16 - anti-heart failure drugs

b. Na+/K ATPase pump inhibitor

1. MOA of digoxin

   a. HMG coA reducatse inhibitor

   b. Na+/K ATPase pump inhibitor

   c. Na/Ca exchanger blocker

   d/ Na/Cl symporter blocker

a. increased digoxin toxicity

2. Digoxin + Furosemide

   a. increased digoxin toxicity

   b. decrease digoxin toxicity

   c. no drug interaction

   d. NOTA

a. Captopril

3. which of the ff drugs cold cause dry cough due to increased bradykinin level?

   a. Captopril

   b. Losartan

   c. Aliskiren

   d. Verapamil

b. CCB

4. Which if the ff drugs are generally not useful in CHF management

   a. Beta blockers

   b. CCB

   c. ACEI

   d. AT-1 receptor blockers

d. Nesiritide

5. A human B-type natriuretic peptide

   a. Losartan

   b. Fusinopril

   c. Inamrinone

   d. Nesiritide

Systemic circulation (poor oxygen) → right atrium → right ventricle → lungs (Oxygen Rich) → left atrium → left ventricle → systemic circulation

Normal Blood Circulation

• Low Stroke Volume (Low CO)

• Low Inotropy,

• High Preload, &

• High Afterload (vasoconstriction),

• Increased cardiac remodelling

Problems w/ Heart Failure Drugs

Increase Inotropy, Low Preload, Low Afterload, Slow or reverse cardiac remodelling

Goals of therapy for Heart Failure:

Left HF

• does not deliver enough oxygen-RICH blood through the body

• tired, out of breath

• pulmonary edema/ congestion

Right HF

• unable to pump blood from right ventricle to the lungs

• build-up of blood in the veins

• peripheral edema/congestion

Rejection Fraction formula

Ejection diastole volume (EDV)

active relaxation

Ejection systole volume (ESV)

active contraction

120 mL

Normal EDV:

50 mL

Normal ESV:

50-70 EF

Normal Ejected Fraction:

41-49 EF

Borderline of EF:

<40 EF

Borderline of Systolic EF:

Preload

volume of blood in ventricles at end of diastole (End diastolic pressure)

Afterload

Resistance left ventricle must overcome to circulate blood

• Digoxin

• Milrinone

• Dobutamine & Dopamine

POSITIVELY INOTROPIC DRUGS

Digoxin

• MOA: (-) of Na/K ATPase pump

• Result: Increase Inotropy, (-) Chronotropy (HR)

N/V, Anorexia, AV block, Neurologic symptoms (blurred vision, greenish yellow halo), seizure

Digoxin A/E:

Lanoxin

Digoxin’s Brand Name:

Digoxin Fab fragment

Antidote for Digoxin toxicity:

hypokalemia

Digoxin + diuretics (loop) = can cause what disease?

Milrinone

• Tx for acute HF

• MOA: (-) PDE3 = degradation of cAMP

• Results: increase Ca = inc inotropy

Dobutamine & Dopamine

• MOA: (+) B- receptor = inc inotropy

• Tx: HF, Cardiogenic Shock

ACE-Inhibitors

• 1ST line for Heart Failure (-pril)

• Decrease afterload, cardiac remodelling,

• S/E: Dry cough

• Increase survival time

ARBs

• sartans

• Same as ACEIs

• NO dry cough (RARE)

NESERITIDE

• Human B-type natriuretic peptide

• (+) Guanyl Cyclase = Inc cGMP

• Use: Acute HF

ΒETA-ADRENOCEPTOR BLOCKERS

• once contraindicated in heart failure because of their negative inotropic effect

• Rationale of use: protects the heart cells from damaging effects of NE

• Spironolactone

• Eplerenone

Examples of Aldosterone Blockers that improve survival time

Loop diuretics & Thiazides

Diuretics for for pulmonary edema

HYDRALAZINE AND NITRATES

• Dec preload and afterload

• Use: If px can’t tolerate ARBs & ACEI

• Isosorbide dinitrate

• Hydralazine

HYDRALAZINE AND NITRATES’ drugs: