Pharm II (CCF treatment)

BNP

-shortness of breath, edema and fatigue.

-Coronary artery disease (CAD), Hypertension, Diabetes, Mitral valve disease and Chronic alcohol.

• ACE Inhibitors
• Beta blockers
• Cardiac glycosides - digoxin
• Diuretics
• Vasodilators

-Inotropes

ACE inhibitors improve exercise tolerance and left ventricular ejection fraction. It decreases mortality and morbidity due to CCF.

-decrease preload, afterload, aldosterone production and inhibit cariac and vascular remodeling

• -Dry irritating persistent cough (due to increased Bradykinin)
• -Hyperkalemia
• -Angioedema
• -Fetal toxicity

• -Isosorbide dinitrate and hydralazine
• -Amlodipine and prazosin are other vasodilators and can be used in CCF

• Useful in reducing the symptoms of volume overload by:
• -decreasing the extra cellular volume
• -decreasing the venous return

• -The loop diuretics are the most effective
• -Thiazides are effective in mild cases only.

• K sparing diuretics
• -Spironolactone and Eplernone

It is a synthetic BNP (and a Arterial and venous dilator)

-It increases CO by vasodilation without increasing HR or Oxygen consumption

used to treat acutely decompensated congestive heart failure with dyspnea at rest or with minimal exertion

• -Acts primarily by inhibiting the sympathetic nervous
• system.
• -Increases beta receptor sensitivity (up regulation).
• -Anti-arrhythmic properties.
• -Anti-oxidant properties.

-Start at low dose and monitor for bradycardia

-Carvedilol and Metoprolol are the most commonly used for CCF amongst beta blockers

• Digoxin
• -Inhibition of Na/K ATPase pump increase intracellular sodium concentration – eventually increase cytosolic calcium.
• -It restores the vagal tone and abolishes the
• sympathetic over activity.

-

-Increase the refractoriness of AV node -->decreases ventricular response to atrial rate.

-Digoxin is used as a first-line drug in patients with congestive heart failure who are in atrial fibrillation.

• N/V
• Gynecomastia, visual disturbances and psychosis
• -AV block and bradycardia

Amiodarone, Verapamil and Quinidine

Enhanced by Hypokalemia and hypercalcemia

-Digoxin antibody (Digibind)

- Digitoxin is another cardiac glycoside and is similar to digoxin, but it has a LONGER half life and is eliminated via the liver. Can be used in patients with poor renal Function.

• 1. Phosphodiesterase III inhibitors
• -Milrinone (positive inotropic and vasodilator)

2. Dobutamine (a beta 1 agonist with increases contractility and CO) --- Does NOT increase HR.

• Dobutamine (or dopamine)
• Milrinone
• ___________________
• Ace inhibitors
• ARB
• Renin inhibitors
• Spironolactone/eperenone
• Diuretics
• Digoxin