Download Drugs used for Congestive Heart Failure

Drugs used for Congestive Heart
Failure
Drug List
Inotropic
Drugs
Digoxin
Dobutamine
Dopamine
Milrinone
Drugs affecting the
renin-angiotensinaldosterone system
Captopril
Enalaprilat
Losartan
Spironolactone
Diuretics
Furosemide
Thiazides
More drugs have been mentioned in the following slides
Beta-blockers
Metoprolol
Carvedilol
Vasodilators
Nitrates
Hydralazine
Nesiritide
• Vasodilators: Nitrates that act to directly relax
vascular muscle tone and cause decrease in blood
pressure with pooling of blood in the veins. The
preload and afterload will be decreased
• ACE inhibitors: are agents that block the
conversion of angiotensin 1 to angiotensin 2.
These drugs causes vasodilatation and decreased
blood volume. The afterload will be decreased.
• Diuretics: are employed to decrease the blood
volume, which decreased the venous return and
blood pressure. The results are decreased preload
and decreased afterload.
• Beta agonists: will stimulate the beta receptors in
the heart, increasing the myocardial contraction –
called positive inotropic effect
• Cardio-tonic drugs: These agents effect the
intracellular Ca++ levels in the heart muscle cells
leading to increased contractility. The result is
increased cardiac output, increased renal blood
flow, increased perfusion and increased urine
formation. Cardiotonic drugs are:
• Cardiac Glycosides
• Phosphodiesterase inhibitors
Cardiac glycosides - Digoxin
• They increase the level of calcium inside the
cardiac myocyte by inhibiting the Na+/K+ pump.
• More Ca++ accumulates in the cytoplasm
during depolarization and the myocardium will
contract forcefully. This is known as positive
inotropic effect
• Increased cardiac output
• Increased blood flow to the body organs like the kidney
and liver
Effects of Cardiac Glycosides
• Negative chronotropic effect: The heart rate
is slowed due to decreased rate of cellular
repolarization
• Decreased conduction velocity through AV
node
Contraindications and Precautions
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Allergy
Ventricular dysrhythmias
Heart block
Sick sinus syndrome
Acute myocardial infarction
Aortic stenosis
Electrolyte imbalances: Hypokalemia,
Hypomagnesemia, hypercalcemia
• Renal failure may cause accumulation of drug
Adverse effects of digoxin
• Headache, weakness, seizures and drowsiness
• Arrhythmias
• Signs of digitalis toxicity: anorexia, nausea
and vomiting, visual changes – yellow halo
around objects, palpitations or slow heart rate