Inotropic agents. Congestive Heart Failure (CHF) Heart pumps less blood than it receives, so excess blood pools in the chambers and stretches the walls.

Slides:



Advertisements
Similar presentations
© 2004 by Thomson Delmar Learning, a part of the Thomson Corporation. Fundamentals of Pharmacology for Veterinary Technicians Chapter 8 Cardiovascular.
Advertisements

Agents used in therapy of Congestive Heart Failure
BACK TO BASICS: PHARMACOLOGY CHAD C. CRIPE, MD Department of Anesthesiology & Critical Care Medicine Division of Cardiothoracic Anesthesiology The Children’s.
 Cardiovascular System – Heart and Blood Vessels Topics in Human Pathophysiology Fall 2011 Gilead Drug Safety and Public Health.
ACE Inhibitors ACE = Angiotensin I Converting Enzyme 10 ACE inhibitors available in US:  benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril,
Drugs for treating heart failure. A. Introduction Heart failure (HF) is due to the inability of the ventricles to pump sufficient blood thru-out the body.
A Look Into Congestive Heart Failure By Tim Gault.
Any of a group of antihypertensive drugs that relax arteries and promote renal excretion of salt and water by inhibiting the activity of an angiotensin.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
B) Drug Therapy (Antihypertensives) ACEi B.B CCB D iuretics. Centrally acting agents: alphametyldopa, HTN + pregnancy.
Pharmacology DOR 101 Abdelkader Ashour, Ph.D. 9 th Lecture.
Drugs Used In the Treatment of Congestive Heart Failure(Cont) Garrett J. Gross, Ph.D. Drugs Used In the Treatment of Congestive Heart Failure(Cont) Garrett.
1 Cardiac Pathophysiology Part B. 2 Heart Failure The heart as a pump is insufficient to meet the metabolic requirements of tissues. Can be due to: –
Diseases of the Cardiovascular System Ischemic Heart Disease – Myocardial Infartcion – Sudden Cardiac Death – Heart Failure – Stroke + A Tiny Bit on the.
Prepared by : Nehad J. Ahmed.  Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's.
Cardiac drugs Cardiac glycoside Cardiac glycosides are the most effective drugs for treatment of C.H.F. Digitoxins are plant alkaloids. They increase myocardial.
Drugs for Congestive Heart Failure BACKGROUND DEFINITION: The inability of heart to meet the needs of peripheral systems. PATHOGENY: myocardium contraction.
Drugs for Heart Failure
Drugs for CCF Heart failure is the progressive inability of the heart to supply adequate blood flow to vital organs. It is classically accompanied by significant.
Heart Failure Heart Failure Heart failure, also called congestive heart failure, is a disorder in which the heart loses its ability to pump blood efficiently.
Chapter 18 Agents that Dilate Blood Vessels. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Coronary.
Cardiovascular Meds. Arrhythmias Heart attacks sometimes cause damage to the myocardium (heart muscles) Irregular heart beats may develop post MI’s Atrial.
Gilead -Topics in Human Pathophysiology Fall 2010 Drug Safety and Public Health.
CARDIOVASCULAR DISEASE 1.HYPERTENSION 2.ISCHAEMIC HEART DISEASE 3.THROMBO-EMBOLIC DISEASE Myocardial infarction Stroke Medical Pharmacolgy & Therapeutics.
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 22 Heart Failure Drugs.
 Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension Moderate hypertension Severe Hypertension 180.
Medical Progress: Heart Failure. Primary Targets of Treatment in Heart Failure. Treatment options for patients with heart failure affect the pathophysiological.
Drug Therapy Heart Failure by Pat Woodbery, MSN, ARNP.
OBJECTIVES At the end of lectures the students should Describe the different classes of drugs used for treatment of acute & chronic heart failure.
