Cardiovascular Drugs (Heart Failure)

Heart failure

a complex, progressive disorder in which the heart is unable to pump a sufficient amount of blood to meet the needs of the body because it cannot fill and/or eject properly. Symptoms include dyspnea, fatigue, and fluid retention. Underlying causes including varying forms of heart disease.

Atherosclerotic heart disease

condition where fatty deposits (plaque) build up in blood vessels. A common cause of heart failure

reduce symptoms, slow disease progression, increase survivability

three goals of heart failure treatment

reduce work load

decrease fluid volume

improve contactility

reduce cardiac remodeling

four mechanisms that drugs used in the treatment of heart failure utilize to reduce symptoms and improve survivability

Cardiac myocytes

cells that are electrically excitable. They have a spontaneous rhythm generated by cells located in the SA and AV nodes. They have unusually long action potentials that can be divided into five phases.

sodium, depolarization

phase 0 of cardiac myocyte action potential involves the opening of _____ channels and rapid _____

sodium, potassium

phase 1 of cardiac myocyte action potential involves the closing of _____ channels and the slow leaking of ____ outside of the cells

calcium, plateau

phase 2 of cardiac myocyte action potential involves the opening of _____ channels resulting in a slow depolarizing current that counteracts the polarizing leak of potassium. This results in a ____

calcium, potassium

phase 3 of cardiac myocyte action potential involves the closing of _____ channels, opening of ____ channels, which functions to re-establish resting membrane potential

phase 4

phase of cardiac myocyte action potential that represents full repolarization and return to resting membrane potential. At this phase another action potential can occur.

Calcium

ion whose concentration in the cytosol of cardiac muscle cells is directly related to their force of contraction. Increase in this ion increases the force of contraction

Chronotropic effect

increasing or decreasing the rate of heart contraction

increase sympathetic activity

activates renin aldosterone activity

activates natriuretic peptides

myocardial hypertrophy

four methods of the body to compensate for heart failure

Afterload

vascular resistance which the heart must overcome during systole

Preload

initial stretching of cardiac myocytes prior to systole

ACE inhibitors

anti-heart failure drugs that block the ACE enzyme that cleaves angiotensin I into angiotensin II. They also diminish the inactivation of bradykinin. As a result this decreases afterload and preload, block release of epinephrine and aldosterone, and improve symptoms and survival of heart failure. Ie) captopril, enalapril, lisinopril

lisinopril

captopril

enalapril

(Light Cardio Everyday)

name three ace inhibitors used in the treatment of heart failure

Beta blockers

anti heart failure drugs that decrease heart rate and inhibit the release of renin in the kidneys. Also prevent deleterious effects of norepinephrine on the cardiac muscle fibers decreasing cardiac hypertrophy Ie) bisoprolol, carvedilol, metoprolol

timolol

carredilol

propranolol

atenolol

metroprolol

bisoprolol

betaxolol

(The Coach PAM Bypasses Bikers)

name seven beta blockers used in the treatment of heart failure

Spironolactone

Sacubritil

Nesiritide

Furosemide

(Sodium Secretion Never Fails)

name four drugs used in the treatment of heart failure that work by increase sodium secretion thereby decreasing peripheral edema, preload, and afterload.

angiotensin receptors blockers

which drugs can be used as a substitute to ace inhibitors if dry cough and angioedema are a problem?

Aldosterone receptor antagonists

anti heart failure drugs that block the effects of increased aldosterone production seen in patients having heart failure. Prevent salt retention, myocardial hypertrophy, and hypokalemia. Used commonly for symptomatic heart failure. Ie) spironolactone

Gynecomastia

enlargement of breast tissue in males. A common side effect of spironolactone

Dysmenorrhea

painful uterine contractions. A common side effect of spironolactone

Loop diuretics

the most commonly used diuretics in heart failure treatment. Are used to treat the sign and symptoms of volume excess related to heart failure. By decreasing peripheral edema this decreases cardiac preload and therefor the workload and oxygen demand of the heart. Reduced plasma volume decreased afterload as well. Ie) furosemide

