Chf Drugs (Not Previously Covered)

Front 1

Decreases afterload and preload via reducing TPR and aldosterone secretion

No baroreceptor reflex

Protects against adverse remodeling of heart

Back 1

Enalapril

Front 2

Adverse Effects:

Increases bradykinin = dry cough

Not in pregnancy

Renal failure in patients with bilateral renal artery stenosis

Reflex tachycardia, drug-induced lupus, hyperkalemia

Back 2

Enalapril

Front 3

Patient Population:

Prevention/delay of progression in MI and CHF

Regression of LVH

Diabetes to prevent renal failure

Back 3

Enalapril

Front 4

Blocks binding of AT II to receptor = inhibits vasoconstriction and inhibits aldosterone release = promotes renal Na+ secretion = decreases preload and afterload

Back 4

Candesartan

Front 5

Adverse Effects:

Not in pregnancy

Back 5

Candesartan

Front 6

Patient Population:

CHF to prevent remodeling of heart due to volume overload

Back 6

Candesartan

Front 7

Blocks mostly B-1 receptors and a-1 receptor

Inhibits adverse remodeling of heart from chronically elevated catecholamines

Back 7

Carvedilol

Front 8

Adverse Effects:

Start with small dose

Hypotension, fluid retention, bradycardia, bronchospasm (asthma COPD)

Back 8

Carvedilol

Front 9

Patient Population:

CHF (improves survival)

Combined with ACE inhibitor, diuretic, and digoxin

Only after patient is stabilized

Back 9

Carvedilol

Front 10

Inhibits aldosterone = decreases Na+ reabsorption = decreases preload and afterload

Protects heart and blood vessels from fibrosis from excessive aldosterone

Also binds androgen receptors

Back 10

Spironolactone

Front 11

Adverse Effects:

Hyperkalemia (monitor plasma K+)

Can lead to AV block with digoxin

Back 11

Spironolactone

Front 12

Patient population:

CHF (improves survival)

Back 12

Spironolactone

Front 13

Aldosterone antagonist

More selective for aldosterone receptors (no binding androgen receptors)

Inhibits aldosterone = decrease Na+ reabsorption = decrease preload and afterload

Protects heart and blood vessels from fibrosis from excessive aldosterone

Back 13

Eplerenone

Front 14

Adverse Effects:

Hyperkalemia

Back 14

Eplerenone

Front 15

Patient Population:

CHF following acute MI hypertension

Back 15

Eplerenone

Front 16

Blocks PDE = increases cAMP levels in heart and vascular smooth muscle = increases IC Ca2+ and CO

Back 16

Milrinone

Front 17

Adverse Effects:

Long-term use is detrimental to heart muscle

Back 17

Milrinone

Front 18

Patient Population:

Short term management of CHF

Back 18

Milrinone

Front 19

Partially inhibits Na+/K+ ATPase = increase IC Na+ = increase [Ca2+]in because decrease driving force of Na/Ca exchanger = increase contractility = increase in CO = decrease RAS so decrease preload and afterload = decrease in heart size and congestion

Also increases vagal influences = decrease pacemaker activity at SA and AV node

Back 19

Digoxin

Front 20

Adverse Effects:

Risk of ventricular arrhythmias at high dose

Vomiting, vision changes, anorexia

Drug interactions: hypokalemia with diuretics, increased concentrations with quinidine and amiodarone, poor absorption with cholestyramine

Long half-life with narrow TI so monitor

Back 20

Digoxin

Front 21

Patient Population:

CHF

No deleterious effects on heart muscle, but does not improve survival with CHF

Decrease rate of hospitalization, decrease CHF symptoms, and increase exercise tolerance in systolic dysfunction

Back 21

Digoxin

Front 22

Combination of these venous and arteriolar dilators has been proven to prolong life in CHF

Especially in African Americans

Back 22

Isosorbide dinitrate and hydralazine