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Heart Failure Drugs


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

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