Lectures

Inotropes – Angina and Heart Failure Management

by Pravin Shukle, MD
(1)

Questions about the lecture
My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides HeartFailureAndAngina CardiovascularPharma.pdf
    • PDF
      Download Lecture Overview
    Report mistake
    Transcript
    Let's go on to heart failure. Heart failure is kind of a sister disease to angina treatment because we use many of the similar kinds of treatments. Now, how we treat heart failure is a little bit different. We can use inotropes and those inotropes include cardiac glycosides, beta agonists, and PDE inhibitors. We can use vasodilators like the PDE inhibitors, nitrates, and the loop diuretics. And we can use classic cardiac remodelling agents like loop diuretics, ACE inhibitors, ARBs, spironolactone, and the new nesiritide. Let's move on to the cardiac glycosides. The prototypical agent in this drug class is digoxin. There are other cardiac glycosides out there. Digoxin is derived from the digitalis plant, it's also called the foxglove plant. It inhibits the sodium-potassium-ATPase pump. This results in an increased in sodium levels in the cell. This results in less excretion of calcium through the cotransporter and higher levels of calcium within the cell. With higher levels of calcium within the cell, you have increased calcium release from the sarcoplasmic reticulum. Now, the strength of contraction is going to be increased because you have more calcium. So, strength of contraction is proportional to intercellular calcium. Interestingly enough, you'll also have a reduction in heart rate. Digoxin reduces symptoms of heart failure, and it reduces hospitalization due to heart failure, but it does not prolong life. This is based on major studies looking at this particular agent in heart failure. Dosing. It has a very narrow therapeutic window. So, we actually have to monitor digoxin levels in patients. The drug can accumulate in the body, so that's why we monitor the serum levels. You can get digoxin toxicity. This beautiful picture here is just a picture of the foxglove plant, which actually grows as a weed where I grew up....

    About the Lecture

    The lecture Inotropes – Angina and Heart Failure Management by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:

    • Overview Heart Failure
    • Cardiac Glycosides
    • β1 Agonists
    • Phosphodiesterase Inhibitors

    Included Quiz Questions

    1. Quinidine
    2. increased calcium levels.
    3. increased magnesium levels.
    4. increased potassium levels.
    1. The naturopathic product foxglove has combined with digoxin to cause toxicity.
    2. The metoprolol and the nifedipine combined to cause excessive bradycardia and dizziness.
    3. The furosemide and perindopril have combined to cause excessive hypotension and dizziness.
    4. The homeopathic mixture has caused the blood pressure to drop.
    1. ...have a narrow therapeutic window.
    2. ...have a moderate therapeutic window.
    3. ...have a wide theraputic window.
    4. ...have a high therapeutic window.
    1. ...inhibits the Na/K ATP ase, which results in increased calcium within the cell, and an increased cardiac contractile force.
    2. ...induces the Na/K ATP ase, which results in increased calcium within the cell, and an increased cardiac contractile force.
    3. ...inhibits the Na/K ATPase, which results in decreased calcium within the cell, and an increased cardiac contractile force
    4. ...induces the Na/K ATPase, which result in decreased calcium within the cell, and an increased cardiac contractile force.
    1. ...decreases heart failure symptoms, reduces heart rate, but does not prolong life or save lives.
    2. ...decreases heart failure symptoms, reduces heart rate, and saves lives.
    1. ...is a phosphodiesterase inhibitor, which will increase cAMP levels in the cell, and increase contractile force.
    2. ...is a phosphodiesterase inhibitor, which will decrease AMP levels in the cell, and increase contractile force.
    3. ...is a phosphodiesterase inhibitor, which will decrease cAMP levels in the cell, and increase contractile force.
    4. ...is a phosphodiesterase inhibitor, which will increase AMP levels in the cell, and increase contractile force.

    Author of lecture Inotropes – Angina and Heart Failure Management

     Pravin Shukle, MD

    Pravin Shukle, MD


    Customer reviews

    (1)
    5,0 of 5 stars
    5 Stars
    5
    4 Stars
    0
    3 Stars
    0
    2 Stars
    0
    1  Star
    0