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Ch 24 Pharm
Cardiac Contractitlity
74
Pharmacology
Graduate
09/13/2012

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Cards

Term
Positive inotropes
Definition
increase the contractile force of cardiac myocytes
Term
Preload
Definition
intraventricular blood volume
Term
Afterload
Definition
resistance against left ventricle ejection
Term
Ca+ enters myocyte thru
Definition
L type channels
Term
Ca+ enters myocyte thru
Definition
L type channels
Term
Ca stimulates this receptor on SR
Definition
ryanodine receptor
Term
Cacliuum binds to which troponin
Definition
Troponin C: release inhibitory troponin I
Term
Inhibitory troponin
Definition
Troponin I
Term
Frank Starling Law
Definition
increased force of contraction due to increased end diastolic volume of the left ventricle
Term
Frank Startling Law WHY?
Definition
increased stretch releases more Ca from SR and allows for more actin/myosin binding sites
Term
2 types of pumps in cardiac muscle
Definition
Na/K ATPase, and NA/Ca Exchanger
Term
Pumps Ca back into SR
Definition
SERCA once phospholamban is phosphorylated
Term
Phosphorylates phospholamban
Definition
ATP---> ADP
Term
Positive chronotropic
Definition
increased heart rate in dose format
Term
Positive Lusitropic effect
Definition
enhanced rate and extent of disastolic relaxation
Term
B1 Receptor
Definition
Lusitropic effect is very important to maintain output with increased HR
Term
B2 receptor agonists
Definition
dilates vascular smooth muscle, increased gluconeogenesis, glycogenolysis
Term
B1 agonists
Definition
increase chronotrophy and inotropy, increased AV node velocity, increased renin secretion
Term
B3 receptor agonist
Definition
Lipolysis
Term
B3 receptor agonist
Definition
Lipolysis
Term
A1 receptor agonist
Definition
Vascular smooth muscle contraction
GU SM contraction
GI SM RELAXATION
Heart: increased Rate and Inotrophy
Term
a2 receptor agonist
Definition
decrease insulin, block platelet aggreg, decrease NE release, Vascular smooth muscle contraction
Term
B2 agonist effects
Definition
decreased systemic resistance, and afterload
Term
a1 receptor effects
Definition
increased vascular reisistance and afterload
Term
Digoxin
Definition
inhibits Na/K ATPase channel
Term
Digoxin
Definition
increases intracellular Na and leads to decreased calcium efflux and thus SR can pick up more Ca+
Term
Digoxin
Definition
decreased automaticity of AV node, prologned refractory period of AV node, inhibits sympathetic outflow and increased parasympathetic tone
Term
Digoxin metabolism
Definition
Kidney 70%
Term
Digoxin can be effected by what ion
Definition
Hypokalemia- increases digoxen binding in heart muscle
Term
Digoxin can be effected by what ion
Definition
Hypokalemia- increases digoxen binding in heart muscle
Term
Tx of digoxin toxicity
Definition
Hyperkalemia to promote dephosphorylation of proteins
Term
Digoxen plus Beta blockers
Definition
high grade AV block
Term
Beta blockers/Ca blockers effects on digoxen
Definition
block the inotrophic effects
Term
K wasting diuretics (furosemide) + digoxen
Definition
decrease plasma potassium and can lead to increased affinity of digoxen with NA/K ATPase channels
Term
Life threatening Digoxen overdose
Definition
Antidigoxin antibodies
Term
Digoxin
Definition
Systolic heart faiure, Supraventricular arrythmias (afib, a flutter, paroxysmal atrial tachy)
Term
Digitoxin
Definition
Systolic heart faiure, Supraventricular arrythmias (afib, a flutter, paroxysmal atrial tachy)
Term
Digitoxin prefered
Definition
with kidney failure (due to liver metabolism)
Term
Digoxin and Digitoxin
Definition
arrhythmias, AV block, PVC, agitation, blurred vision with yellow green halo
Term
Digoxin and Digitoxin
Definition
Never with ventricular fib. or tachy
Term
Digoxin Immune FAB
Definition
life threatening digitalis toxicity
Term
Digoxin Immune FAb
Definition
Heart failure, anaphylaxis
Term
Dopamine low infusion
Definition
overall cardiostimulatory effect
Term
Dopamine low infusion
Definition
vasodilatory effect thru D1 in renal and mesenteric vascular beds
Term
Dopamine intermediate infusion
Definition
vasodilation via stimulation of B2 receptors and activates b1 receptors increasing rate and strength of contraction
Term
Dopamine high infusion
Definition
activates A1 receptor leading to vasoconstriction and increased afterload
Term
Dopamine low infusion
Definition
cardiogenic shock or HF
Term
Dopamine AE
Definition
Bradycardia, asthma, wideening of QRS, arrhythmias
Term
Dopamine
Definition
pheochromocytoma, v fib, uncorrected tachy arrhythmias
Term
Dopamine + MAOI
Definition
decrease metabolism and result in tachycardia and arrhythmia
Term
Dobuatmine
Definition
mostly a B1 agonist
Term
Dobutamine
Definition
modest peripheral vasodilation via b2 receptor
Term
dobutamine
Definition
treates cardiac decompensation due to cardiogenic shock
Term
dobutamine
Definition
less frequent arrhytmias than dopamine
Term
Epinephrine
Definition
Bronchospasm, anaphylactic shock, cardiac resuscitation, nasal congestion
Term
Epinephrine
Definition
open angle glaucoma, prolongs local anethetic use
Term
Epinephrine
Definition
non selective a1, a2, b1, b2 agonist
Term
Epinephrine low
Definition
b2 vasodilation
Term
Epinephrine high
Definition
a1 vasoconstriction and increased afterload
Term
Epinephrine
Definition
excreted by kidneys
Term
NE
Definition
nonselective b1, a1 and a2 agonist
Term
NE
Definition
used for acute hemodynamic support due to shock in the absence of heart disease
Term
NE
Definition
arrhythmias, cerebral hemorrhage, hypertension, headache, tachycardia, nervousness
Term
Isoproterenol
Definition
B1/B2 agonist
Term
Isoproterenol
Definition
emergency arrhythmias, atropine resistant arr, heart block, broncospasm
Term
Isoproterenol
Definition
do not use with angina or digitalis intoxication
Term
Inamrinone
Definition
PDE inhibitor leading to increased cAMP and increased Ca intracellularly
Term
Milrinone
Definition
PDE inhibitor leading to increased cAMP and increased Ca intracellularly
Term
Vesnarinone
Definition
PDE inhibitor leading to increased cAMP and increased Ca intracellularly
Term
PDE inhibitors
Definition
decrease preload and decrease after load
Term
inamrinone
Definition
TCP, arrhythmias- AE
Term
vesnarinone
Definition
reversible neutropenia and agranulocytosis
Term
Levosimendan
Definition
enhances troponin c to calcium sensitivity and induces periperial vasodilation
Term
Levosimendan
Definition
not used in the US
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