CARDIOLOGY DRUGS
Heart failure
Tablets used in heart failure include:
• Diuretics
• Spironolactone
• ACE-Is and ARBs
• Nitrates
• Ivabradine
• Sacubitril
• Heparin (inpatient)
• Digoxin (?)
• Other vasodilators (?)
Acute left ventricular failure
• Nitrate infusion
o Causes veno-relaxation, reduces preload
o Has less effect on afterload
o Metabolized and release nitric oxide
§ This increases cGMP and activates protein kinase G
o SEs: headaches, hypotension
• IV loop diuretics
• IV diamorphine
• Oxygen
Congestive cardiac failure
Would look for the cause and treat if possible. Quality vs quantity of life.
• Loop diuretics
• ACE-I + ARBs
• Spironolactone
• Beta blockers
• Ivabradine
• Sacubitrol
• (?) IHD
o Statins, aspirin, clopidogrel
• Other vasodilators – e.g. hydralazine
• Digoxin
• Heart transplant, stem cells, renal denervation
DIURETICS
• Thiazide-like
• Metolazone
• Loop diuretics
o E.g. bumetanide, furosemide
o MOA:
§ Inhibit transport of NaCl from ascending loop
of henle into interstitial fluid
§ Act on Cl binding site
§ Cause Na loss (wanted), K + Mg loss
(unwanted), Ca loss (useful in hypercalcaemia)
§ Stimulate RAAS
§ (?) decrease absorption with gut oedema and ascites
§ Probable veno-dilator effect when given IV
• Potassium sparing
o E.g. amiloride, triamterene
• Aldosterone antagonists
o E.g. spironolactone, eplenerone
Heart failure
Tablets used in heart failure include:
• Diuretics
• Spironolactone
• ACE-Is and ARBs
• Nitrates
• Ivabradine
• Sacubitril
• Heparin (inpatient)
• Digoxin (?)
• Other vasodilators (?)
Acute left ventricular failure
• Nitrate infusion
o Causes veno-relaxation, reduces preload
o Has less effect on afterload
o Metabolized and release nitric oxide
§ This increases cGMP and activates protein kinase G
o SEs: headaches, hypotension
• IV loop diuretics
• IV diamorphine
• Oxygen
Congestive cardiac failure
Would look for the cause and treat if possible. Quality vs quantity of life.
• Loop diuretics
• ACE-I + ARBs
• Spironolactone
• Beta blockers
• Ivabradine
• Sacubitrol
• (?) IHD
o Statins, aspirin, clopidogrel
• Other vasodilators – e.g. hydralazine
• Digoxin
• Heart transplant, stem cells, renal denervation
DIURETICS
• Thiazide-like
• Metolazone
• Loop diuretics
o E.g. bumetanide, furosemide
o MOA:
§ Inhibit transport of NaCl from ascending loop
of henle into interstitial fluid
§ Act on Cl binding site
§ Cause Na loss (wanted), K + Mg loss
(unwanted), Ca loss (useful in hypercalcaemia)
§ Stimulate RAAS
§ (?) decrease absorption with gut oedema and ascites
§ Probable veno-dilator effect when given IV
• Potassium sparing
o E.g. amiloride, triamterene
• Aldosterone antagonists
o E.g. spironolactone, eplenerone
