heart failure drugs
improve cardiac blood flow
reduce blood volume
control heart rate
reduce blood clotting in narrow vessels.
reduce lipids. prevent the blockage of coronary arteries before they become narrowed and damage
arterial blood pressure
Cardiac Output x Peripheral Vascular Resistance BP=COxPVR
Heart rate x Stroke Volume CO= HR x SV
the amount of stretch applied to a muscle before contraction. determined by force of venous return. constriction=increase preload dialation=decreased preload.
the load the heart must overcome in order to contract. as afterload increases, stroke volume decreases.
the force of ventricular contraction
Force of contraction. positive inotropic-increased force. negative inotropic-reduced force.
Heart Rate. Positive chronotropic-increase heart reate. Negative chrontropic-decrease heart rate.
Conduction of electrical heart impulses. Positive dromotropic-enhanced condution. Negative dromotropic-decreased conduction.
The heart normals ejects 65% of the volume (preload) it receives.
A major contractile element. Must be moved into cells for contraction to occur.
A condition that exists when the right, left or both ventricles lose the ability to pump enough blood to meet the body's needs.
Drugs used in CHF treatment (7)
Cardiac Glycosides, Phosphodiesterase inhibitors, Drugs affects RAAS (ace inhibitors), nitrate vasodilators, diuretics, beta blocks, human B-type natriuetic
increase the force of contraction and thus increase CO. ONLY indicated in HF. derived from foxglove. patinets are said to be undergoing "digitalization"
ONLY indicated in HF. Positive Inotropic. descreases preload and afterload. used shortterm. can cause dysrhymias.
digoxin and digitoxin
used in CHF and dysrhythmias. Narrow therapeutic window (0.5 to 2 mg/dl). Side Effects: Bradycardia, CNS affects, confusion, vision, GI effects.
Used in digoxin overdose.
RAAS=Renin-Angiotension aldosterone system.
Angiotension-converting enzyme inhibitors. Blocks enzyme involved in conversion of angiotension I to II. Inhibits aldosterone secretion. END IN RIL. First choice for hypertension and CHF
ARBS; aldosterone blockers
Similar to ACE, but in different part of RAAS. Blocks aldosterone blockers in heart and blood vessels. dilation of arteries and veins.
Blocks renin release from the kidneys. prevents formation of angiotension II
Dilate vessels and increase oxygen to heart. Decrease workload of the heart.
drugs used in management of angina. (chest pain) Minimize frequency of attacks, duration and intensity.
chest pain that is the result of cardiac tissue being deficient in O2 and nutrients
Chronic Stable Angina
caused by atherosclerosis, triggerd by exertion or stress
seen in early stages of coronary disease and ends in MI. called preinfarction angina. pain increases in severity.
caused by spasms of the smooth muscle surronding the athereroschlerotic coronary vessels. pain at rest, same time of day
Classes of Drugs used in angina
NBC-Nitrates, Beta-blocks, Calcium channel blockers.
Dilate blood vessels. Can be rapid or long-acting.
Decrease heart rate and cardiac contraction. Beta-adrenergic receptor antagonist. (beta1 on the heart)
Calcium channel blockers
Block inflow of CA+ needed for smooth muscle contractoin. Reduces contractility. Relaxation increased blood flow to heart.
Reduce volume by decreasing preload and afterload. decreased volume.
Decrease heart rate and cardiac contraction. Beta-adrenergic receptor antagonist. Decrease contractility(not a good thing)
Human Brain Natriuretic Peptide
Newest drug. Short term. IV for severe heart failure. Reduces preload and afterload. body naturally releases when blood volume is in excess.
Used to treat defects in the electrical system of the heart. Not used much anymore.
A disturbance of impulse formation. Disturbance of conduction through AV node. arrthymia-absence of pattern. dysrhythmia-disturbance of pattern.
Class 1 Antidysrhytmics
sodium channel blocks. Ic is most potent.
Class 2 Antidysrhytmics
beta blockers. prevent stimulation of beta cells on heart.
Class 3 antidysrhytmics
potassium channel blockers. slows the rate of electrical conduction and prolongs repolarization.
Class 4 antidysrhytmics
calcium channel blockers. decrease excitabilty and contractility.
a drug that promotes the excretion of urine. increase the removal of sodium and water. treatment of hypertension and HF.
Carbonic Anhydrase Inhibitors (CAI's)
diuretic. derivative of sulfonamide antibiotic. weak, not used often. main use if glaucoma.
more potent than thiazides. inhibit reabsorption of sodium and chloride in the ascending loop of Henle.
Proximal tubule action. Work by osmosis; pull water into blood vessels and nephrons.
Aldosterone antagonist. blocks aldosterone action in distal nephron. K retained, sodium excreted. CHF in children.
disrupts sodium potassium exchange. directly blocks exchange.
derivatives of sulfonamides. Inhibit NA, water, CL, K reabsorption.
alpha 1 blockers
block vascular alpha 1 receptors on smooth muscle of peripheral vascular system. End result is decreased vascular resistance.
alpha 2 agonists
stimulate alpha 2 receptors in medulla. decreased outflow of norepinephrine from brain. decrease renin in kidney.
act directly on arteriolar smooth muscle to cause relaxation. Hypotensive side effect.
Calcium channel blockers
inhibit the movement of calcium across the cell membrane, relaxation.
biologically active polypeptide, consisting of nine amino acids, that forms from a blood plasma globulin and mediates the inflammatory response, increases vasodilation and causes contraction of smooth muscle.
blocks impulse transmission through ganglia in both SNS and PSNS. only in severe hypertension.
