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Drugs for HF and Angina

Drugs for HF and Angina

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Published by: api-3739910 on Oct 15, 2008
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DRUGS FOR CARDIAC DISORDERS
Congestive heart failure (CHF)
\ue000condition when heart muscle fails to effectively pump blood through the heart & systemic
circulation\ue001 build-up of blood (congestion).
\ue000Causes:
\u2022
damaged heart muscle
\ue002atherosclerosis / coronary artery dse (CAD)
\ue002cardiomyopathy
\u2022
increased demand to heart muscle to work harder
\ue002hypertension
\ue002valvular disease
\u2022
abnormal heart structure
\ue002congenital cardiac defects
Left-sided Heart failure
\ue000when LV does not contract sufficiently \ue001 excessive blood backs up into lung tissue.
\ue000s/sxs
\u2022
pulmonary edema
o
tachypnea
o
dyspnea
o
orthopnea
o
hemoptysis
o
rales /wheezes
\u2022
cardiomegaly, increase HR, S3
\u2022
anxiety
\u2022
decrease peripheral pulses
Right-sided Heart Failure
\ue000when right side of the heart does not contract sufficiently \ue001 excessive blood backs up into
peripheral tissues.
\ue000s/sxs:
o
elevated jugular venous pressure
o
hepatomegaly
o
splenomegaly
o
decrease renal perfusion when upright
o
increase renal perfusion when supine\ue001 nocturia
o
pitting edema
o
weakness & fatigue
Compensatory Mechanisms in CHF
Treatment for CHF:
Nonpharmacologic measures:
1. limit salt intake to 2 gms daily.
2. limit alcohol intake
3. avoid smoking
4. low fat & low caloric diet
5. mild exercise
Pharmacologic measures:
1.cardiotonic /inotropic agents\ue001 directly stimulate heart muscle to contract
more effectively.

2.vasodilators\ue001 reduce cardiac workload
3.diuretics\ue001 reduce blood volume & heart\u2019s workload
4.beta- blockers (in some cases)\ue001 reduce heart\u2019s workload precipitated by

sympathetic activity.
5.beta-adrenergic agonists\ue001 increase heart contractility.
CARDIOTONIC DRUGS
I. Cardiac Glycosides
a. Digoxin ( Lanoxin, Lanoxicaps)
b. Digitoxin
II. Phosphodiesterase Inhibitors
a. Inamrinone (Inocor)
b. Milrinone (Primacor)
I.Cardiac Glycosides / Digitalis Glycosides
\ue000increase calcium movement into heart muscle
\u2022
increase force of myocardial contraction\ue001 (+ ) inotropic effect
\u2022
increase CO & renal perfusion\ue001increase stroke volume & increase UO\ue001 decrease
blood volume
\u2022
slowed HR\ue001( - ) chronotropic effect
\u2022
decreased conduction velocity thru AV node\ue001 (-) dromotropic effect
decrease cardiac workload & relief of CHF
\ue000primarily excreted unchanged in urine
\ue000Indications:
1. treat CHF

2. correct atrial fibrillation
3. correct atrial flutter
4. treat paroxysmal atrial tachycardia

A.
Digoxin (Lanoxin, Lanoxicaps)
\ue000absorption rate \ue001 oral tablet \ue001 > 70%
\ue001 li qu i d \ue001 90 %
\ue001ca p s u l e \ue00190-100%

\ue000narrow margin of safety
\ue000therapeutic serum level 0.5 to 2.0 ng/ ml
\ue000half-life is 36 hours

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