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Glossary of Classes of Drugs used in Heart Failure

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Heart Failure
cardiac output not enough to sustain tissues
components of heart failure
systolic dyfxn- weak contraction
dyastolic dysfxn- stiff ventricle
Cardiac Output
Stroke volume X Heart Rate
Stroke Volume
1)Preload- filling pressure
2)Afterload- vascular resistance
3)Contractility
Factors leading to decreased CO
1)Low preload
2)High afterload
3)(-) contractility
4) low heart rate
Main cardiac calcium channels
1)V-gated calcium channel
(aka L-channel: allows entrance of calcium into cardiac cell)
2)Ca+ gated calcium channel
(allows calcium release from SR)
Neurohumoral compensation in HF
1)SNS--> increased myocardial contractility,HR,and renin release
2)RAS activation-->increased Na+ retention and peripheral vasoconstriction
Frank-starling compensation in HF
cardiac muscle stretch-->decreased contractile strength
Main classes of drugs used in HF
1)Afterload reduction
2)Diuresis
3)Positive inotropy
4)Beta-adrenergic blockade
Drugs for AFTERLOAD REDUCTION
1)ACE (-)s
2)ARBs
3)Isordil/Hydralazine
4)alpha/calcium channel blockers
Drug classes that cause DIURESIS
1)Loop diuretics
2)Spironolactones
Adrenergic agonists
1)NE
2)Isoproterenol
3)Dopamine
4)Dobutamine
Isoproterenol
(beta 1, beta 2)
Adrenergic agonist used for short term support to induce POSITIVE INOTROPY
beta 1 receptor activity in
1)myocardium
2)SA node
3)AV node
1)increase contractility
2)increase HR
3)increase conductance
beta 2 receptor activity in
1)arterioles
2)lung
1)vasodilation
2)bronchodilation
alpha 1 receptor activity in
1)peripheral arterioles
1)vasoconstriction
alpha 2 receptor activity in
1)nerve terminals
1)(-) NE release
Epinephrine
(alpha 1, beta 1 and beta 2)
Adrenergic agonist
NE
(alpha 1, beta 1)
adrenergic agonist with
1)beta 1--> inotropic, chronotropic effects (raises O2 consumption)
2) beta 2--> vasodilation
3) alpha 1-->systemic vasoconstriction and increased work load
Dopamine
(beta 1 and alpha 2 at high[]s
adrenergic agonist used for short term support
Dobutamine
(beta 1 and beta 2)
Adrenergic agonist
Dopamine receptors not affected
Inotropic
Vasodilation
Increases CO, but doesnt change HR and O2 consumption
Used for short term (ICU)
phosphodiesterase inhibitors
amrinone
milrinone
phosphodiesterase (-)s action
inotropic w/o increased HR
peripheral vasodilation
side effects of phosphodiesterase (-)s
Toxicity: GI, fever, thrombocytopenia

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