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54 Cards in this Set
- Front
- Back
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ACE Inhibitors: recommendation
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all patients with HF
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ACE Inhibitors: mech of action
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- inhibit conversion of AT1 to AT2
- inhibit breakdown of bradykinin |
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ACE Inhibitors: outcomes
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- prevent worsening cardiac remodeling
- decreased afterload |
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ACE Inhibitors: long-term benefits
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- reduce morbidity/mortality
- improve clinical status, slow disease progression |
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Captopril
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ACE Inhibitor
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Enalapril
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ACE Inhibitor
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Lisinopril
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ACE Inhibitor
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Ramipril
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ACE Inhibitor
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Quinapril
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ACE Inhibitor
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ACE Inhibitors: absolute contraindications
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- angioedema with prior ACE use
- renal artery stenosis |
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ACE Inhibitors: side effects
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- cough (decreased breakdown of bradykinin)
- increase SCr - hyperkalemia - hypotension - rash, taste disturbance (rare) |
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ARBs: recommendations
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for all patients with HF who are intolerant to ACE inhibitors due to angioedema or cough
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ARBs: mech of action
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Blockade of angiotensin II
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ARBs: outcomes
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- afterload reduction
- prevent worsening of remodeling??? |
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ARBs: long-term benefits
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- decrease mortality (?)
- decrease hospitilizations |
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ARBs: recent studies
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- suggest that addition of ARB to ACE is beneficial
- Recommended if additional afterload reduction is necessary |
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ARBs: contraindications
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- renal artery stenosis
- angioedema w/ prior ARB |
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ARBs: side effects
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- hyperkalemia
- increase SCr - hypotension |
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Beta Blockers: recommendation
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All clinically stable HF patients
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BBs: mech of action
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- blockade of beta-receptors
- decrease heart rate (workload of heart) |
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BBs: outcome
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- prevent worsening cardiac remodeling
- prevent arrhythmias |
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BBs: long term benefits
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- decrease morbidity/mortality
- improve clinical status (long term) |
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BBs: contraindications
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- reactive airway disease
- significant bradycardia |
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BBs: side effects
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- bradycardia
- fluid retention and worsening HF - hypotension - fatigue |
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Bisprolol
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Beta Blocker
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Carvedilol
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Beta Blocker
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Metoprolol XL
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Beta Blocker
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Spironolactone
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competive antagonist of the aldosterone receptor (myocardium, arterial walls, kidney)
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Spironolactone: recommended dosage
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12.5-50 mg daily
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Spironolactone: contraindications
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- SCr > 2.5 mg/dL
- Serum K > 5 mmol/L |
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Spironolactone: side effects
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- hyperkalemia
- gynecomastia (10%) |
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Eplerenone (Inspra)
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- Selective aldosterone antagonist
- less gynecomastia - approved for use in pts. with LV dysfunction following an MI - Role in CHF yet to be defined |
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Hydralazine and Isosorbide Dinitrate: recommendation
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patients with HF unable to take ACE or ARBs or in addition to ACE/ARB in african americans
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Hydralazine and Isosorbide Dinitrate: mech of action
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afterload and preload reduction
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Hydralazine and Isosorbide Dinitrate: outcomes
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- increase nitric oxide
- reduce endothelial dysfunction |
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Hydralazine and Isosorbide Dinitrate: side effects
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- headache
- gastrointestinal complaints - hypotension |
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Diuretics: recommendation
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all patients with symptomatic HF
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Diuretics: mech of action
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- increase excretion of sodium/fluid
- decrease fluid retention |
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Diuretics: outcomes
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- Effect on morbidity/mortality is unknown
- Alleviate symptoms (fastest onset) |
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Diuretics: long term benefits
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none - symptomatic relief only
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Diuretics: Thiazide/Thiazide-like
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- act in distal tubule - inhibit H2O and Na reabsorp
- Decreased efficacy w/ impaired renal func - End stage: used in combo with loop diuretic |
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Diuretics: Loop
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- Act in loop of henle
- Maintain efficacy w/ impaired renal func - Diuretics of choice in pts. with HF |
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Hydrochlorthiazide
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Thiazide/Thiazide-like diuretic
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Chlorothiazide (IV)
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Thiazide/Thiazide-like diuretic
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Chlorthalidone
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Thiazide/Thiazide-like diuretic
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Metolazone
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Thiazide/Thiazide-like diuretic
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Furosemide (lasix)
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Loop diuretic
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Bumetanide (bumex)
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Loop diuretic
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Torsemide
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Loop diuretic
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Diuretics: goal of therapy
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decrease edema and pulmonary congestion
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Diuretics: side effects
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- electrolyte abnormalities
- hypotension - azotemia (renal dysfunc) - Rashes. hearing difficulties (rare) |
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Digoxin: long term benefits
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- no effect on mortality
- improve symptoms, quality of life - decrease hospitilizations |
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Digoxin: side effects
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- GI symptoms (nausea, anorexia, vomiting)
- Arrhythmias - Neuro (vis. disturbances, disorientation, confusion) |
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Calcium Channel Blockers
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- no sig. role in treatment of HF
- Avoid non-DHP due to negative ionotropic effects |