Drugs for Congestive Heart Failure
1 Drug Treatment of heart failure. Prof. Azza El-Medani Prof. Abdulrahman Almotrefi.
1 Drug Therapy of heart failure. Prof. Azza El-Medani Prof. Abdulrahman Almotrefi.
PROF. AZZA El-Medany Department of Pharmacology OBJECTIVES At the end of lectures the students should Describe the different classes of drugs used for.
TREATMENT OF CONGESTIVE HEART FAILURE (CHF) DIGITALIS GLYCOSIDES AND OTHER POSITIVE INOTROPIC AGENTS.
Drugs for Heart Failure Identify the major risk factors that accelerate the progression to heart failure. 2.Relate how the classic symptoms associated.
Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 21 Positive Inotropic Drugs.
Nursing and heart failure
Bipyridines :(Amrinone,Milrinone ) only available in parenteral form. Half-life 3-6hrs. Excreted in urine.
6/3/ CARDIOVASCULAR MEDICATIONS. FIRST DO NO HARM 6/3/ There are 5 rights to patient medication administration: 1. Right patient 2. Right.
Heart Failure Heart is unable to pump sufficient blood to meet the needs of the body. It is key symptoms are dyspnea, fatigue, fluid retention. HF is.
Drugs Affecting the Cardiovascular System. Cardiovascular System Z Muscular organ with 4 chambers Z Pumps 5-6 liters blood/minute.
DRUGS FOR СONGESTIVE HEART FAILURE (CHF)
ANGIOTENSIN-CONVERTING-ENZYME INHIBITORS. benazepril (Lotensin), Captopril (Capoten), enalapril (Vasotec), enalaprilat (Vasotec(IV), fosinopril (Monopril),
Heart Failure. Introduction It is the inability of the heart to pump sufficient blood to meet body requirement. HF can be due to 1.Increased preload.
Shock It is a sudden drop in BP leading to decrease
أ. م. د. وحدة اليوزبكي Head of Department of Pharmacology- College of Medicine- University of Mosul-2014 Management of Heart Failure 2.
 Discuss the possible causes of heart failure.  Distinguish left heart failure from right heart failure in terms of etiology and physiologic effects.
Drugs used for Congestive Heart Failure
– Dr. J. Satish Kumar, MD, Department of Basic & Medical Sciences, AUST General Medicine CVS Name:________________________________________ Congestive Heart.
Internal Medicine Workshop Series Laos September /October 2009
Heart Failure Cardiac Insufficiency. What is Heart Failure? Heart failure is a progressive disorder in which damage to the heart causes weakening of the.
Heart Failure What is Heart Failure? The heart is not pumping properly.  Usually, the heart has been weakened by an underlying condition  Blocked arteries.
Heart Failure: medication Types of Heart Failure Systolic (or squeezing) heart failure –Decreased pumping function of the heart, which results in fluid.
DRUGS FOR TREATMENT OF HEART INSUFFICIENCY Treatment of chronic heart insufficiency Heart glycosides Nonglycoside cardiotonic drugs Inhibitors of angiotensine.
Pharmacology of Renin-Angiotensin system
Heart Failure  Dfinition:  Clinical features  Underlying causes of HF include Arteriosclerotic heart disease, MI, hypertensive heart disease, valvular.
POTASSIUM-SPARING DIURETICS 1.Aldosterone antagonists: Spironolactone and eplerenone: The spironolactone-receptor complex is inactive complex results in.
Result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood to meet the body's metabolic.
Drug Therapy of Heart Failure
Drugs Used to Treat Heart Failure
Drugs used for Congestive Heart Failure
Drugs for Hypertension
Drugs for Heart Failure
Heart Failure - Summary
Treatment of Congestive Heart Failure
Drug Therapy Heart Failure
Copyright © 2017, Elsevier Inc. All rights reserved.
Hypertension (High Blood Pressure)
Drugs Acting on the Heart
CARDIOVASCULAR AGENTS
Presentation transcript:

