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Cardiotonic drugs

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

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Cardiotonic drugs

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  1. Cardiotonic drugs

  2. Inotropic agentsCongestive Heart Failure (CHF) • Heart pumps less blood than it receives, so excess blood pools in the chambers and stretches the walls of the heart

  3. 2 MAIN TYPES of CHF SYSTOLIC CHF – insufficiency of output DIASTOLIC CHF - insufficiency of input

  4. 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

  5. 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 Causes of Congestive Heart Failure

  6. DRUGS FOR СONGESTIVE HEART FAILURE (CHF)

  7. CARDIAC GLYCOSIDES

  8. Strophantus

  9. Purple Foxglove

  10. Foxglove

  11. Lily of the valley

  12. Lychnis

  13. Chemical structure of cardiac glycosides

  14. Pharmacodynamics Cardiac action Extracardiac action

  15. Cardiac action • Positive inotropic • Positive bathmotropic • Negative chronotropic • Negative dromotropic

  16. Cardiac Glycosides

  17. 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

  18. ECG changes under the influence of CG Vvvvvvvvvvvvvvvvvvvvvvvv vvvvvvvvvvvvvvv • Changes which correlate to positive inotropic action Narrowing QRS complex Decreasing ST T-blip – double-phased, negative • Changes which correlate to negative dromotropic action Prolongation of PQ interval • Changes which correlate to negative chronotropic action Increase of RR interval

  19. Extracardiac action of CG • Diuretic • Sedative • Stimulating influence on smooth muscles

  20. The following manifestations testify about therapeutic action of CG1. 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

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

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

  23. “dig toxicity” • Systemic accumulation Happens frequently - 6-23 % Mortality - over 40 % Warning!

  24. Intoxication with CG

  25. Drug List Agents for CHFVasodilators • milrinone (Primacor) • nitroprusside (Nitropress)

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

  27. 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 angiotensineIIdecreases (vasoconstrictor, inductor of aldosterone, norepinephrine, endothelin secretion, myocardium hypertrophy) • Accumulation of bradikinin (inductor of prostacycline and nitrogen oxide synthesis)

  28. captopril (capoten), ramipril, enalapril etc.

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

  30. Drug List Agents for CHFACE Inhibitors • benazepril (Lotensin) • captopril (Capoten) • enalapril (Vasotec) • fosinopril (Monopril) • lisinopril (Prinivil, Zestril)

  31. Drug List Agents for CHFACE Inhibitors • moexipril (Univasc) • perindopril (Aceon) • quinapril (Accupril) • ramipril (Altace) • trandolapril (Mavik)

  32. INHIBITORS OF ANGIOTESINE CONVERTING ENZYME (IACE) captopril (capoten), ramipril, enalapril etc.

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