Drugs for Heart Failure Chapter 16

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Drugs for Heart FailureChapter 16
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Introduction

• Heart failure (HF) is one of the most common and
  fatal of the cardiovascular diseases, and its
  incidence is expected to increase as the
  population ages.
• On your own!!

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Cardiac Glycosides

• Cardiac glycosides increase the force of
  myocardial contractionTable 16.2 pg. 283
• Traditional drugs of choice for HF
• Extracted from foxglove plants (Digitalis purpura
  and Digitalis lanata)

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Cardiac Glycosides

• Digitalis helps heart contract more forcefully
  and beat slower
• Narrow margin of safety
• DPdigoxin (Lanoxin)---pg. 285
• Hold if HR lt 60
• Monitor serum levels

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Angiotensin Converting Enzyme (ACE Inhibitors)

• ACE inhibitors are becoming first-line drugs for
  cardiac failureTable 16.2 pg. 283
• Lower peripheral resistance and reduce blood
  volume diminishes the after-load and increase
  cardiac output
• Dilate veins returning blood to heart decreases
  preload and peripheral edema
• DPlisinopril (Prinivil, Zestoric) pg. 286

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Vasodilators

• Vasodilators can help reduce symptoms of heart
  failure by decreasing the oxygen demands on the
  heartTable 16.2.
• Minor role in drug therapy for HF.
• Relax blood vessels and lower BP
• Many side effects-reserved for clients who cannot
  tolerate ACE inhibitors
• DPisosorbide dinitrate (Isordil) pg. 289

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Diuretics

• Diuretics are effective at reducing fluid volume
  and relieving symptoms of heart failureTable
  16.2 pg. 283
• Reduce blood volume, edema and congestion.
• Workload on heart reduced and cardiac output
  increases.
• Used in combination with other drugs to treat HF.
• DPfurosemide (Lasix) pg. 287

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Phosphodiesterase Inhibitors

• Phosphodiesterase inhibitors increase the force
  of contraction and cause vasodilationTable 16.2
  pg. 283.
• Used for short-term control of acute HF.
• Block enzyme phosphodiesterase in cardiac muscle
  and smooth muscle
• Very toxic
• Reserved for clients not responding to ACE
  inhibitors or cardiac glycosides
• Used generally 2-3 days
• DPmilrinone (Primacar) pg. 288

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Beta-Adrenergic Blockers

• Beta-adrenergic blockers play a minor role in the
  treatment of HF
• Reduce cardiac worklooad by decreasing afterload.
• Usually used in combination with other drugs
• DPcarvedilol (Coreg) pg. 289