congestive heart failure(drtruly)

8/12/2019 Congestive Heart Failure(DrTruly)

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DRUGS USED IN THE

TREATMENT OF CONGESTIVE

HEART FAILURE

TRULY SITORUS


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Congestive Heart Failure

CHF is a condition in which the heart is unable to

pump suffient blood to meet the needs of the body.

Underlying disease: Hypertensiv Heart Disease

Coronary Heart Disease

Valvular Heart Disease

Cardiomyopathy

Congenital Heart Disease

Others


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Compensatory mechanism:

Pre Load Cardiac Output

Compensatory

Na+ - H2O Retention Renin-Angiotensin,

Aldosteron

Sympathetic ActivitySystemic Vascular Resistance Na+-H2O Retention


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Cardiac Failure

Venous pressure Cardiac output

Sympathetic activity Blood pressure

Renal blood flow

Renin, angiotensin II

Aldosteron

Sodium retentioncapillary filtration

Edema


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Drug used to treat CHFI. Inotropic Agents

Increase the strength of contraction of

cardiac muscle

II. Diuretics

Decrease ECF volume

III. VasodilatorReduce the load on the myocardium


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Drug used to treat CHF

I. Inotropic Agents

1.1. Cardiac Glicosides

- Digoxin- Digitoxin

- Quabain

1.2. Adrenergic Agonist- Dobutamin- Dopamin


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1.3. Phosphodiesterase Inhibitors

- Amrinone

- Milrinone

II. Diuretics

Furosemid

- HydrochlorothiazideIII. Vasodilators

3.1. ACE Inhibitors

- Captopril - Enalapril- Fosinopril - Lisinopril

- Quinapril

3.2. Others


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DIGOXIN

Therapeutic use of glycosides is

confounded by:

1. Variable pharmacokinetics

2. Numerous drug interaction

3. Narrow therapeutic index


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Mechanism of action

Inhibiting membran Na+,K+ATP ase

intracellular Na+

intracellular Ca+

myofibril contraction Cardiac Output!!Modifying autonomic neural discharge

the rate of impulse formation by the S-A node High concentration

(depress) conduction of the impulses throughthe A-V Node


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Effect

Inotropic

Chronotropic

Domotropic Oxygen consumption?


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Toxic effect of digoxin

Gastrointestinal

Anorexia, nausea, vomiting, abdominal pain

Visual

Disturbed color vision (green or yellow haloaround lights)

Psychiatric

Delirium, fatigue, malaise, confusion, dizziness,abnormal dream

Respiratory

Ventilatory response to hypoxia


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Cardiac

Dysrhytmia,

Ventricular fibrillation and cardiac arrest are

the most common causes of death


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Factors that alter patient sensitivity to

digoxin Serum electrolyte abnormalities:

Hypokalemia

HypomagnesiaHypercalcemia

Acid base imbalance

Thyroid (hypothyroid)

Renal failure


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Drug interaction

Increased digitalisConcentration may

occur during

Concurrent therapy

AmiodaroneErythromycin base

Quinidine

Tetracycline

Verapamil

Enhanced potential

for cardiotoxicity

Decreased levels of

Blood potassium

Corticosteroids

Thiazide diuretics

Loop diuretics


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Indication

Congestive Heart Failure

Other condition: Cardiac Arrhythmias

Contraindication:

ArrhythmiasPotassium depletion


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Beta Adrenergic Agonist

I. DopamineStimulated effect on the:

receptor inotropicchronotropicDopamine receptor blood flow to thekidney, viscera

receptor vasoconstrictionIndication: Refractory Cardiac Failure

Cardiogenic Shock


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II. Dobutamin

Asynthetic analog of dopaminDopamine increase Cardiac Output with

little change in the HR and does not

significantly elevated oxygen demandsof the myocard.

Indication: Refractory Heart Failure

Severe acute myocardial failure

(after cardiac surgery)

Cardiogenic shock


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Diuretics

I. Loop Diuretics:FurosemidTorsemidBumetamid

II. Thiazide Diuretics:ChlorothiazideHydrochlorothiazideChlorthalidone

III. Potassium Sparing Diuretics:Spironolactone


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Effect

Relieve peripheral edema

Relieve pulmonary congestion

symptoms: orthopnea, paroxysmalnocturnal dyspnea.

Decreased plasma volume

preload

cardiac load and O2afterload demandBP

Hypokalemia


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Thiazide

Decrease the reabsorption Na+by inhibitionof Na+/ Cl-cotransporter

Increase excretion of Na+

and Cl-

loose of K+Decreased urinary Ca++excretion

Reduced peripheral vascular resistance

Furosemid (?)

Spironolactone (?)


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Angiotensin Converting Enzime (ACE)

Inhibitors Vasodilatation

Bradikinin

Sympathetic NS

Na-water retention

AI AII Preload

Afterload

Cardiac output


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ACE Inhibitor

Captopril Quinapril

Enalapril Rapipril

Lisinopril Fosinopril

Benazepril


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ADR

Skin rash, dysgeusia and proteinuria

Angioedema

Neutropenia, agranulocytosis,

glomerulonephritis (rare)


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Indication

CHF in a symptomatic patient (left

ventricular dysfunction)

Patient who have had a recent myocardialinfarction


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Angiotensin II Receptor Blockers

Losartan

Condersartan

Valsartan

Iberstan

Eprosartan

Tazosartan

Telmisartan Zolasartan

congestive heart failure(drtruly)

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