Drugs Used in Heart Failure I Flashcards
heart failure
CO inadequate to proved O2 needed by body
CAD, MI, HTN, damaged valves, external pressure around heart, Vit B deficiency, cardiac muscle disease
decreased mortality in HF
ACE, ARBs, aldosterone antagonists, beta-blockers
Tx for symptoms of HF
volume overload - diuretics
myocardial dysfunction - positive inotropes
most efficacious for reducing volume overload
loop diuretics
loop diuretics
forusemide
bumetadine
ethacrynic acid (no sulfa)
torsemide
furosemide
loop diuretic
-inhibit Na, K, 2Cl cotransporter in thick ascending limb of loop of henle
decreased reabsorption of Ca and Mg
improve symptoms, NOT mortality
ethacrynic acid
loop diuretic - no sulfa allergy
adverse of loops
hypokalemia alkalosis hypocalcemia hypomagnesemia hyperuricemia
hypercalcemic state
loop diuretic
nagging cough and swollen tongue
ACE inhibitor
angioedema
combination with furosemide to control BP and edema in CHF patient
losartan
ACE and ARBs
reduce mortality for CHF***
ANG II
blocked by ACE and ARB
vasoconstrictor Na/water retention increased aldosterone catecholamine release arrhythmias hypertrophy of cardiac myocyte death
HF drug - symptoms first worse and then better
beta blocker
3-6 months
beta blocker
reduce symptoms AND improve mortality in HF patients
beta blockers in HF
increased CO initially
- dowregulation of beta receptors
- reduced responsive myocardium
low dose beta blockers***
-increased EF, slow HR, reduce symptoms and mortality
spironolactone
aldosterone antagonist
eplerone
aldosterone antagonist
hydralazine and nitrate
reduce mortality
-improves quality of life
in HF patients
useful, especially in AA patients who have persistance symptoms regardless of ACE and beta blocker therapy
aldosterone antagonists
reduce mortality with CHF
monitor for normal plasma K levels
drug that may cause paroxysmal atrial tachycardia with block at high concentrations
digoxin
digoxin
cardiac glycoside
inhibit Na/K ATPase and increase myocardial contractility
narrow therapeutic index
NO effect on mortality for HF
-only reduces symptoms
mechanism of digoxin
block Na/K ATPase
- decreased Na/Ca exchange
- results in more Ca intracellular
- stronger contraction
effects of therapeutic digoxin
prolongation of AP with AP shortening
-increased intracellular calcium
-increased cardiac contractility
increased PS tone, decreased S tone
