#NewDrugs Ans: D Noradrenaline -> All three drugs except no
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Dr. Natesh Prabhu
#NewDrugs

Ans: D
Noradrenaline -> All three drugs except noradrenaline decreases the after load. Noradrenaline doesn’t have ?2 activity. Rather it has strong ?1 activity. This leads to intense vasoconstriction thereby increasing the after load --> increased LV EDP (Left ventricle End diastolic pressure).

LEVOSIMENDAN is a calcium sensitizer, which is used is used in acute decompensated heart failure. This increases the cardiac contractility without increase in myocardial oxygen consumption. Opening of adenosine triphosphate (ATP)-sensitive potassium channels in vascular smooth muscle to cause smooth muscle relaxation --> Vasodilatation

ISTAROXIME is a Na/K ATPase inhibitor and SERCA2A stimulator. This dual mechanism of action results in Istaroxime having both inotropic action by allowing the accumulation of cytosolic calcium during contraction and a lusitropic effect (improvement in diastolic relaxation) by sequestering calcium during relaxation. This increases the cardiac contractility in systolic failure. This is under development. Due to its lusitropic activity it decreases LV EDP.

OMECAMTIV MECARBIL is the first selective cardiac myosin activator (under development) which selectively activates the S1 domain of cardiac myosin --> increases the rate of ATP turnover by accelerating actin-dependent phosphate release and by slowing the rate of adenosine 5?-diphosphate (ADP) release --> increases the occupancy time of myosin on actin, leading to increased numbers of myosin molecules bound to actin, which causes prolongation of the contractile force without increasing left ventricular pressure (LV EDP).

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