per minute

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what are the 3 factors affected by changes in SV

1) PRELOAD

2) AFTERLOAD

3) CONTRACTILITY

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

CO is affected mostly by what subfactors

preload and afterload

thus CO is most affected by SV since preload and afterload are components of SV

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is preload

the component of SV

preload: is the volume inside the ventricles at the end of diastole right before systole (this is also called EDV end diastolic volume)

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is being described

1) the stretch of the ventricles prior contraction

preload

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what are two factors that affect preload

1) the amount of venous blood return to the left V during diastole (from the L and R pulmonary veins)--> this makes sense since preload is the amount of volume the L V fills up with and more volume coming to L v means higher preload

2) the amount of blood left in the L V

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

the 4 factors that affect CO directly are what

preload

afterload

myocardial contractility

HR

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

factors which affect preload (volume of blood in LV before ejection) is affected by venous return to the L V: explain in a little more detail what affects venous return to the heart

blood volume (is it little or large) and the flow (smooth or turbulent) going back to the LV throug the venous system and the effectiveness of the AV valves determines venous return

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is being described

= right before the heart contracts they are filled to the max capacity of blood

the term to describe this is

preload

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

the amount of volume that can fill the heart depends on the stretching capacity of the myocardial fibre cells of the ventricle

think of it like a balloon

the more stretchy a water balloon is the more water it can fill

the less stretchy a water balloon is the less water it can fill

thus the degree to which the myocardial fibers can stretch while filling up with blood is called what

preload

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

the more the myocardial fibers of the ventricle strecth the more force of contraction they eject out of blood

think back to balloon example

1) more bigger the water balloon gets the more water it eject out when compressed

this principle is called what

FRANK STARLING LAW

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

the strength measured of the contraction of the heart is called what

contractility

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

drugs that increase preload and increase CO

also increase what?

remember

preload and contractility

fall under SV

and

increased SV

means

increased CO

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what are some drugs that increase contractility of the heart

EPI

NOREPI

THYROID HORMONE

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

drugs which increase contractility of the heart are called what class of drugs

POSITIVE (+)

INOTROPIC

DRUGS

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

drugs that decrease contractility

thus decreasing SV

thus decreasing CO

are called what

and give two examples of them

called

NEGATIVE INOTROPIC DRUGS

and some examples

include

beta blockers like metaprolol

and quinodine

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is ESV end systolic volume

the amount of blood in ventricles after contraction

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

the heart does not eject all the blood it fills up with out

some blood is still stuck inside the ventricle when the heart contracts

this volume of blood is called what

END SYSTOLIC VOLUME

(the amount of blood in the heart that remains even after the heart has contracted)

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

the end systolic volume depends on what

(remember this is the amount of blood that remains in the ventricles after contraction); so think about what some factors are that

specifically affect how much of that blood in the heart gets pumped out?

1) ventricular contraction strength (more strength of contraction means more blood ejected out means lower ESV)

2) ventricular emptying ability (the higher the ability of ventricles to empty means more blood which will be ejected out means lower ESV)

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

what is afterload

(remember this is also a factor of SV)

afterload: is that exact pressure in the aorta (that strength of contraction) needed to overcome for all that blood that has filled up in the L V to be ejected out from the heart into the bodys arteries

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

so _________ is the volume of the blood in the heart before ejection

and

__________ is the pressure needed to be overcome to eject blood out of the heart for systole

a. preload

b. afterload

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

RECAPING SLIDE ONE

1. preload is affected by what two things

venous return

ESV

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

RECAPING SLIDE ONE

afterload is affected by what two things

1) aortic pressure

2) total peripheral vascular resistance (ask how about this one)

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

RECAPING SLIDE ONE

what are some factors affecting the contractility of the heart (remember this is the strength of which the heart contracts)

1) EDV (Volume that needs to be ejected out will affect the strength the heart will contract at push that volume at)

2) sympathtic stimulation = increases contractility

3) myocardial oxygen supply (lack of oxygen---> poor contraction ability---> poor strength of contraction)

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

RECAPING SLIDE ONE

what are some factors that affect the heart rate

1) CNS

2) ANS (think PSNS means SLOWER HR and SNS means FASTER hr

3) neural reflexes

4) atrial receptors

5) hormones

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1. FACTORS AFFECTING CARDIAC PERFORMANCE

RECAPING SLIDE ONE

many of the cardiovascular medications have a common goal of what

1. decreasing cardiac workload

(so decreasing

preload and afterload which decreases CO)

2. and decreasing the 02 demands of the heart

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2. OVERALL PHARMACOLOGICAL GOALS ARE WHAT

what are the 5 overall pharmacoglocial goals of cardiac medications

1) tx the symptom

2) decreasing heart worklaod and oxygen demands

3) improving oxygen

4) improcving cardiac function

5) reducing pain and anxiety

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2. OVERALL PHARMACOLOGICAL GOALS ARE WHAT

T OR F

reducing pain and anxiety is a pharmacological goal of cardiac medications

TRUE

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2. OVERALL PHARMACOLOGICAL GOALS ARE WHAT

after tx the symptoms of the heart the second thing meds concern themselves with is what

decreasing heart workload

and oxygen demands

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3.4.5 THE NEXT SLIDES ARE CONCERNED WITH

medications for tx different cardiovascular problems

like

1) angina

2) MI

3) HF

brielfy explain what each is

1) angina is chest pain r/t to the heart

2) MI is heart attack due to decresed myocardial 02 demand

3) heart failure is failure of the heart to do its job

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SLIDE 5: LETS TALK ABOUT WHAT ANGINAL MEDICATIONS DO FOR "ANGINA"

what is the goals of medications tx angina

1) reduce the fq of angina episodes

2) stop angina episodes from occuring

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SLIDE 5: LETS TALK ABOUT WHAT ANGINAL MEDICATIONS DO FOR "ANGINA"

how do anginal medications work

there are 4 mechanisms name them

1) slow HR

2) dilates veins

3) decrease contractility (think of how epi nore epi and thyroid hormone + inatropic drugs increase cxn)