Neprilysin inhibitor

drugs that block enzyme responsible for the breakdown of vasoactive peptides. This allows for increased activity of natriuretic peptides which allow for sodium excretion and therefore reduce angioedema. Must be taken with angiotensin receptor blocker (ie valsartan) to block the increased activity of bradykinin also caused by the blocking of this receptor to prevent further vasodilation. Ie) sacubitril

angiotensin receptor blocker

neprilysin inhibitors Must be taken with an _____ (ie valsartan) to block the increased activity of bradykinin also caused by the blocking of this receptor to prevent further vasodilation.

Neprilysin

the enzyme responsible for breaking down vasoactive peptides such as angiotensin I and II, bradykinin, and natriuretic peptides. Inhibitors of this enzyme can be used in combination with angiotensin receptor blockers to reduce the incidence of angioedema.

Sacubitril/valsartan

neprilysin inhbitor/ARB combination used in the treatment of angioedema during heart failure

Nitrates

commonly used venous dilators that reduce preload for patients with chronic heart failure

Hydralazine

arterial dilator used in the treatment of heart failure. Reduces systemic arteriolar resistance and decreases afterload.

Hydralazine and isosorbide dinitrate

the vasodilator/venodilator combination used in the treatment of heart failure

hydralazine

which vasodilator can cause drug induced lupus?

Inotropic drugs

anti heart failure drugs that enhance cardiac contractility and cardiac output. Action is the result of an increased cytoplasmic calcium concentration. Only used for a short period of time in an inpatient setting.

Phosphodiesterase inhibitors

anti heart failure drugs that increase intracellular cAMP levels resulting in increased intracellular calcium levels and therefore increased cardiac contractility. Given via IV infusion for short term treatment of heart failure Ie) milrinone

Recombinant B type Natriuretic peptide

drug that binds to natriuretic peptide receptors to stimulate the secretion of sodium via urine. Reduces preload and afterload. Used when IV diuretics are not effective. Ie) nesiritide

when diuretics are ineffective

when is nesiritide used in the treatment of HF?

IV bolus

how is nesiritide administered?

short term treatment

when are dobutamine and dopamine used in the treatment of heart failure?

Beta adrenergic agonists

anti heart failure drugs that improve cardiac performance by causing positive inotropic effects and vasodilation. Increase entry of calcium into myocardial cells and enhance contraction. given via IV infusion in the short term treatment of heart failure Ie) dobutamine, dopamine

Digoxin

Dobutamine

Dopamine

name three beta agonists that work as positive inotropes (increase heart contractility) in the treatment of heart failure

iv infusion

how is dobutamine and dopamine administered?

Digitalis glycosides

anti heart failure drugs that are derived from the foxglove plant. Increases the contractility of the heart muscle by inhibition of the Na K ATPase enzyme which in turn increases the amount of free calcium available to the muscle cell. Has a low therapeutic index because relatively toxic. Ie) digoxin

Ivabradine

Losartan

Valsartan

Isosorbide dinitrate

Hydralazine

(I Loathe Very Inadequate Hearts)

name one HCN channel blocker, two AT1 receptor blockers, and two vasodilators used in the treatment of heart failure.

HCN blocker

anti heart failure drug that inhibits the HCN channel responsible for the current and pace within the SA node. This causes a dose dependent reduction in heart rate. Ie) Ivabradine

Angiotensin receptor blockers (ARBs)

anti heart failure drugs that are competitive antagonists of the angiotensin II type 1 receptor. Have the advantage of a more complete blockade of actions against angiotensin II without affecting bradykinin levels (and therefore does not cause dry cough like ACE inhibitors). Ie) Losartan

Ivabradine

A HCN channel blocker used in the treatment of heart failure.

losartan and valsartan

name two AT1 receptor blockers used in the treatment of heart failure.

Isosorbide dinitrate

Hydralazine

name two vasodilators used in the treatment of heart failure.