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Heart Failure (Neprilysin inh. (drug (Sacubitril (ARNI :<3:)), NP…

- - - - ARNI :<3:
  - - - AT 1 R
        
        Vasoconstrict --> BP ,sympathetic tone,aldosterone เพิ่ม
- - - - act. D2 --> inh NE release --> vascular muscle vasodilater
      - (+) renal bloo flow maintain GRF (renal protection)
  - - - blood flow ดี
    - - Tachycardia , Arrhymia
- - - - ลด Ctecholamine -induce cardiomyocyte toxicity
      - ลด Myocyte ตาย
- - - - (+) Vein capacity
        
        (-) preload :<3:
        
        ลด LV filling Pressure :<3:
    - - Improve exercise capacity
      - ลด pulmonary,systemic vascular R.
      - systolic ,diastolic function เพิ่ม --> coronary blood flow
  - - - (-) After load :<3:
- - - - CO (+) --> blood perfusion เพียงพอ
- - - - Nifedipine
      - Veraplamil , Diltiazem
  - - - Survive HF :check:
- - - - (+) HR,(+) CO
      - artery,Vein dilate
    - - use acute HF
  - - - (-) contrat =Vasodilator ที่venouse
    - - (+) contract heart
- - - - drug of choice :<3:
    - - combine w/ Loop diuretic
    - - spironolactone
    - - vasopressin Anta.
- - - - RAAS --> (-) remodeling ห้อง Ventricle
      - (-) collagen synt.
        
        ลด fibrosis
      - improve Endothelial Func.
        
        Improve NO act.
      - s/e :!:
        
        รบกวน HM เพศ
        
        Gynecomastear
        
        รบกวนรอบเดือน
- - - - intracellular NA--> intracelluar Ca2+--> contractivity
    - - (+) smooth muscle contract, vasoconstrict
      - (-)symp drive, (-) renal sodium pump ..inh renin ..vasodilate