Inotropic agents

Congestive Heart Failure (CHF) Heart pumps less blood than it receives, so excess blood pools in the chambers and stretches the walls of the heart

Discussion Why is it dangerous for blood to pool in the chambers of the heart?

Discussion Why is it dangerous for blood to pool in the chambers of the heart? Answer: decreased oxygen supply to tissues; risk of blood clot formation and movement throughout the body

2 MAIN TYPES of CHF SYSTOLIC CHF – insufficiency of output DIASTOLIC CHF - insufficiency of input

CHF Occurs in 10% of the population over 75 Can result in death through progressive heart damage or sudden death Overworking of the heart leads to cardiomegaly and myocardial hypertrophy

Causes of Congestive Heart Failure Primary causes: –Cardiomyopathy –Coronary artery disease –Hypertension Secondary causes: –High salt intake –Noncompliance with treatment –Side effects of drug therapy –Kidney failure –Stress –Infection and inflammation –Cigarette smoking –Obesity

CARDIAC GLYCOSIDES

Purple Foxglove

Foxglove

Lily of the valley

Lychnis

Chemical structure of cardiac glycosides

Pharmacodynamics Cardiac action Extracardiac action

Cardiac action Positive inotropic Positive bathmotropic Negative chronotropic Negative dromotropic

Cardiac Glycosides

MECHANISM OF CARDIOTONIC (POSITIVE INOTROPIC) ACTION Of CG Promote increasing of Calcium ions concentration in myocardiocytes cytoplasm - Transport of Са inside the cell - Stimulate exit of Са from sarcoplasmic reticulum - Block К, Na-АTP-ase (braking repolarization) Improve usage of macroergic substances by cells, decrease myocardium need in oxygen Increase tone of sympathetic nervous system

Extracardiac action of CG Diuretic Sedative Stimulating influence on smooth muscles

MODE of ACTION of CG IN CASE OF CHF Increasing of systolic and minute volumes of heart activity (enhancing cardiac muscle contractility, thus increasing output) Improving of circulation in lungs and peripheral organs, decreasing volume of blood circulation, excretion of surplus liquid from the organism Elimination of hypoxia and metabolic acidosis in tissues

The following manifestations testify about therapeutic action of CG 1. Improving of general state of the patient (decreasing of weakness, short breath, sleep normalization, disappearing of edema, cyanosis, etc.) 2. Tachycardia transforms into normo (brady)cardia 3. Increasing of diuresis 4. Typical changes in ECG

Agents for CHF digoxin (Lanoxicaps, Lanoxin) Antidote for digoxin toxicity: digoxin immune Fab (Digibind) Drug List

digoxin (Lanoxicaps, Lanoxin) Increases force of contraction Increases effective refractory period Affects SA node, causing direct stimulation

digoxin Dispensing Issues “dig toxicity” –Systemic accumulation Warning!

Intoxication with CG Happens frequently % Mortality - over 40 %

Intoxication with CG Intoxication with CG

Agents for CHF Vasodilators milrinone (Primacor) nitroprusside (Nitropress) Drug List

ACE Inhibitors Inhibits conversion of angiotensin I to angiotensin II Lowers blood pressure and lowers the stress on the heart

INHIBITORS OF ANGIOTENSINE CONVERTING ENZYME (IACE) In case of CHF they brake pathological consequences of activation of renin-angiotesine system by inhibiting ACE: production of angiotensine II decreases (vasoconstrictor, inductor of aldosterone, norepinephrine, endothelin secretion, myocardium hypertrophy) Accumulation of bradikinin (inductor of prostacycline and nitrogen oxide synthesis)

INHIBITORS OF ANGIOTESINE CONVERTING ENZYME (IACE) Increase duration and improve quality of life of patients with CHFIncrease duration and improve quality of life of patients with CHF Increase tolerance towards physical loadsIncrease tolerance towards physical loads Decrease risk of recurring MIDecrease risk of recurring MI Brake development of myocardium hypertrophyBrake development of myocardium hypertrophy

ACE Inhibitor’s Side Effects Dry, nonproductive cough Dizziness during first few days

ACE Inhibitor Dispensing Issues Stand slowly to prevent orthostatic hypotension Avoid salt substitutes Do not take potassium supplements Warning!

Agents for CHF ACE Inhibitors benazepril (Lotensin) captopril (Capoten) enalapril (Vasotec) fosinopril (Monopril) lisinopril (Prinivil, Zestril) Drug List

Agents for CHF ACE Inhibitors moexipril (Univasc) perindopril (Aceon) quinapril (Accupril) ramipril (Altace) trandolapril (Mavik) Drug List

Angiotensin II-Receptor Antagonists Blocks the action of angiotensin II Works as well as ACE inhibitors with less coughing and better toleration

Angiotensin II-Receptor Antagonist Dispensing Issues Look-alike and Sound-alike Drugs: –losartan (Cozaar) –valsartan (Diovan) Warning!

Agents for CHF Angiotensin II-Receptor Antagonists Human B-type Natriuretic Peptide (hBNP) nesiritide (Natrecor) Drug List

NONGLYCOSIDE CARDIOTONIC DRUGS DobutaminDobutamin – beta 1 -adrenomimetic - in case of acute and chronic CHF – intravenously dropping – 2, mcg/(kg.min); in case of constant infusion tolerance develops after 3-4 days; in case of increasing of dose – heart arrhythmias Amrinon, milrinonAmrinon, milrinon – inhibitors of phosphodiesterase – for temporary improvement of patient’s condition in terminal stages of CHF