Download 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 .
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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
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Change of neural-endocrine system in
CHF
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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
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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
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Cardiac Glycosides
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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.
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Cardiac Glycosides
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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)
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OTHERS
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β-R blockers
β-R sensitivity
RAS
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DIURETICS
CCB proliferation
Vasodilatiors
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REVIEW & QUESTIONS
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The mechanisms of cardiac glycosides.
The ADR of them.
The classification of drugs for CHF.