Question

Q13. Agents used to treat heart disease??? What agents are used to treat heart failure?? Q15. Adverse effects of heart failure??

Answer 1

Ans) 13) Agent used to treat heart disease/failure:

• ACE Inhibitors
• Diuretics
• Beta Blockers
• Cardiac Glycosides

Aliskiren- Renin inhibitors

Bosentan- Competitive inhibitor of endothelin, used in pulmonary hypertension. No benefit in heart failure.

Captopril- ACE-inhibitor, blocks production of ATII-a potent vasoconstrictor. Reduces afterload. Increases bradykinin - vasodilator. Reduce mortality in CHF.

Carvedilol- Alpha and beta antagonist, afterload reduction.

Digitalis/Digoxin- Inhibits Na/K/ATPase, reduction in Ca expulsion (NCX), renal dependent clearance, increases in intracellular Na, more Ca to be released. Low TI (2:1). Shortens APD directly.

Dobutamine- B1 stimulator, IV, inotropic with vasodilator, less tachycardia and less O2 consumption.

Dopamine- Beta 1 stimulator, D1 increase in renal blood flow

Enalapril- ACE-inhibitor, blocks production of ATII-a potent vasoconstrictor. Reduces afterload. Increases bradykinin - vasodilator. Reduce mortality in CHF.

Eplerenone- Reduce aldosterone and reduce afterload. Anti-fibrotic effects shown to reduce mortality. Hyperkalemia side effect.

Furosemide- Large muscular arteries to dilate reducing afterload.

Inamrinone- Phosphodiesterase inhibitor (PD-3), increases Ca. Increase mortality so don't use it. Bone marrow and liver toxicity.

ISDN/hydralazine- Vasodilator. ISDN (Nitrate) develops tolerance and hydralazine reduces tolerance. Used in AA.

Lisinopril- ACE-inhibitor, blocks production of ATII-a potent vasoconstrictor. Reduces afterload. Increases bradykinin - vasodilator. Reduce mortality in CHF.

Losartan- Angiotensin receptor blockers. Reduce mortality in CHF. Adding ACE to an ARB worsens outsome. No cough!

Metolazone- Thiazide diuretic, added to patients with diuretic resistance to loop diuretics.

Metoprolol- Beta-1 blocker, absolute reduction in mortality. May initially worsen conditions.

15) Adverse effects:

- dehydration, electrolyte imbalance, hypotension, ototoxicity, Increase urine flow.

- Weakened heart so we: decrease vascular resistance
- reduce amount of blood going into heart
- Slow heart rate
- Increase contractility
- Reduce heart workload