Drug Therapy for Heart Failure
Cardiac Glycosides Sympathomimetics Phosphodiesterase
Diuretics Inhibitors
Thiazide diuretics Loop Diuretics Potassium-Sparing
diuretics
*Prototype *hctz (HydroDiuril) *furosemide (Lasix) *spironolactone (Aldactone) *digoxin (Lanoxin) *dobutamine *milrinone (Primacor)
-chlorothiazide (Diuril) -ethacrynic acid (Edecrin) -triamterene (Dyrenium) -dopamine -inamrinone (Inocor)
and -bumetanide (Bumex) -Amiloride (Midamor)
Others
Action -acts on proximal portion of -acts on ascending loop of -spironolactone: acts on -Na, K-ATPase inhibited by digoxin -HF decrs cardiac OP, renal -ihn PDE3, an enzyme that
distal convoluted tubule Henle in renal tubule distal portion of nephron unit -intracellular calcium increase; perfusion breaks down cAMP, which
blocks Na, Cl reabsorption blocks reabsorption of Na, -> blocks actions of support interaction bw actin & -Dobutamine activase beta 1 accumulates w/in cardiac cells,
(increase excretion of NA, Cl, Cl (incrs excretion of Na, aldosterone so incrs excretion myosin adrenergic receptors when incrs contractility (+ effect),
H2O/urine O/P, K) Cl, H2O, urine o/p, K of Na, decrs excretion of K, -> incrs myocardial contraction (+ given in therapeutic doses. which incrs force of
-adequate kidney perfusion, small incrs in excretion of inotropic effect)-> incrs cardiac OP ->incrs cardiac contraction (+ contraction, incrs cardiac OP
GFR is needed for drug to H2O (decrs in release of angiotensin II & effct), force of heart contract,
work. renin, so decrs vasoconstriction, incrs cardiac OP & incrs kidney
incrs excretion of water, Na) perfusion-> incrs urine OP & Na
->incrs parasympathetic, decrs excretion, so decrs fluid load
sympat influence -> slow electrical decrs workload of the heart.
conduction thru AV node (negative
chronotropic) -> slows HR.
Treatment -HF -pulmonary edema in HF -HTN -maintain therapy for HF -increases cardiac Output in -ST tx for low cardiac OP in HF
-hypertension -edema caused by renal, -edema caused by HF -cardiac dysrhythmias severe HF (ST use only)
for: -cirrhosis of liver hepatic, cardiac failure not -cirrhosis of liver A-fib (atrial fibrillation)
-renal failure affected by other diuretics -nephrotic syndrome atrial flutter
-HTN not controlled by -hypokalemia -->paroxysmal A-tachycardia (A-
other diuretics tach)
Giving by -PO, combo with other drugs: -PO (w/foods), IM, IV -PO w/food to incrs absortion -PO in caps (w/foods or w/o), elixir, IV infusion only -IV only
K-sparing diuretics, ACE inh, -if ordered bid, give 2 dose -tablet maybe crushed/mixed IV -dose base on pt’s wt, titrated -give a loading dose over 10
ARBs, beta blockers by early afternoon w/foods/fluids if pt is unable -tabs maybe crushed/mixed base on continuous monitoring min, then a dose based on pt’s
-give w/foods to min GI effects -give IV form undiluted to swallow whole w/foods of vs, ecg, urine op, cardiac op, wt by continuous infusion
-give last dose of day by 3pm slowly to prevent -IV gives directly over at least 5 pulmonary wedge pressures -some soln incompat exist; use
to prevent nocturia, sleep loss. ototoxicity mins, monitor sites carefully for -peak effect- 10mins after dedicated IV line if possible.
