256 ()

1-4

.. 2542 PHARM study
(the Pharmacist in Heart Failure Assessment
Recommendation and Monitoring study)5
.. 25466

beta blockers
ACE inhibitors
(morbidity)



4,9,10

11

(functional limitation)

New York Heart Association Functional
Classification system (NYHA)

Vol 20 No 3 September - December 2010

Functional Class I -

Functional Class II -

Functional Class III -

Functional Class IV -

ACE Inhibitors (ACEIs)11-14

ACE inhibitors ( 1) preload

anti-aldosterone effects afterload (arterial
vasodilatation)
1 (cardiac output; CO)
ACE inhibitors
angiotensin II
(sympathetic) ACE
inhibitors (left
ventricular hypertrophy)
(cardiac remodeling)


ACE inhibitors

1.
(renal insufficiency)
angiotensin II (vasocon-

257

strict) efferent
arteriole ACE inhibitor

(glomerular filtration rate; GFR)

ACE inhibitor

ACE inhibitor

(creatinine) 3
/ ACE inhibitor
(bilateral
renal artery stenosis)
2.


(dose)

ACE inhibitor
3.




ACE inhibitor


(K-sparing
diuretics)

258 ()

ACE inhibitor

5 /
4. class effect
5-15
tissue bradykinin



ACE inhibitors angiotensin receptor
blockers (ARBs)
Beta Blockers (first
line therapy)
beta blockers

(hemodynamic improvements)

(ejection fraction; EF)

(reverse remodeling)

(exercise tolerance)
beta blockers

11-14

beta blockers

(target dose)
1-2

()

beta blockers
( 2)

1. Carvedilol15-19 non-selective
beta blocker alpha-1 (alpha-1
receptor blocking effect) beta blocker

(US FDA) ..
2540
(mild), (moderate), (severe)
3.125 2


25 2 ( 50
2
85 )
2. Bisoprolol11,12,20 beta-1 selective
blocker 1.25


10 1
3. Metoprolol11,12 beta-1 selective
blocker metoprolol
(controlled release; CR/
XL)

Vol 20 No 3 September - December 2010

259

1 ACE inhibitors angiotensin receptor blockers

12

2 beta blockers 12
Initial Daily Dose

12.5
-25 1

200 1
beta blockers

Maximum Daily Dose

beta blocker


beta blocker

260 ()

3 12

loop diuretics ( 3) furosemide

preload




21
11-13,

1-2

Digoxin digoxin
(neuro-hormonal
effect)
(sympathetic outflow)

(baroreceptor)
(autonomic function)
vagal tone11-13

digoxin digoxin

DIG trial (Digitalis Investigation Group trial)22

digoxin (serum digoxin
concentration; SDC) (0.5-1.1 /
)

(>1.2 /)
SDC 0.5-0.8 /
29.9
( 36.2) SDC 0.91.1 /
38.8
SDC>1.2 /
48.0
digoxin

0.86 /
0.25 /
SDC

digoxin


digoxin

Vol 20 No 3 September - December 2010

digoxin
(renal impairment),
(hypokalemia),
(hypomagnesemia), (hypothyroidism) digoxin
digoxin
clarithromycin, erythromycin, amiodarone,
itraconazole, cyclosporine, verapamil,
quinidine
Aldosterone Antagonists
spironolactone
aldosterone receptor antagonist
androgen progesterone
spironolactone

11-13
functional class III IV 1,663 23
spironolactone
25 / ( 4)
11
46

6

261

45
spironolactone
(gynecomastia)
10
spironolactone

spironolactone
>2.0-2.5 /
(creatinine
clearance) 50 /
5 /

1. Negative Inotropic Agents
3
- Antiarrhythmics disopyramide,
flecainide, propafenone
- Beta blockers propranolol,
metoprolol, atenolol
- Calcium channel blockers
verapamil, diltiazem, dihydropyridine

4 aldosterone antagonist 12
Daily Dose

Maximum Dose

262 ()

2.
preload
- Nonsteroidal anti-inflammatory
agents cox-2 inhibitors prostaglandin afferent arterioles





- Glitazones
6-7
2-5
(peripheral edema)


glitazones

Guideline AHA/ADA
functional class I II
glitazones


functional class III IV
glitazones

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3.
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Vol 20 No 3 September - December 2010

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