inhibits Na/K pump in cardiomycocytes to increase concentration of sodium & calcium; slows the heart and increases the force of contraction
Digoxin MOA?
increases renal perfusion by decreasing renin production and increasing diuresis
How does Digoxin affect the kidneys?
increases CO; prevents neurohormonal activation by decreasing HR & PR
How does Digoxin affect the heart?
increases parasympathetic outflow at SA and AV node; decreases AV node automaticity
How does Digoxin decrease heart rate?
f; affects sodium pumps of other excitable tissue
Digoxin only affects cardiac muscle cells. T/F?
loop diuretics; these can cause hypokalemia & hypomagnesemia
Which drugs can induce Digitalis toxicity? Why?
correct K/Mg deficiencies, anti-arrhythmic drugs, DigiFab
How can we combat the AE's associated with Digoxin? (3)
selectively inhibits cardiac pacemaker ion channels; causes hyperpolarization through funny (iF) channel; reduces heart rate
Ivabradine MOA?
patients who are not receiving efficacy from BBs
Who do we use Ivabradine in?
dose
Ivabradine provides a ________ dependent reduction of heart rate.
f; heart rate only
Ivabradine reduces heart rate & contractility. T/F?
loop, thiazides, K+ sparing, SGLT2 inhibitors
Which drugs are involves in preload reduction? (4)
vericiguat, BiDil
Which drugs are involved in afterload reduction? (2)
digoxin
Which drug is a positive inotropoic agent?
ivabradine
Which drug is a heart rate reducer?
a
Which is a VENODILATOR ?
a) low dose nitroglycerin
b) high dose nitroglycerin
c) nitroprusside
b
Which is an ARTERIAL VASODILATOR?
a) low dose nitroglycerin
b) high dose nitroglycerin
c) nitroprusside
c
Which is an EQUAL arterial & venous vasodilator?
a) low dose nitroglycerin
b) high dose nitroglycerin
c) nitroprusside
a
A patient comes in with Acute HF, they are presenting with dyspnea and showing signs of fluid overload/congestion? What should we treat them with?
a) loop diuretic
b) thiazide diuretic
c) MRA diuretic
d) hydralazine
loop; thiazide
If a patient with Acute HF, is resistant to _______ diuretic we can add ______.
Brain natriuretic Peptide (BNP
-secreted by the ventricles due to excessive myocardial stretch; part of
HF compensatory mechanisms
causes vasodilation of arterial & venous blood vessels
How does BNP affect the Vasculature?
causes potent natriuretic/diuretic effects
How does BNP affect the kidneys?
binds to natriuretic peptide receptors A; activates membrane-bound guanyly cylase; causes intracellular rise in cGMP
BNP MOA?
Nesiritide
-synthetic analog of BNP for acute HF
preload; afterload; CO; ejection fraction
Nesiritide decreases ____ & ____; while increasing _____ & _____.
a,d
All positive inotropes increase the risk of _______.
a) tachycardia
b) bradycardia
c) hypotension
d) arrhythmias
cardiac myocyte death
Positive inotropes can cause risk of _________, due to poor perfusion.
they increase energy expenditure & have less time for coronary perfusion in diastole
Why can positive inotropes cause tachycardia?
a, b
(+) enantiomer of Dobutamine agozines
a) B1
b) B2
c) A1
d) A2
c
(-) enantiomer of Dobuatmine agonizes
a) B1
b) B2
c) A1
d) A2
c,d
Agonizing B1 & B2 will cause
a) vasoconstriction
b) negative inotropism
c) positive inotropism
d) vasodilation
a
Agonizing A1 will cause
a) vasoconstriction
b) negative inotropism
c) positive inotropism
d) vasodilation
predominate agonist activity towards B1; increases myocardial contractilty; increases CO
Dobutamine MOA?
a,b,c
Epinephrine is an agonist of
a) B1
b) B2
c) A1
d) A2
a,c
Norepinephrine is an agonist of
a) B1
b) B2
c) A1
d) A2
b
Which is a potent cardiac stimulant?
a) dobutamine
b) epinephrine
c) norepinephrine
d) milrinone
c
Which is a more potent vasoconstrictor?
a) dobutamine
b) epinephrine
c) norepinephrine
d) milrinone
c
Which causes TOO MUCH of an increase in afterload?
a) dobutamine
b) epinephrine
c) norepinephrine
d) milrinone
b
Which has positive inotropic & chronotropic actions?
a) dobutamine
b) epinephrine
c) norepinephrine
d) milrinone
b
Which has a 2-minute half-life?
a) dobutamine
b) epinephrine
c) norepinephrine
d) milrinone
d
Which is an inotropic agent and vasodilator (Inodilator)?
a) dobutamine
b) epinephrine
c) norepinephrine
d) milrinone
inhibits PDE3 to decrease cAMP degradation; activates PKA cascade to increase ca++ influx and increase contractility
Milrinone MOA?