DRUGS FOR CHF
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Transcript DRUGS FOR CHF
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
Extracellular
matrix(ECM)
fibrosis
Myocardial hypertrophy and
remodeling.
Change of myocardial function in CHF
Systolic dysfunction
actin-troponin-tropomyosin system
ATP
Ca-excitation-contraction-coupling
Diastolic dysfunction
compliance
Change of neural-endocrine system in
CHF
sympathetic nerve system activation
renin-angiotensin-aldosterone system activation
Arginine-Vasopressin
Endothelin
Tumor necrosis factor- α
Atrial natriuretic peptide
EDRF-NO
Prostaglandins
Classification of Drugs for CHF
Cardiac glycosides
ACEI
Diuretics
Others
β-R blockers
CCB
PDEI(phosphodiestrase inhibitor)
Vasodilators
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
Cardiac Glycosides
P.K
Absorption
Distribution
Metabolism
Excretion
Influencing factors
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.
Cardiac Glycosides
Interactions:
Antiarrhythmia
Agents
Digitoxin, Cediland, Strophanthin K
PDEI (milrinone, amrinone, vesnarinone)
ATP AC cAMP PDEI 5’AMP
Ca influx
RAS BLOCKERS
ACEI (Captopril, enalapril)
Mechanism
BK
a.
AngⅡ
( )
(-)
NO
Hypertrophy & proliferation
of myocardium & VSMC
b. Afterload
diastolic dysfunction ( + )
Antagonist of AT1 (Losartan)
OTHERS
β-R blockers
β-R sensitivity
RAS
DIURETICS
CCB proliferation
Vasodilatiors
LOAD
REVIEW & QUESTIONS
The mechanisms of cardiac glycosides.
The ADR of them.
The classification of drugs for CHF.