DRUGS USED IN THE TREATMENT OF

CONGESTIVE HEART FAILURE

Congestive Heart Failure

CHF : COP does not meet the needs of the tissue.

The therapeutic goal: ( COP) - the cardiac muscle strength- ECF vol. (diuretic)

Note: vasodilator the load on myocardium

Cardiac Failure

Venous pressure Cardiac output

Sympathetic activity Blood pressure

Renal blood flow

Renin, angiotensin II

Aldosteron

Sodium retentioncapillary filtration

Edema

Drug used to treat CHF

• contractility of cardiac muscle CO Inotropic

Agents

• ECF volume preload edema

Diuretics

• afterload CO

Vasodilator

Drug Used To Treat CHF

Cardiac Glycosid

es

• Digoxin• Digitoxin• Quabain

Adrenerg

ic Agonist

• Dobutamin

• Dopamine

Bipyridines (p.e)

• Inamrinone

• Milrinone

Inotropic agent

Drug Used To Treat CHF

•FurosemidDiuretics

•ACEI•CCB

Vasodilators

DIGOXIN (Inotropik agents)Therapeutic use of glycosides is confounded by:

1. Variable pharmacokinetics2. Numerous drug interaction3. Narrow therapeutic index

Mechanism of action>< membrane Modifying SympatheticNa+ /K+ ATP ase activity

Intracellular Na+ & Ca+ Myofibril contraction rate of impulse (inotropic +) by SA-node

(chronotropic -)

Cardiac output depress High level conduction via AV-node

-Adrenoceptor

V.Constriction PR

Toxic Effect Of Digoxin

GITAnorexia, nausea, vomiting, abdominal pain

VISUALDisturbed color vision (green or yellow halo around lights)

PSYCHIATRICDelirium, fatigue, malaise, confusion, dizziness, Abn dream

RESPIRATORYVentilatory response to hypoxia

CARDIACDysrhytmia, Ventricular fibrillation and cardiac arrest are the most common causes of death

Factors that alter patient sensitivity to digoxin

Serum electrolyte abnormalities:HypokalemiaHypomagnesiaHypercalcemia

Acid base imbalance Thyroid (hypothyroid) Renal failure

DRUG INTERACTION

Digitalis level may

AmiodaroneErythromycin base

QuinidineTetracyclineVerapamil

Enhanced potentialfor cardiotoxicity

levels ofBlood K+

CorticosteroidsThiazide diuretics

Loop diuretics

Beta Adrenergic AgonistI. Dopamine Stimulated effect on the:

receptor inotropic chronotropic Dopamine receptor blood flow to the kidney, viscera receptor vasoconstriction Indication: - Refractory Cardiac Failure - Cardiogenic Shock

II. Dobutamin

Asynthetic analog of dopamin Cardiac Output

Indication: - Refractory Heart Failure

- Severe acute myocardial failure (after cardiac surgery)

- Cardiogenic shock

Diuretics I. Loop Diuretics: Furosemid,

BumetamidII. Thiazide Diuretics: Chlorothiazide,

Hydrochlorothiazide III. Potassium Sparing Diuretics:

Spironolactone

EFFECT Relieve peripheral edema Relieve pulmonary congestion symptoms:

orthopnea, paroxysmal nocturnal dyspnea. Decreased plasma preload cardiac load and O2

demand afterload BP Hypokalemia

Angiotensin Converting Enzyme (ACE) Inhibitors

Angiotensin II bradikynin sympathetic activities

Vasodilatation aldosteron

afterload water & Na retention

preload

CO hypertrophy edemaremodeling heart & vasc.

Indication DOC HT CHF (left ventricular dysfunction) Patient who have had a recent myocardial

infarction

Angiotensin II Receptor Blockers

Losartan Condersartan Valsartan Iberstan

• Eprosartan• Tazosartan• Telmisartan• Zolasartan

Calcium Channel Blockers Vasodilator --- Ind: HT with heart

disfunctions Golongan:1. Verapamil2. Diltiazem3. Dihidropiridin- Nifedipine- Amlodipine- Ticlodipine- Etc ...