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19 Cards in this Set
- Front
- Back
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Heart Failure (Congestive heart failure)
Fall '09 |
Sad heart or Stressed heart
:( |
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What are complications of Heart Failure?
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Heart failure (CHF):
Ventricular dysfunction Reduced cardiac output Insufficient tissue perfusion Fluid retention |
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These are the principle drugs that are given for heart failure:
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Principle drugs for HF:
ACE inhibitors Diuretics Inotropic agents(sympathomimetic) Beta blockers Aldosterone Receptor Blocker |
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ACE inhibitors
Major parts of 1st line of treatment What are an ACE inhibitor's actions? |
Action
1.)Block production of angiotensin II 2.)Dilate arterioles and veins 3.)Decrease release of aldosterone |
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ACE inhibitors adverse effects:
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ACE inhibitors adverse effects:
*Hypotension Hyperkalemia Cough |
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Diuretics
1st line therapeutics |
1st-line therapeutics:
High GFR = thiazides Low GFR = loop diuretics Use of K-sparing to offset K loss (as with HTN) |
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Diuretics
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Mechanism of Action:
*Reduce blood volume, decrease venous pressure, decrease afterload, decrease pulmonary edema, peripheral edema, cardiac dilation |
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Diuretics
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Side effects:
*Hypokalemia in thiazides and loop diuretics, which increases risk of digoxin-induced dysrhythmias *Hyperkalemia in K-sparing diuretics, especially if not discontinued when beginning an ACE inhibitor |
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Beta Blockers
Metoprolol [Lopressor] Carvedilol [Coreg] You've learned this already |
Action:
With careful control of dosage, can improve patient status (Previously thought counterintuitive to use b/c contractility) Improves LV ejection and exercise tolerance, slows HF progression |
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Beta Blockers Adverse effect:
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Adverse effects:
Fluid retention, Fatigue Hypotension, Bradycardia or heart attack |
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Spironolactone:
Aldosterone receptor blocker (Unrelated to spironolactone’s K-sparing diuretic effect) |
Inhibits:
Aldosterone-mediated Na retention and also Myocardial remodeling (impairs pumping) Activation of sympathetic nervous system (promotes dysrhythmia and ischemia) Baroreceptor dysfunction |
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Spironolactone:
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Side effects:
Gynecomastia & hyperkalemia Measure K levels, ACE inhibitors contraindicated, ARBs in pts w/ renal insufficiency |
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Inotropic Agents
Mode of action: |
Inotropic Agents Mode of action:
Increase force of contraction |
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Inotropic Agents
Sympathomimetics (Here are the two important ones): |
Dopamine [Intropin]
Activates beta1 AR in heart Increases contractility and HR (risk of tachycardia) |
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Inotropic Agents
Sympathomimetics (Here are the two important ones): |
Dobutamine [Dobutrex]
More beta1 selective (no alpha1) Can cause tachycardia |
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Digoxin [Lanoxin]
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Digoxin aka Digitalis or digitalis glycosides:
Oldest and most frequently prescribed ionotropic drug Digitoxin withdrawn from US market |
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Digoxin Positive inotropic effect
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Digoxin effect:
Increases myocardial contractility Increases cardiac output |
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Digoxin:
Decreased sympathetic tone Increases arterial pressure Increased urine production Decreased renin release |
Digoxin MOA:
**Inhibits Na/K-ATPase, promoting calcium accumulation Calcium release causes increased force Low K = high dig binding |
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Digoxin:
Due to dysrhthmias, significant cardiotoxicity if not monitored |
Digoxin CAUTION:
Hypokalemia, Elevated digoxin levels, Heart disease, Cardiotoxicity Therapeutic range (0.5 to 1.1 ng/ml) |
