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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
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