Drugs Used in Heart Failure Flashcards
Chlorthalidone
Class:Thiazide Diuretics
MOA:Relieve pulmonary congestion & peripheral edema
↓ symptoms of volume overload [orthopnea]
↓ plasma volume → ↓ venous return i.e. preload →
decreased workload and O2 demand
↓ Afterload
Uses:Loop: more effective than thiazides
Thiazides: pts with hypertensive heart disease
congestive symptoms]! ineffective by itself due to its
weak diuretic effec
AE:
Hydrochlorothiazide
Class:Thiazide Diuretics
MOA:Relieve pulmonary congestion & peripheral edema
↓ symptoms of volume overload [orthopnea]
↓ plasma volume → ↓ venous return i.e. preload →
decreased workload and O2 demand
↓ Afterload
Uses:Loop: more effective than thiazides
Thiazides: pts with hypertensive heart disease
congestive symptoms]! ineffective by itself due to its
weak diuretic effec
AE:
Metolazone
Class:Thiazide Diuretics
MOA:Relieve pulmonary congestion & peripheral edema
↓ symptoms of volume overload [orthopnea]
↓ plasma volume → ↓ venous return i.e. preload →
decreased workload and O2 demand
↓ Afterload
Uses:Loop: more effective than thiazides
Thiazides: pts with hypertensive heart disease
congestive symptoms]! ineffective by itself due to its
weak diuretic effect
AE:
Furosemide
Class : Loop Diuretics
MOA:Relieve pulmonary congestion & peripheral edema
↓ symptoms of volume overload [orthopnea]
↓ plasma volume → ↓ venous return i.e. preload →
decreased workload and O2 demand
↓ Afterload
USES:Loop: more effective than thiazides
Thiazides: pts with hypertensive heart disease
congestive symptoms]! ineffective by itself due to its
weak diuretic effect
AE:
Eplerenone
CLASS:Aldosterone Antagonist
MOA:Prevents Na+ retention, myocardial hypertrophy & K+
loss
[When combined with ACE-I’s→ ↓M&M of severe HF]
USES:Advanced heart disease or pts with LV dysfunction
after an MI (these pts have elevated aldosterone due
to angiotensin stimulation and reduced hepatic
clearance)
AE: Hyperkalemia, gyecomastia, lowered libidio
Spironolactone
CLASS:Aldosterone Antagonist
MOA:Prevents Na+ retention, myocardial hypertrophy & K+
loss
[When combined with ACE-I’s→ ↓M&M of severe HF]
USES:Advanced heart disease or pts with LV dysfunction
after an MI (these pts have elevated aldosterone due
to angiotensin stimulation and reduced hepatic
clearance)
AE: Hyperkalemia, gyecomastia, lowered libidio
Captopril
CLASS:ACE-I
MOA:↓PVR → ↓BP/afterload → ↑CO
↓Na+ and H2O retention → ↓preload
↓long term remodeling
USES:DOC in heart failure
Dilates arterioles and
veins
All pro-drugs except
captopril
High risk pts: diabetes, HTN,
atherosclerosis, obesity
AE:Persistent dry cough Hypotension Renal insufficiency Hyperkalemia Angioedema Teratogenic!contraindicated in pregnancy
Enalapril
CLASS:ACE-I
MOA:↓PVR → ↓BP/afterload → ↑CO
↓Na+ and H2O retention → ↓preload
↓long term remodeling
USES:DOC in heart failure
Dilates arterioles and
veins
All pro-drugs except
captopril
High risk pts: diabetes, HTN,
atherosclerosis, obesity
AE:Persistent dry cough Hypotension Renal insufficiency Hyperkalemia Angioedema Teratogenic!contraindicated in pregnancy
Lisinopril
CLASS:ACE-I
MOA:↓PVR → ↓BP/afterload → ↑CO
↓Na+ and H2O retention → ↓preload
↓long term remodeling
USES:DOC in heart failure
Dilates arterioles and
veins
All pro-drugs except
captopril
High risk pts: diabetes, HTN,
atherosclerosis, obesity
AE:Persistent dry cough Hypotension Renal insufficiency Hyperkalemia Angioedema Teratogenic!contraindicated in pregnancy
Candesartan
CLASS:
MOA:Block AT-I receptor
USES:Candesartan is used for CHF
Used in pts intolerant to ACEI
[no cough/angioedema]
AE:Hypotension Renal insufficiency Hyperkalemia Teratogenic!contraindicated in pregnancy
Valsartan
CLASS:
MOA:Block AT-I receptor
USES:Candesartan is used for CHF
Used in pts intolerant to ACEI
[no cough/angioedema]
AE:Hypotension Renal insufficiency Hyperkalemia Teratogenic!contraindicated in pregnancy
Hydralazine
CLASS:Direct Vasodilator
MOA:↑venodilation → ↓preload
