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Drugs for Congestive Heart Failure. BACKGROUND. DEFINITION: The inability of heart to meet the needs of peripheral systems. PATHOGENY: myocardium contraction & heart load SYMPTOMS: weakness, fatigue and dyspnea, cyanosis, edema . Change of myocardial structure in CHF. Apoptosis

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Drugs for Congestive Heart Failure


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    1. Drugs for Congestive Heart Failure

    2. BACKGROUND • DEFINITION: The inability of heart to meet the needs of peripheral systems. • PATHOGENY: myocardium contraction & heart load • SYMPTOMS: weakness, fatigue and dyspnea, cyanosis, edema .

    3. Change of myocardial structure in CHF • Apoptosis • Extracellular matrix(ECM) fibrosis • Myocardial hypertrophy and remodeling.

    4. Change of myocardial function in CHF • Systolic dysfunction • actin-troponin-tropomyosin system • ATP • Ca-excitation-contraction-coupling • Diastolic dysfunction • compliance

    5. Change of neural-endocrine system in CHF • sympathetic nerve systemactivation • renin-angiotensin-aldosterone system activation • Arginine-Vasopressin • Endothelin • Tumor necrosis factor- α • Atrial natriuretic peptide • EDRF-NO • Prostaglandins

    6. Classification of Drugs for CHF • Cardiac glycosides • ACEI • Diuretics • Others • β-R blockers • CCB • PDEI(phosphodiestrase inhibitor) • Vasodilators

    7. Cardiac Glycosides • Positive inotropic effect K-Na-ATPase Na Ca Ca • Effects on neural-hormone • To inhibit sympathetic nerve activity • To enhance vagus nerve activity • Electrophysiologic effects • Effects on ECG • Effects on Kidney

    8. Cardiac Glycosides • P.K • Absorption • Distribution • Metabolism • Excretion • Influencing factors

    9. Cardiac Glycosides • Clinic uses • CHF • Arrhythmia: Atrial fibrillation, Atrial flutter • ADR • Extracardiac • Cardiac: Supra -/-Ventricular arrhythmia , Atrial Ventricular Block , ventricular premature beat • Therapy: K, phenytoin sodium, lidocaine. Antibody of it.

    10. Cardiac Glycosides • Interactions: • Antiarrhythmia • Agents • Digitoxin, Cediland, Strophanthin K • PDEI (milrinone, amrinone, vesnarinone) • ATP AC cAMP PDEI 5’AMP Ca influx

    11. RAS BLOCKERS • ACEI (Captopril, enalapril) • Mechanism a. AngⅡ ( ) Hypertrophy & proliferation of myocardium & VSMC b. Afterload Antagonist of AT1 (Losartan) • BK ( - ) NO ( + ) diastolic dysfunction

    12. OTHERS • β-R blockers β-R sensitivity RAS • DIURETICS • CCB proliferation LOAD • Vasodilatiors

    13. REVIEW & QUESTIONS • The mechanisms of cardiac glycosides. • The ADR of them. • The classification of drugs for CHF.