Anti- CHF drugs Flashcards
Drugs in the acute CHF toolkit
Diuretics
Vasodilators
Inotropes
Morphine
Preferred diuretic for acute CHF and physiologic action
- furosemide (Lasix) (loop diuretic)
- lowers central venous pressure, clears up pulmonary edema
Vasodilators that can be used for CHF, physiological action and when to avoid
- nitroglycerin
- nitroprusside
- nesiritide
- all decrease preload by venodilation**
- *avoid with pts who have low BP**
Inotropes and when to use
Dobutamine (B1 and B2 agonist)
Milrinone
use with patients that have low BP
Vasopressors and when to use
- dopamine
- norepinephrine
**use with patients that have low BP*
Actions of morphine on acute CHF
- depresses respiratory centre
- reduces anxiety
- arteriolar and venous dilation
Drugs with proven mortality reduction in chronic HF management? Drugs without proven mortality reduction?
- ACEi and B-blockers have proven mortality reduction
- digoxin and diuretics don’t and their use should be guided by symptoms
All patients with CHF and EF<40% should be treated with…
A B-blocker and ACEi
-start with ACEi, titrate up then add B- blocker
ACEi physiologic effects
- vaso and venodilation (AT1 receptor and presence of bradykinin)
- antihypertrophic
Clinical course when initiating B-blockers
- Clinical deterioration for 1-2 months then improvement over the next year.
B-blocker physiologic effects
- improve EF
- reduce LV size
When not to give B-blockers
- symptomatic hypotension
- bradycardia
- significant AV block
- severe asthma
When to use ARBs for CHF
- if ACEi is not tolerate
- it doesn’t reduce mortality and is not equivalent to ACEi
Aldosterone antagonists used in CHF, and when to use and how much to use
- spironolactone, eplerenone
- use when the pt is still symptomatic and is on B-blockers and an ACEi (NYHA II, III)
- Use the lowest dose possible
When to use digoxin? Physiologic action
when pt is symptomatic
-digoxin increases contractility ( therefore SV)
