CHF PHARM Flashcards
Aldosterone Antagonists
Spironolactone
K+ sparing diuretics
-reserved for pts with class III-IV HF, reduces HF related death
-Well tolerated
CI: hyperkalemia, gynecomastia
K and creatinine levels should be monitored
Loop Diuretics
Furosemide
Lower BP by depleting NA+ stores, reduced total blood volume –> decreased CO then decreased PVR
-relief of fluid retention: pulmonary congestion or peripheral edema improves exercise tolerance
AE: electrolyte depletion, higher doses assoc w/ mortality
CI: never use alone to tx CHF only provides symptomatic relief
ACE inhibitors
Enalapril, Captopril
Blocks conversion of angiotensin I to angiotensin II
- recommended for all CHF pts (EF <40%), decreases afterload by decreasing systemic vascular resistance, relieves sxs, improves exercise tolerance and reduces progression and risk of death
-AE: decreased BP, worsen kidney function, hyperkalemia, chronic cough
CI: pts w/ hx of angioedema and preg
ARBS
Candesaran, Losartan
Block AT1 receptors that bind angiotensin II, prevent vasoconstriction, NA retention, SNS activation and cardiac remodeling
-Tx of pts who are ACE intolerant or w/ hx of angioedema
-AE: hyperkalemia, 1st dose hypotension, taste disturbances
CI: preg
not considered equivalent or better than ACE
Beta Blockers
Metoprolol, Carvedilol
Blocks excessive sympathetic NS stimulation, decreases Co and renin release
reserved for pts with class I-III HF, combo w/ ACE both at high dose, reduces disease progression and risk of death
AE: hypotension, lightheaded, bradycardia, fatigue, GI or CNS tox
CI: less effective for AA
Glycosides
Digoxin
-enhances contractility of cardiac muscles, reduces activation of the SNS and RAAS
-pts w/ mild-moderate HF taking B-Blockers or ACCE and pts w/ Afib, reduces sxs and increases exercise tolerance, reduce hospitalization and disease progression
AE: tox GI, CNS, HA, weakness, dizzy, skin rash, arrhythmias, gynecomastia
CI: IV or PO not IM, IV given over 15 min
Does not improve survival
