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Flashcards

Heart Failure Review

Amelia Claire pharmacology English 29 cards

Cards in this deck (29)

  1. 1Two types of Left Ventricular Dysfunction in Heart FailureReduced Ejection Fraction and Preserved Ejection Fraction
  2. 2Left Ventricular Reduced Ejection FractionHeart Failure with SYSTOLIC dysfunction
    heart fails as a pump due to decreased myocardial contractility, usually due to coronary artery disease
  3. 3Left Ventricular Preserved Ejection FractionHeart Failure with DIASTOLIC dysfunction
    heart failed as a pump due to decreased ability to relax, impaired filling during diastole
  4. 4Ejection FractionSV/EDV x 100
    measure of how well the heart squeezes -
    normal is 50-70%
    borderline is 41-49%
    reduced is ≤40%
  5. 5remodelling in HFrEFVolume Overload, resulting in eccentric hypertrophy, thinning of the left ventricular walls and decreased systolic function, with enlarged left ventricular volume.
  6. 6remodelling in HFpEFPressure Overload, resulting in concentric hypertrophic growth -normal sized left ventricle cavity, but thickened walls.
  7. 7Right Ventricular DysfunctionUsually secondary to pulmonary hypertension. Heart gradually weakens.
  8. 8Congestive Heart FailureHeart Failure and congestion, R side backs up, L side can't pump, Fluid collects around the heart
  9. 9compensatory mechanisms in heart failureheart output ≠ needs for organ perfusion and body activates compensatory mechanisms:
    increased sympathetic tone
    RAAS
    sodium and water retention
  10. 10neurohormonal systems when cardiac function is abnormal - SNSSNS - epinephrine and norepinepherine
    α1, β1, β2 receptors
    vasoconstriction
    ^RAAS
    ^Vasopressin
    ^heart rate
    ^contractility
  11. 11neurohormonal systems when cardiac function is abnormal - RAASRAAS - Angiotensin II
    AT1 Receptor
    ^BP
    ^Sympathetic Tone
    ^Aldosterone
    ^Hypertrophy
    ^Fibrosis
  12. 12classificationsClass I - no limitations on ordinary activities
    Class II - slight limitations, breathlessness, fatigue, palpitations occur but ok at rest
    Class III - marked limitations, ok at rest but undue fatigue with ordinary activity
    Class IV - unable to carry out any activity without discomfort, symptoms at rest
  13. 13Drugs For Heart FailureACE inhibitors
    ARBs
    Neprilysin Inhibitors
    Beta Blockers
    Diruetics
    Aldosterone Antagonists
    Digoxin and other Inotropes
    Vasoldilators
    Ivabradine
  14. 14aims of treatment in heart failurereduce symptoms
    improve exercise tolerance
    prevent hospitalisation
    reduce mortality
  15. 15ACE Inhibitors MOABlock the conversion of angiotensin I to angiotensin II by blocking the Angiotensin Converting Enzyme. This reduces the effects of Angiotensin II, which include vasoconstriction and sodium retention, as well as aldosterone release. Also inhibit breakdown of bradykinin which may support vasodilation.
  16. 16ACE Inhibitors - drugsCatopril (active)
    Enalapril (prodrug)
    Perindopril (prodrug)
    Ramipril (prodrug)
  17. 17Angiotensin II Receptor Blockers (ARBs/Sartans) MOAcompetitively block binding of
    Angiotensin II to the AT1 Receptor reducing Angiotensin II effects. No impact on Bradykinin.
  18. 18Angiotensin II Receptor Blockers (ARBs/Sartans) DrugsIrbesartan (active)
    Candesartan (prodrug- ester hydrolysis)
  19. 19Neprilysin Inhibitors - MOANeprilysin is a metalloprotease enzyme that cleaves and inactivates naturetic proteins. Naturetic proteins are released in response to cardiac stress and neprilysin inhibitors potentiate their effects of aldosterone suppression, rennin inhibition, vasodilation, inhibition of RAAS, and reduction of kidney and heart remodelling.
  20. 20Neprilysin Inhibitors - drugssascubitril
  21. 21beta blockers MOAcompetitively antagonise beta receptors reducing heart rate and contractility and inhibit renin release from the kidney (β1) and slow ventricular remodelling
  22. 22beta blockers drugsMetoprolol - β1 selective / hep CL
    Bisoprolol - β1 selective / hep and renal CL
    Carvedilol - β1, β2, α1 / hep CL
  23. 23diuretics MOAincrease water and sodium excretion in kidney, reducing intravascular volume, thus reducing preload, reducing fluid retention related symptoms such as peripheral and pulmonary oedema.
  24. 24Loop Diuretic Drugfrumeside - inhibits reabsorption of sodium and chloride in the ASCENDING limb in the Loop of Henle. This leads to increased sodium delivery to the DCT increasing activity of the Na+/K+ pump. (can cause low K+)
  25. 25Aldosterone Antagonists MOAAldosterone promotes reabsorption of sodium and water in the distal tubule of the nephron. Aldosterone antagonists are weak diuretics and competitive antagonists, reducing preload and aldosterone induced myocardial and vascular damage. work in DCT of nephron.
  26. 26Aldosterone Antagonist DrugsSpironolactone
    Eplerenone
  27. 27digoxininhibits Na+/K+ ATPase transport pump in myocardial cell membranes - increases intracellular calcium
    +ve inotrope, increases EF and CO
    reduces compensatory mechanisms
    narrow TI and AEs can occur within TI range
  28. 28Digoxin Drug interactionsCaution with other drugs that reduce heart rate
    P-gylcoprotein (P-gp) substrate concentration may be affected by induces or inhibitors. Risk of arrhythmia in pts with hypokalaemia
    Renal CL = caution renal impairment
  29. 29Ivabradinereduces heart rate inhibits current regulating interval between depolarisations of SA node

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pharmacology (Pathophysiology / Physiology ) Flashcards on Heart Failure Review, created by Amelia Claire on 24/05/2017.
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