Drugs for Heart Failure Flashcards
What usually causes heart failure
reduced ejection fraction
What are the main signs of heart failure
- Decreased force of contraction
- Decreased tissue perfusion
- Edema (pulmonary or peripheral)
- Diaphoresis
Drugs for chronic heart failure
- ACE inhibitors or AngII Receptor Blockers
- Angiotensin receptor neprilysin inhibitors
- Beta Blockers
- Mineralocorticoif receptor antagonists
- Sodium glucose transport inhibitor diuretics
- Diuretics
- Ivrabadine
- Cardiac glycosides
- Nitrates + hydralazine
Adverse effects of Beta Blockers
- Bradycardia
- Risk of an AV block
- Heart Failure
- Hypotension
General Effects of Beta Blockers
- Fatigue
- Nightmares
- Sexual Dysfunction
Adverse Effects of Non Specific Beta Blockers (propranolol)
- Bronchoconstriction (caution for asthma)
- Reduce the release of glucose - masking the symptoms of hypoglycaemia (caution for diabetics)
- Slight increase in peripheral resistance
- inhibit lipolysis (increase in triglycerides)
Use of Ivabradine
Patients with a heart rate less than 70
What is used when ACEi/ARB/ANRI is not tolerated
Hydralazine/nitrate
What is the new heart failure drug
Angiotensin receptor neprilysin inhibitor
How does Ivabradine work
Slows accelerated heart rate by blocking an ion channel that is responsible for generating the pacemaker current
- Acts on the pacemaker current
Examples of the SGLT - 2 Inhibitors (sodium glucose 2 cotransporter)
The Gliflozins
- dapagliflozin
- empaglifozin
- canaglifozin
How do SGLT-2-Inhibitors work
- Inhibit Na/Glucose reabsorption in the proximal tubule of the kidney
- diuretic effect through the increased loss of na and glucose
- Reduces circulation volume and reduces preload
Used in the treatment of diabetes because it makes you lose glucose
Adverse effects of SGLT -2- Inhibitors
- Fungal infections (due to increased urination)
- polyuria
- hypotension
- euglyemic
- diabetic ketoacidosis (rare)
What do drugs for acute heart failure aim to do
They seek to increase force of contraction and eliminate edema as required
What are the 2 drug classes used for acute heart failure
- Phosophodiesterase inhibitors
- Adrenergic agonists
Drug class used for chronic heart failure
cardiac glycosides
What is the example of a Cardiac Glycoside
Digoxin
What is the mechanism of action of digoxin
- Blocking Na - K ATPase by poising it - digoxin and potassium compete to bind to the pump so if there is a decrease in potassium, digoxin may act more than it should
- Results in increased intracellular calcium levels leading to increased force of contraction and increased PNS effects on the heart
Physiological effects of digoxin
Mechanical - Increased force of contraction (positive inotropic effect)
Electrical - Decreased heart rate, decreased AV conduction
Adverse effects of Digoxin
- Nausea and vomiting
- Arrhythmias
- Very narrow therapeutic window
- Dangerous is patients are hypokalemic
- Can make people see different shades of yellow
How to treat an overdose of digoxin
Administration of neutralizing anti digoxin antibody fragments (digibind)
Treatment algorithm for acute heart failure
- Increase inspired O2 (target O2 above 92%)
- Reduce volume overload
- Increase cardiac contractility and blood pressure
Examples of Beta Adrenergic Agonists
- Dopamine
- Dobutamine
Mechanism of action of Beta Adrenergic Agonists
- Increase force of contraction and heart rate
- Dobutamine stimulates beta 1 adrenergic receptors
