Heart Failure Pharmacology Quiz

Drugs Used to Treat Heart Failure

• Heart failure treatment drugs are divided into two categories: those with a positive inotropic effect and those without.

Drugs with Positive Inotropic Effect

• Increase the heart muscle contraction force.
• Types include:
  • Cardiac Glycosides: Examples are digoxin and digitoxin. Mechanism of action involves inhibiting Na+/K+ ATPase, leading to increased intracellular sodium and calcium, enhancing cardiac output.
  • Beta-Adrenergic Stimulants: Examples include dobutamine and dopamine. These are used for acute heart failure management, increasing myocardial contractility and cardiac output.
  • Methylxanthines: Example is aminophylline (theophylline), which has positive inotropic and bronchodilating effects, also aiding renal blood flow. Used for acute left ventricular failure and pulmonary edema.

Drugs without Positive Inotropic Effect

• Include diuretics and vasodilators, mainly used for heart failure management.
• Diuretics: Such as hydrochlorothiazide and furosemide, which reduce ventricular preload.
• Vasodilators: Examples like hydralazine and sodium nitroprusside decrease both preload and after-load, improving heart function.
• ACE Inhibitors (ACEIs): Such as captopril and enalapril, lower both preload and after-load, also linked with potential megaloblastic anemia.

Folate Deficiency in Pregnancy

• Can lead to congenital malformations in newborns, such as spina bifida.
• Causes include dietary deficiencies, alcoholism, hemolytic anemia, malabsorption syndromes, certain cancers, chronic skin diseases, and medications impairing absorption (e.g., phenytoin, oral contraceptives, isoniazid).
• High-risk individuals (e.g., pregnant women, alcoholics, those with hemolytic anemia) should consider folic acid supplements.
• Folic acid does not prevent neurological manifestations of vitamin B12 deficiency; it may correct anemia.

Endocrine System Overview

• Communicates through hormones to target cells.
• Major hormones include glucagon (from A-cells), insulin (from B-cells), and somatostatin (from D-cells).

Endocrine System Functions

• Regulates water balance, uterine contractions, metabolism, ion regulation, heart rate, blood pressure, and blood glucose levels.

Insulin Types

• Long-Acting Insulin: Example includes Protamine Zinc Insulin.
• Therapeutic Uses: Management of diabetes, particularly insulin-dependent diabetes and non-insulin-dependent diabetes not controlled by diet and oral agents.

Oral Hypoglycemic Agents

• Indicated for Type II diabetes.
• Main classes include:
  • Sulfonylureas: Stimulate insulin production and inhibit hepatic gluconeogenesis. Examples: tolbutamide, glimepiride, chlorpropamide, glibenclamide.
  • Biguanides: Example is metformin, which suppresses gluconeogenesis and enhances glucose uptake, thus does not cause hypoglycemia.

Cornerstones of Diabetes Management

• Consist of healthy eating, exercise, monitoring blood glucose, medication adherence, and patient education.

Adrenocortical Hormones

• Control the metabolism of carbohydrates, proteins, fats, and water/electrolytes.
• Classified into glucocorticoids (e.g., hydrocortisone, aldosterone) and sex hormones (e.g., testosterone, estrogen).

Male Sex Hormones

• Androgens: Primary one is testosterone, vital for spermatogenesis and libido.
• Anabolic Steroids: Synthetic and may lead to abuse, increased aggression, and adverse masculinizing effects in women.

Female Sex Hormones

• Estrogens: Used in various forms, including IUDs that prevent ovulation and pregnancy.
• Emergency contraceptive pills can prevent ovulation and fertilization within 72 hours after intercourse.
• Side effects include thromboembolic complications, weight gain, menstrual disorders, and mood changes.

Oxytocin

• Stimulates uterine contractions, facilitates milk ejection, and is used for labor induction and managing postpartum hemorrhage.
• Side effects may include uterine rupture risk and water retention effects, leading to water intoxication when given IV.