Drugs that decrease heart rate
beta-blockers, alpha-beta blockers, alpha 2 agonists.
Drugs that decrease force of contraction
beta blockers, alpha-beta blockers
Drugs that decrease preload
Drugs that decrease peripheral vascular resistance.
diuretics, calcium channel blockers, ARBS, Ace inhibitors, alpha-beta blockers, alpha 2 agonists
Coagulation Modifying Drugs
Used to keep blood from clotting, or promote clotting. (Prevent MI or Stroke)
inhibition of the clotting pathway. DO NOT lyse of breakdown clots. USED in venous thrombosis.
Anticoagulant. Must be given IV, SQ.
antidote for Heparin
Anticoagulant. po. lots of drug/food interactions.
antidote for warfarin (coumadin)
Prothrombin Time. Test needed for coumadin.
Activated Partial Thromboplastin Time. Test needed for Heparin.
Work in the initial step of the coagulation process by preventing platelet aggregation. Prevention of thrombosis in ARTERIES.
break down or lyse already formed clots by activating the enzyme plasmin.
Promote clot formation. Used in surgical complications and hemophilia.
Reduce lipid levels in the blood in patients after failure of dietary or lifestyle changes.
high cholesterol in blood. drug treatment is always combined with diet and lifestyle changes.
Optimal and High Risk cholesteral values.
optimal- less than 100 mg. high risk-above 160
Bile Acid Sequestrants
treats high cholesterol. blinds bile acids in intestines, prevents recirculation of bile acids. stimulates metabolism of cholesterol.
HMG-CoA reductase inhibitors
AKA the statins. interferes with synthesis of cholesterol by inhibiting the liver enzyme responsible for formation of cholesterol.
Fibric Acid derivatives
AKA fibrates. unknown action, but lower triglycerides by 20-50%
Coined term "antibiosis"
"chemical/magic bullet" salvarsan for treatment of syphillis
Sir Alexander Fleming
any drug natural or synthetic with the ability to suppress or kill microorganisms.
Chemical compound produced by living microorganisms capable of inhibiting or killing the growth of other microbes. Many synthetic.
A drug used to prevent or treat infections. Subgroups, fungal, viral, bacterial etc.
slows growth so bodys natural defenses can dispose of the bacteria.
Antimicrobial actions (4)
Inhibit cell wall synthesis, Interference with DNA replication, Inhibit protein synthesis, Inhibit synthesis of essential metabolites.
Infections that dont need antibiotics (5)
Common Cold, Bronchitis, Sore Throat, Sinusitis, Otitis Media.
Cell Wall Inhibitors
Bacterialcidal. Contain a beta-lactam ring. (penicillin, cephalosporins, carbapenems, monobactams) Vancomycin Isoniazid.
Weaken bacterial cell wall. Take with water, not with food.
Largest class with over 20 drugs.Four generations. Given with food.
Broadest spectrum of all antibiotics to date. only for serious infections. can cause seizures.
Acts on aerobic gram negative. used for UTIs
binds to cell wall, inhibits RNA. used for resistance bacteria. Can have oto and nephro toxicity.
Protein Synthesis Inhibitors
Inhibit protein synthesis by binding to the ribosomal unit in the cell.
small group made from strep. bacteriostatic. teeth discolaration in kids and unborn kids. do not take with milk. photosensitivity.
Broad Spectrum. used in upper and lower resp tract inf, chalymydia, allergies to other medications, lyme, legionnaires. can cause severe interactions with other protein bound drugs. take with food.
Gram negative. Derived from step. Only used in serious life-threatening infections. nephro and ototoxic.
similar to macrolides. broad spectrum.. very toxic, high association with c.diff
Broad spectrum. Only used in severe infections, crosses BBB. Gray Baby Syndrome
new. gram positive.
newests, only for superbugs.
bactericial. used in resp, GI, antrhrax, bone, join, skin, GU no milk, photosensitivity. ANCHILLES TENDON RUPTURE
Act by blocking a step in the synthesis of folid acid needed for bacteria to synthesize RNA, DNA and proteins.
old, lots of resistance. used in UTI, ear infections. Stevens-Johnson Syndrome. ANTIMETABOLITIES
drugs that destroy viruses. inhibit the ability of viruses to replicate. block enyzme necessary for synthesis. virus stays dormant.
act by blocking different phases of the replication cycle.
drugs used in the treatment of systemic and cutaneous fungal. fungi is hard to kill.
yeast. mucous membrane. (oral, vaginal, moist skin) treated topically or systemically. (diflucan) Nystatin.
skin, hair, nails. Ringworm-foot, groin, scalp, body. treated with griseofulvin or loprox Onchomycosis-nail fungus. sporonox. allylamines.
treated with Amphoterician B and nystatin. VERY TOXIC
Tuberculosis. drug resistance is huge problem.
inhibit protein, cell wall synthesis.
used to kill organisms of the Plasmodium species. MALARIA
antimalarial. affects the parasite during the sexual cycle. Can cause cinchonism.
drugs used in the elimination of worms.
for chronic UTI
Drugs used to treat open-angle glaucoma
beta-blockers, alpha 2 agonists: reduce production of aqueous humor. Prostraglandin analogs:increase drainage of humor
Drugs for closed angle glaucoma
Osmotic diuretics, ocular antiinfectives, antiinflammatory agents.