Chapter 51: Drugs for Heart Failure Flashcards
(38 cards)
what are the 2 main types of heart failure
- left ventricular diastolic dysfunction
- preserved LV ejection fraction (diastolic failure)
what is heart failure
- heart is unable to pump sufficent blood to meet the metabolic needs of tissues
heart failure is characterized by
left ventricular dysfunction, reduced cardiac output, insufficent tissue perfusion, signs of fluid retention
causes of heart failure
- chronic hypertension
- myocardial infraciton
- valvular heart disease
- coronary artery disease
- congenital heart disease
- dysrhythmias
- aging of the myocardium
signs and symptoms of heart failure
- decreased exercise tolerance
- fatigue
- SOB
- pulmonary edema
- tachycardia
- cardiogegaly
- peripheral edema
- hepatomegaly
- weight gain
- distention of jugular veins
what are the drugs for heart failure
- Diuretics
- RAAS inhibitors
- beta blockers
- digoxin
- dopamine
- hydralazine
- SGT2 inhibitors
Diuretics MOA
reduce blood volume
- decreases venous and arterial pressure, decrease pulmonary and peripheral edema, cardiac dialtion
what are the types of diuretics
- Thiazide diuretics (hydrochlorothiazide)
- loop Diuretics (furosemide)
ACE inhibitors examples
Enalapril [Vasotec]
Enalapril [Vasotec] effects
Hemodynamic benefits
- arteriolar dilation (increases stroke volume and cardiac output)
- venous dilation (reduces edema)
- suppression of aldosterone release (enhances sodium and water excretion)
Favorable impact on cardiac remodelling
ACE inhibitors adverse effects
- hypotension
- hyperkalemia
- intractable cough (mainly captopril)
- angioedema
- renal failure
- teratogenic
example of ARB
Losartan [Cozaaar]
Losartan [Cozaaar] effects
improve LV ejection fraction, reduce HF symptoms, increase exercise tolerance, decrease hospitalization, enhance quality of life, and reduce mortality
Sacubitril / valsartan [Entresto] is indicated for
HF (NYHA class II or III) to reduce death and hospitalization
Sacubitril / valsartan [Entresto] contradiction
** must wait 36 hours after stopping ACE treatment before starting Entresto
- diabetes and moderate to severe renal impairment, pregnancy/nursing, history of angioedema
Spironolactone [Aldactone] is used for
standard HF therapy
- can decrease symptoms, hospitalizations, and prolonged life
patients taking Spironolactone [Aldactone] should be monitored for
hyperkalemia
Beta blocker adverse effects
- fluid retention or worsening of HF
- fatigue
- hypotension
- bradycardia or heart block
example of beta blockers
- Carvedilol
- Bisoprolol
- Metoprolol
SGLT2 Inhibitors
- lower BP, reducing cardiac afterload which increases cardiac efficiency
SGLT2 inhibitors examples
- Dapagliflozin
- Empagliflozin
- Canagliflozin
Vasodilators examples
- Nitroglycerin
- Sodium nitroprusside [Nitropress]
- Nesiritide [Natrecor}
Nitroglycerin principle adverse effects
- hypotension
- resultant reflex tachycardia
Sodium nitroprusside [Nitropress] principle adverse effect
- profound hypotension
