Heart Failure

Question 1

ACE INHIBITORS
Drug names all end in -pril
Quinipril, captopril, etc.

Answer 1

MECHANISM
Inhibit converstion of angiotensin 1 to angiotensin 2. This inhibits vascular smooth muscle contraction. Total result is arterial vasodilation, decreased peripheral resistance.

INDICATIONS
Managing CHF 
Usually STEP 1 in managing L ventricular failure.
STEP 2 would be loop diuretics.
STEP 3 is a non-selective beta blockers.
STEP 4 is Digoxin.

SIDE EFFECTS
Nonproductive dry cough

ADVERSE EFFECTS
Excessive hypotension
Hyperkalemia
Angioedema

Question 2

Digoxin (Lanoxin)

Answer 2

MECHANISM
Increased force of contraction of cardiac muscle cells without increasing oxygen demand. EF may increase.
STEP 4 in managing heart failure.

ADVERSE EFFECTS
Toxicity which can be fatal.
Signs: cardiac arrhythmia, anorexia, nausea, vomiting, mental status changes, hallucinations and blurred vision.
ALERT
Confusion or GI symptoms in elderly may NOT be result of flu or dimentia, but digoxin toxicity. Dosage compliance is crucial. Watch for cancelled appointments as a precursor to real trouble.