↑arterial dilation → ↓PVR/↑SV & afterload
Hydralazine dilates the arterioles
USES:Pt’s that are intolerant to ACEI’s/ARBs or β-blockers or
black patients with advanced HF [adjuvant TXT]
Sustained improvement of LVEF when both oral
vasodilators are combined
AE:Combination: Hypotension,
dizziness, reflex tachycardia,
Na+/H20 retention, GI issues
Hydralazine: tachycardia,
peripheral neuritis and a lupus like syndrome
Isosorbide Dinitrate
CLASS:Direct Vasodilator
MOA:↑venodilation → ↓preload
↑arterial dilation → ↓PVR/↑SV & afterload
Nitrates dilates the veins and venules
USES:Pt’s that are intolerant to ACEI’s/ARBs or β-blockers or
black patients with advanced HF [adjuvant TXT]
Sustained improvement of LVEF when both oral
vasodilators are combined
AE:Combination: Hypotension,
dizziness, reflex tachycardia,
Na+/H20 retention, GI issues
Carvedilol
CLASS:B-blocker
MOA: Can reverse cardiac
remodeling and reduce mortality
↓HR and RAAS [-ve inotrope]
Prevents deleterious effects of
NE on cardiac muscle fibers
USES:Heart disease [stage B and C] in addition to an ACE-
AE:Initial treatment can cause fluid retention Abrupt withdrawal!unstable angina, MI, death Hypoglycemia CNS effects Use cautiously in pts with asthma or severe bradycardia/ AV block
Metoprolol
CLASS:B-blocker
MOA: Can reverse cardiac
remodeling and reduce mortality
↓HR and RAAS [-ve inotrope]
Prevents deleterious effects of
NE on cardiac muscle fibers
USES:Heart disease [stage B and C] in addition to an ACE-
AE:Initial treatment can cause fluid retention Abrupt withdrawal!unstable angina, MI, death Hypoglycemia CNS effects Use cautiously in pts with asthma or severe bradycardia/ AV block
Digoxin
CLASS Inotropic Agent, Cardiac glycoside
MOA:Inhibits Na/K ATPase → ↓Na+ gradient→ indirect inhibition of Na+/Ca2+ exchange→ ↑cytoplasmic Ca2+→ ↑contractility ↓SNS, RAAS & PVR → ↓HR Enhanced vagal tone → ↓O2 demand ↓conduction through AV node; ↑effective refractory period baroreceptor desensitization! sustained elevation of plasma NE
Does NOT ↑survival
USES: Indicated in pts with heart failure with A-fib along with ACE-I and β-blocker
AE:Toxicity [very common]:
Cardiac: Atrial arrhythmia, AV block Anorexia, nausea, vomiting, Headache, fatigue, confusion,
blurred/yellow vision, altered color perception, halos on
dark objects d/t narrow therapeutic window
Treat with digitalis antibodies
Treat V-tach with lidocaine
Milrinone
Class: Inotropic Agent, PDE-III inhibitor
MOA:↑cAMP→ +ve inotropic effects and ↑CO [similar to β1]
Systemic and pulmonary vasodilation→ ↓preload and afterload Slight ↑AV conduction
USES:IV for acute/short term ↑COin pts w/ intractable HF
AE:Arrhythmia
Hypotension
Thrombocytopenia
Inamrinone
Class: Inotropic Agent, PDE-III inhibitor
MOA:↑cAMP→ +ve inotropic effects and ↑CO [similar to β1]
Systemic and pulmonary vasodilation→ ↓preload and afterload Slight ↑AV conduction
USES:IV for acute/short term ↑COin pts w/ intractable HF
AE:Arrhythmia
Hypotension
Thrombocytopenia
Dopamine
Class: Inotropic Agent, Stimulates, a1 B1/B2 and D1
MOA:Low dose: D1 → dilate renal and mesenteric blood vessels! may
induce natiuresis and ↑urine output
Intermediate dose: dopaminergic and β1 receptors→ ↑ force and
rate of contraction and renal vasodilation
High dose: α1 receptors→ vasoconstriction [not helpful
USES:treatment of
shock that persists after
volume replacement
AE:Arrhythmia
High doses!↑myocardial O2 demand!worsen ischemia in
some pts with CAD
Dobutamine
Class: Inotropic Agent, B-agonist
MOA:+ve inotropic effects and vasodilation
↑cAMP [Gs]→ … phosphorylation of Ca2+ channels with ↑Ca2+ entry
into myocardium→ ↑contraction
Little or no effect on HR
↑CO w/o inc O2 demands!major advantage
USES:Used to ↑CO in acute mgmt. of HF(cardiogenic shock, MI)
AE:less arrhythmogenic than dopamine
Glucagon
MOA:Gs→ ↑cAMP→ ↑contractility [without using β-receptors]
+ve inotropic & chronotropic effects
USES:Mgmt. of severe β-blocker overdose
