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