Hear failure unit

Question 1

Digoxin

Answer 1

– not uses as standard therapy b/c of risk of fatal arrythmias
- Increase cytosolic calcium levels within cardiac myocytes to enahance contractility
- Mechanism
o Inhibition of sodium potassium ATPase
o Increases cytosolic calcium levels within cardiac myocytes to enhance contractility
- Clincal effects
o Increases cardiac contractility
o Onset is slow
o Improves quality of life
o Reduces recurretndecompensation
o Decreases rate of hospitalization
- Adverse effects
o Arrhythmias and other hear problems can be elthal
o Narrow therapeutic indext: Toxicity common
o Visual disturbance

chronic heart failure

Question 2

Captropril

Answer 2

ACE inhibitor
- Benefical effects
o Decrease peripheral resistance decrease blood pressure
o Increase cardiac performance
o Decrease wate reabsorotion decreaseedmea and pulmonary congestion
o Improves survival in patients
chronic heart failure

Question 3

Losartan

Answer 3

(angiotensin II receptor blocker)
- Selective antagonist
- Inhibits downstream effects of Angiotensin II without altering ACE activity

chronic heart failure

Question 4

Propanolol

Answer 4

• Nonselective beta blocker
• Clinical use
  o Hypertension
  o Angina
  o Arrhytmias
• Adverse effects
  o Bronchoconstriction through beta 2 = asthma and COPD
  chronic heart failure

Question 5

metoprolol

Answer 5

• Relatively selective beta 1 antagonist
• Second generation beta blockers
• Selects beta 1 2x more than beta 2
• Clinical uses
  o Angina
  o Heart failure
  o Beta blocker of choice for diabetics, COPD
  o hyptertension
  chronic heart failure

Question 6

Carvedilol

Answer 6

• Combined non selective beta and alpha antagonist
• Third generation beta blocker
• Also blocks alpha 1 receptors and antioxidant properties
• Clinical uses
  o Angina
  o Heart failure
  o Hypertension
• Adverse effects
  o Bronchoconstriction
  o Diabetics must use insulin with greater caution
  chronic heart failure

Question 7

milrionone

Answer 7

• Mechanism: cardiac myocytes
• Inhibits PDE type III in the breakdown of cyclic AMP
  o Phosphorylation of voltage-dependent calcium channels and increased calcium influx.
  o Increased calcium influx increases cardiac contractility
• Increases stroke volume and cardiac output via two mechanisms that BYPASS adrenergic beta 1 and alpha 1 receptors
  o Positive inotropic agent: increases cardiac contractility
  o Vasodilator: reduces impedance to blood flow
• Adverse effects
  o Ventricular arrhythmias, hypotension, angina
  o Long term use leads to increase mortality rates – why it is ont used for chronic heart failure
  acute heart failure

Question 8

Dobutamine

Answer 8

beta receptors
- Positive inotropic agent
o Cardiac stimulation in heart failure or acute myocardia infarct
 Effect mostly increase heart contraction
 Short term – tolerance is likely to develop in prolonged use
o Adverse effects
 Tachycardia, arrhythmia
acute heart failure

Question 9

Epinephrine

Answer 9

beta receptors
Positve intropuc agent – stimulate beta 1, beta 2, and alpha 2 receptors
o INceases cardiac output by stimulating beta 1 increase contractions
o Increase vascular ressientcc and constrict blood vessels increases blood pressure
o Benefical when blood pressure is very lowand need to raise it quickly
- Adverse effects
o Tachycardia, arrthmia
acute heart faliure