Chapter 51: Drugs for Heart Failure Flashcards
what are the 2 main types of heart failure
- left ventricular diastolic dysfunction
- preserved LV ejection fraction (diastolic failure)
what is heart failure
- heart is unable to pump sufficent blood to meet the metabolic needs of tissues
heart failure is characterized by
left ventricular dysfunction, reduced cardiac output, insufficent tissue perfusion, signs of fluid retention
causes of heart failure
- chronic hypertension
- myocardial infraciton
- valvular heart disease
- coronary artery disease
- congenital heart disease
- dysrhythmias
- aging of the myocardium
signs and symptoms of heart failure
- decreased exercise tolerance
- fatigue
- SOB
- pulmonary edema
- tachycardia
- cardiogegaly
- peripheral edema
- hepatomegaly
- weight gain
- distention of jugular veins
what are the drugs for heart failure
- Diuretics
- RAAS inhibitors
- beta blockers
- digoxin
- dopamine
- hydralazine
- SGT2 inhibitors
Diuretics MOA
reduce blood volume
- decreases venous and arterial pressure, decrease pulmonary and peripheral edema, cardiac dialtion
what are the types of diuretics
- Thiazide diuretics (hydrochlorothiazide)
- loop Diuretics (furosemide)
ACE inhibitors examples
Enalapril [Vasotec]
Enalapril [Vasotec] effects
Hemodynamic benefits
- arteriolar dilation (increases stroke volume and cardiac output)
- venous dilation (reduces edema)
- suppression of aldosterone release (enhances sodium and water excretion)
Favorable impact on cardiac remodelling
ACE inhibitors adverse effects
- hypotension
- hyperkalemia
- intractable cough (mainly captopril)
- angioedema
- renal failure
- teratogenic
example of ARB
Losartan [Cozaaar]
Losartan [Cozaaar] effects
improve LV ejection fraction, reduce HF symptoms, increase exercise tolerance, decrease hospitalization, enhance quality of life, and reduce mortality
Sacubitril / valsartan [Entresto] is indicated for
HF (NYHA class II or III) to reduce death and hospitalization
Sacubitril / valsartan [Entresto] contradiction
** must wait 36 hours after stopping ACE treatment before starting Entresto
- diabetes and moderate to severe renal impairment, pregnancy/nursing, history of angioedema
Spironolactone [Aldactone] is used for
standard HF therapy
- can decrease symptoms, hospitalizations, and prolonged life
patients taking Spironolactone [Aldactone] should be monitored for
hyperkalemia
Beta blocker adverse effects
- fluid retention or worsening of HF
- fatigue
- hypotension
- bradycardia or heart block
example of beta blockers
- Carvedilol
- Bisoprolol
- Metoprolol
SGLT2 Inhibitors
- lower BP, reducing cardiac afterload which increases cardiac efficiency
SGLT2 inhibitors examples
- Dapagliflozin
- Empagliflozin
- Canagliflozin
Vasodilators examples
- Nitroglycerin
- Sodium nitroprusside [Nitropress]
- Nesiritide [Natrecor}
Nitroglycerin principle adverse effects
- hypotension
- resultant reflex tachycardia
Sodium nitroprusside [Nitropress] principle adverse effect
- profound hypotension
Nesiritide [Natrecor] principle adverse effect
symptomatic hypotension
Digoxin use
- second line
- doesn’t prolong life (actually shortens it)
Digoxin relationship to potassium
low K = high digoxin
digoxin [Lanoxin] effects
- postive inotropic action (increases forces of contraction)
- increased cardiac output ( decreases sympathetic tone, increased urine production, decreased renin release)
- suppresses renin release in the kidney
- increases responiceness/ electrical properties of the heart
- anorexia, nausea, vomiting, fatigue, visual disturbances
Digoxin [Lanoxin] adverse effects
- cardiac dysrhythmias
predisposting factors for cardiac dysrhythmias from digoxin
- hypokalemia
- elevated digoxin level (narrow therapeutic range)
- heart disease
how to manage digoxin- induced dysrhythmias
- stop drug, stop K depleting diuretics, monitor K, treat symptoms
- Digoxin Immune FAB (Digibind)
- activated charcoal
Stage A of managing heart failure
- management is directed at reducing the risk
management of stage B heart failure
- prevent development of symptomatic HF
- treatment is the same as stage A but with the addition of ACE inhibitors or ARBs
management of stage C heart failure
- releive pulmonary and congestive symptoms
- improve functional capacity and quality of life
- slow cardiac remodeling and progression of LV dysfunction
- prolong life
stage C heart failure drug therapy
- Diuretics
- ACE inhibitors and ARBs
- aldosterone antagonists
- beta blockers
- Digoxin
- Isosorbite dinitrate/hydralazine
drugs to avoid during stahe C heart failure
- antidysrhythmic agents
- calcium channel blockers
- NSAIDS (asprin)
stage D heart Failure
- marked symptoms of HF
- best solution is heart transplant
- advanced structural heart disease
management of stage D heart failure
Control of fluid retention
- loop diuretic, thiazide diuretic
- dopamine, dobutamine
