Heart Failure Drugs
Terms
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- ACE Inhibitors: recommendation
- all patients with HF
- ACE Inhibitors: mech of action
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- inhibit conversion of AT1 to AT2
- inhibit breakdown of bradykinin - ACE Inhibitors: outcomes
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- prevent worsening cardiac remodeling
- decreased afterload - ACE Inhibitors: long-term benefits
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- reduce morbidity/mortality
- improve clinical status, slow disease progression - Captopril
- ACE Inhibitor
- Enalapril
- ACE Inhibitor
- Lisinopril
- ACE Inhibitor
- Ramipril
- ACE Inhibitor
- Quinapril
- ACE Inhibitor
- ACE Inhibitors: absolute contraindications
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- angioedema with prior ACE use
- renal artery stenosis - ACE Inhibitors: side effects
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- cough (decreased breakdown of bradykinin)
- increase SCr
- hyperkalemia
- hypotension
- rash, taste disturbance (rare) - ARBs: recommendations
- for all patients with HF who are intolerant to ACE inhibitors due to angioedema or cough
- ARBs: mech of action
- Blockade of angiotensin II
- ARBs: outcomes
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- afterload reduction
- prevent worsening of remodeling??? - ARBs: long-term benefits
-
- decrease mortality (?)
- decrease hospitilizations - ARBs: recent studies
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- suggest that addition of ARB to ACE is beneficial
- Recommended if additional afterload reduction is necessary - ARBs: contraindications
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- renal artery stenosis
- angioedema w/ prior ARB - ARBs: side effects
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- hyperkalemia
- increase SCr
- hypotension - Beta Blockers: recommendation
- All clinically stable HF patients
- BBs: mech of action
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- blockade of beta-receptors
- decrease heart rate (workload of heart) - BBs: outcome
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- prevent worsening cardiac remodeling
- prevent arrhythmias - BBs: long term benefits
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- decrease morbidity/mortality
- improve clinical status (long term) - BBs: contraindications
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- reactive airway disease
- significant bradycardia - BBs: side effects
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- bradycardia
- fluid retention and worsening HF
- hypotension
- fatigue - Bisprolol
- Beta Blocker
- Carvedilol
- Beta Blocker
- Metoprolol XL
- Beta Blocker
- Spironolactone
- competive antagonist of the aldosterone receptor (myocardium, arterial walls, kidney)
- Spironolactone: recommended dosage
- 12.5-50 mg daily
- Spironolactone: contraindications
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- SCr > 2.5 mg/dL
- Serum K > 5 mmol/L - Spironolactone: side effects
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- hyperkalemia
- gynecomastia (10%) - Eplerenone (Inspra)
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- Selective aldosterone antagonist
- less gynecomastia
- approved for use in pts. with LV dysfunction following an MI
- Role in CHF yet to be defined - Hydralazine and Isosorbide Dinitrate: recommendation
- patients with HF unable to take ACE or ARBs or in addition to ACE/ARB in african americans
- Hydralazine and Isosorbide Dinitrate: mech of action
- afterload and preload reduction
- Hydralazine and Isosorbide Dinitrate: outcomes
-
- increase nitric oxide
- reduce endothelial dysfunction - Hydralazine and Isosorbide Dinitrate: side effects
-
- headache
- gastrointestinal complaints
- hypotension - Diuretics: recommendation
- all patients with symptomatic HF
- Diuretics: mech of action
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- increase excretion of sodium/fluid
- decrease fluid retention - Diuretics: outcomes
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- Effect on morbidity/mortality is unknown
- Alleviate symptoms (fastest onset) - Diuretics: long term benefits
- none - symptomatic relief only
- Diuretics: Thiazide/Thiazide-like
-
- act in distal tubule - inhibit H2O and Na reabsorp
- Decreased efficacy w/ impaired renal func
- End stage: used in combo with loop diuretic - Diuretics: Loop
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- Act in loop of henle
- Maintain efficacy w/ impaired renal func
- Diuretics of choice in pts. with HF - Hydrochlorthiazide
- Thiazide/Thiazide-like diuretic
- Chlorothiazide (IV)
- Thiazide/Thiazide-like diuretic
- Chlorthalidone
- Thiazide/Thiazide-like diuretic
- Metolazone
- Thiazide/Thiazide-like diuretic
- Furosemide (lasix)
- Loop diuretic
- Bumetanide (bumex)
- Loop diuretic
- Torsemide
- Loop diuretic
- Diuretics: goal of therapy
- decrease edema and pulmonary congestion
- Diuretics: side effects
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- electrolyte abnormalities
- hypotension
- azotemia (renal dysfunc)
- Rashes. hearing difficulties (rare) - Digoxin: long term benefits
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- no effect on mortality
- improve symptoms, quality of life
- decrease hospitilizations - Digoxin: side effects
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- GI symptoms (nausea, anorexia, vomiting)
- Arrhythmias
- Neuro (vis. disturbances, disorientation, confusion) - Calcium Channel Blockers
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- no sig. role in treatment of HF
- Avoid non-DHP due to negative ionotropic effects