Part 1
What is the formula for mean arterial pressure?
MAP = CO x TPR
What are the signs/symptoms of right sided heart failure?
Congestion of peripheral tissues
-Dependent edema and ascites
-GI tract congestion (anorexia, GI distress, weight loss)
-Liver congestion (signs related to liver function)
What is the common suffix of ACE inhibitors?
"pril" (i.e. benazepril)
What is the common suffix of ARBs?
"Artan" (i.e. candesartan)
What is the effect of aldosterone?
Aldosterone acts on the kidneys to stimulate reabsorption of salt (NaCl) and water (H2O)
What is the formula for cardiac output?
CO = HR x SV
-Decreased cardiac output (activity intolerance, etc)
-Pulmonary congestion (impaired gas exchange: cyanosis and signs of hypoxia. pulmonary edema: orthopnea, cough with frothy sputum, paroxysmal nocturnal dyspnea)
What do ACE inhibitors do?
Reduce levels of angiotensin II and increase levels of bradykinin
What is the prototypic ARB?
Losartan (Cozaar)
What is spironolactone? What is it used for?
Spironolactone [Aldactone]
Mechanism of action
•Blocks aldosterone receptors
•Binds with receptors for other steroid hormones
Therapeutic uses
•Hypertension
•Heart failure
What is stroke volume?
The amount of blood pumped by the left ventricle of the heart in one contraction
What are the two important components of chronic heart failure?
Progresses slowly but contains two important components that represent two phases (bring about all the clinical manifestations)
1) Structural remodeling of cardiac tissue as a result of cardiac tissue damage or death – causes a reduction in cardiac function
2) Multiple compensatory events in response to decreased cardiac function makes up the majority of the pathological issues of CHF
What is the effect of blocking the conversion of Angiotensin I to Angiotensin II?
Vasodilation
Decrease in blood volume
Decrease in cardiac and vascular remodeling
Mechanism of action and overview of pharmacologic effects
–Block access of angiotensin II
–Cause dilation of arterioles and veins
–Prevent angiotensin II from inducing pathologic changes in cardiac structure
–Reduce excretion of potassium
–Decrease release of aldosterone
–Increase renal excretion of sodium and water
–Do not inhibit kinase II
–Do not increase levels of bradykinin
What are the adverse effects of spironolactone?
Adverse effects
•Hyperkalemia
•Gynecomastia
•Menstrual irregularities
•Impotence
•Hirsutism
•Deepening of the voice
What is responsible for the short-term regulation of MAP?
Baroreceptor reflex
BP too high-->CV center in medulla-->increased activity in vagus nerve-->decreased HR-->decreased CO-->decreased MAP
What is stage A heart failure? What is stage D heart failure?
Stage A: at high risk for HF but without structural heart disease or symptoms of HF
Stage D: Refractory HF requiring specialized interventions
How are nearly all ACE inhibitors administered? (what route of administration)
orally
What are the therapeutic uses of ARBs?
-Hypertension, heart failure, myocardial infarction
–Diabetic nephropathy
–Patient unable to tolerate ACE inhibitors: Protection against MI, stroke, and death from cardiovascular (CV) causes in high-risk patients
What is the common suffix of beta blockers?
"lol" (i.e. atenolol"
What is responsible for long term regulation of blood pressure?
Renal baroreceptors
Slide 8
Hypertension, atherosclerotic disease, diabetes, metabolic syndrome
What are some adverse effects of ACE inhibitors?
First dose hypotension
Fetal injury
Cough
Angioedema
Hyperkalemia
Renal failure
Neutropenia
What are the adverse effects of ARBs?
Adverse effects
–Angioedema – far lower risk compared to ACEis and via different mechanism
–Fetal harm – 2nd and 3rd trimester
–Renal failure
–ARBs do not promote accumulation of bradykinin in the lung and therefore have a lower instance of cough
What is digoxin? How does it work?
Effects
Positive inotropic action on the heart. Increases force of ventricular contraction. Increases myocardial contractility.
Hemodynamic benefit: increased cardiac output