4) dilate arteries to lower bp

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SLIDE 5: LETS TALK ABOUT WHAT ANGINAL MEDICATIONS DO FOR "ANGINA"

how does dilated veins decrease angina?

dilating veins means the heart receives less blood

less blood to the heart

means

less preload

and less preload means less workload on the heart means less 02 demand

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SLIDE 5: LETS TALK ABOUT WHAT ANGINAL MEDICATIONS DO FOR "ANGINA"

how does decreasing contractility decrease angina

decreased contractility

means

decreased stroke volume

means

decreased CO

means

decreased heart workload which always means decreaesed 02 demand need

means less anigna

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SLIDE 5: LETS TALK ABOUT WHAT ANGINAL MEDICATIONS DO FOR "ANGINA"

LESS HEART WORKLOAD ALWAYS MEANS

LESS MYOCARDIAL 02 DEMAND

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SLIDE 5: LETS TALK ABOUT WHAT ANGINAL MEDICATIONS DO FOR "ANGINA"

how does dilating arterioles to lower bp decrease angina

1) lowering bp

means

less pressure in the LV needed to overcome for ejection

2)meaning less afterload

3) less afterload means less SV

4) less SV means less CO

5) less CO means less heart workload and myocardial 02 demand

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SLIDE 5: LETS TALK ABOUT WHAT ANGINAL MEDICATIONS DO FOR "ANGINA"

all anginal drugs are directed towards tx what?

SYMPTOMS

anginal drugs dont treat the underlyind disorder like cad for example

they only tx the symptoms

they do thus by reducing myocardial demand for 02 thus decreasing angina

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SLIDE 6: LETS TALK ABOUT THE PHARMACOLOGICAL GOALS OF MEDICATIONS AIMED AT TREATING (MI) HEART ATTACK

MI: what are the 5 main goals for treating an ACUTE MI

goal one: restore perfusion to damaged myocardial asap

goal two: reduce myocaridal 02 demans

goal three: control or prevent associated dysarythymais

goal four: reduce post MI mortality

goal five: control MI and associated anxiety

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SLIDE 6: LETS TALK ABOUT THE PHARMACOLOGICAL GOALS OF MEDICATIONS AIMED AT TREATING (MI) HEART ATTACK

GOAL ONE

1) wht drug helps to restore perfusion to the damaged myocardium as quickly as possible

THROMBOLYTICS

think

alteplase (dissolve that clot which is causing poor 02 supply causing MI in the first place)

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SLIDE 6: LETS TALK ABOUT THE PHARMACOLOGICAL GOALS OF MEDICATIONS AIMED AT TREATING (MI) HEART ATTACK

2) what drugs will reduce myocardial 02 demand

nitrates - vasodilator--> we know dilation of arteries----> decreases bp----> decreases afterload---> decreases sv---> decreases CO----> decreases myocardial 02 demand

and

beta blockers (prevent further MI) decrease contractility----> decreases sv----> decreases co----> decreases myocardial 02 demand

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SLIDE 6: LETS TALK ABOUT THE PHARMACOLOGICAL GOALS OF MEDICATIONS AIMED AT TREATING (MI) HEART ATTACK

3) what drugs will control or prevent assoicated dysarythymias

1) beta blockers

2) antidysarythmias

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SLIDE 6: LETS TALK ABOUT THE PHARMACOLOGICAL GOALS OF MEDICATIONS AIMED AT TREATING (MI) HEART ATTACK

4) what drugs will reduce post mi mortality

ASA (anticoagulant properties will prevent clot from forming)

and

ACEI (enalaprils)

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SLIDE 6: LETS TALK ABOUT THE PHARMACOLOGICAL GOALS OF MEDICATIONS AIMED AT TREATING (MI) HEART ATTACK

5) what drugs will control mi and associated anixety

narcotic analgesics like morphine which act on mu and kappa receptors to block pain and cause euphoric like feelings

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SLIDE 7: NOW LETS TALK ABOUT THE GOALS OF TX FOR HF

HF

name the 3 primary goals of tx for HF

1) reduction of preload

2) reduction of SVR (decreased afterload)

3) inhibition of both the RAAS and the vasoconstrictor mechanisms of SNS

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SLIDE 7: NOW LETS TALK ABOUT THE GOALS OF TX FOR HF

HF

goals

1) how does reduction of preload help with the tx of HF

NOTE

this provides symoptomatic relief but does not reverse HF progression

now how it provides sympomatic relief

less preload

less sv

less co

less myocardial 02 demand

decreases symptoms of HF

-CARDIAC PHARMACOTHERAPY--

SLIDE 7: NOW LETS TALK ABOUT THE GOALS OF TX FOR HF

2) how is reduction of svr (afterload) a goal of HF therapy

note: this provides symptomatic releif but does not reverse HF

how it provides symptomatic relief

less afterload

less sv

less co

less myocaridal 02 demand

helps relief symptoms

-CARDIAC PHARMACOTHERAPY--

SLIDE 7: NOW LETS TALK ABOUT THE GOALS OF TX FOR HF

explain how

3) inhibition of both the RAAS and vasoconstrictor mechanisms of SNS are helpful in the tx of HF

= results in the signifcant reduction in morbidity and mortality from HF

raas = increases hr, increased bp, increased pvr, ( a whole lot of mixture that INCREASES CO AND INCREASES MYOCARIDAL 02 DEMAND)