-protect from light; store infiltration-caused tissue damage. infusion begins
oral soln in fridge, others -correct any fluid vol deficits b4
at room temp giving dobut
Side Effects -F/E imbal: low Na -lytes imbal; low Na, Cl, -HyperK -GI: n/v, anorexia -tachycardia -hypoK
(hyponatremia), low Cl severe fld loss, low K, -menstrual irreg, abnormal -CNS: HA, visual disturb, yellow, -cardiac dysrhythmias -cardiac dysrhythmias
and (hypochloremia), severe fluid hypotension hair growth (on face), blurred vision -> may be early signs -possible angina pain -hypotension
Adverse loss (dehydration), low K -ototoxicity (all loop deepening voice may occur in of toxicity -anginal chest pain
(hypokalemia). diuretics) maybe temp or women; gynecomastia -cardiac dysrhythmias- digoxin
Effects -hyperglycemia in pt w/DM permanently depending (growth of breast tissues in toxicity -> any dysrhythmia may
Cardiac Glycosides Sympathomimetics Phosphodiesterase
Diuretics Inhibitors
Thiazide diuretics Loop Diuretics Potassium-Sparing
diuretics
*Prototype *hctz (HydroDiuril) *furosemide (Lasix) *spironolactone (Aldactone) *digoxin (Lanoxin) *dobutamine *milrinone (Primacor)
-chlorothiazide (Diuril) -ethacrynic acid (Edecrin) -triamterene (Dyrenium) -dopamine -inamrinone (Inocor)
and -bumetanide (Bumex) -Amiloride (Midamor)
Others
Action -acts on proximal portion of -acts on ascending loop of -spironolactone: acts on -Na, K-ATPase inhibited by digoxin -HF decrs cardiac OP, renal -ihn PDE3, an enzyme that
distal convoluted tubule Henle in renal tubule distal portion of nephron unit -intracellular calcium increase; perfusion breaks down cAMP, which
blocks Na, Cl reabsorption blocks reabsorption of Na, -> blocks actions of support interaction bw actin & -Dobutamine activase beta 1 accumulates w/in cardiac cells,
(increase excretion of NA, Cl, Cl (incrs excretion of Na, aldosterone so incrs excretion myosin adrenergic receptors when incrs contractility (+ effect),
H2O/urine O/P, K) Cl, H2O, urine o/p, K of Na, decrs excretion of K, -> incrs myocardial contraction (+ given in therapeutic doses. which incrs force of
-adequate kidney perfusion, small incrs in excretion of inotropic effect)-> incrs cardiac OP ->incrs cardiac contraction (+ contraction, incrs cardiac OP
GFR is needed for drug to H2O (decrs in release of angiotensin II & effct), force of heart contract,
work. renin, so decrs vasoconstriction, incrs cardiac OP & incrs kidney
incrs excretion of water, Na) perfusion-> incrs urine OP & Na
->incrs parasympathetic, decrs excretion, so decrs fluid load
sympat influence -> slow electrical decrs workload of the heart.
conduction thru AV node (negative
chronotropic) -> slows HR.
Treatment -HF -pulmonary edema in HF -HTN -maintain therapy for HF -increases cardiac Output in -ST tx for low cardiac OP in HF
-hypertension -edema caused by renal, -edema caused by HF -cardiac dysrhythmias severe HF (ST use only)
for: -cirrhosis of liver hepatic, cardiac failure not -cirrhosis of liver A-fib (atrial fibrillation)
-renal failure affected by other diuretics -nephrotic syndrome atrial flutter
-HTN not controlled by -hypokalemia -->paroxysmal A-tachycardia (A-
other diuretics tach)
Giving by -PO, combo with other drugs: -PO (w/foods), IM, IV -PO w/food to incrs absortion -PO in caps (w/foods or w/o), elixir, IV infusion only -IV only
K-sparing diuretics, ACE inh, -if ordered bid, give 2 dose -tablet maybe crushed/mixed IV -dose base on pt’s wt, titrated -give a loading dose over 10
ARBs, beta blockers by early afternoon w/foods/fluids if pt is unable -tabs maybe crushed/mixed base on continuous monitoring min, then a dose based on pt’s
-give w/foods to min GI effects -give IV form undiluted to swallow whole w/foods of vs, ecg, urine op, cardiac op, wt by continuous infusion
-give last dose of day by 3pm slowly to prevent -IV gives directly over at least 5 pulmonary wedge pressures -some soln incompat exist; use
to prevent nocturia, sleep loss. ototoxicity mins, monitor sites carefully for -peak effect- 10mins after dedicated IV line if possible.
-protect from light; store infiltration-caused tissue damage. infusion begins
oral soln in fridge, others -correct any fluid vol deficits b4
at room temp giving dobut
Side Effects -F/E imbal: low Na -lytes imbal; low Na, Cl, -HyperK -GI: n/v, anorexia -tachycardia -hypoK
(hyponatremia), low Cl severe fld loss, low K, -menstrual irreg, abnormal -CNS: HA, visual disturb, yellow, -cardiac dysrhythmias -cardiac dysrhythmias
and (hypochloremia), severe fluid hypotension hair growth (on face), blurred vision -> may be early signs -possible angina pain -hypotension
Adverse loss (dehydration), low K -ototoxicity (all loop deepening voice may occur in of toxicity -anginal chest pain
(hypokalemia). diuretics) maybe temp or women; gynecomastia -cardiac dysrhythmias- digoxin
Effects -hyperglycemia in pt w/DM permanently depending (growth of breast tissues in toxicity -> any dysrhythmia may
