Heart failure

 ACE & ARBS (Lowers BP)

Lisinopril ACE (1st choice)
Losartan ARB (2nd choice)
Boleh bila HR low
RAAS(restrain fluid-> sodium & air di dlm, potassium keluar) di block/inhibit
Precaution: AVOID PREGNANCY, ANGIOEDEMA (ACE), COUGH (ACE), ELEVATED K
Elevated K -> muscle spasm, elevated ST&peaked T waves
1st dose phenomenon -> big BP drops
 Beta blockers (lowers HR & BP)
Atenolol
- Neg. Chrono (rate)(low resistance)
- Neg. ino (force) (low workload)
- Neg. dromo (beats) (low cardiac ouput)
Gaboleh buat pasien worsening/acute HF
Hati2 bronchospasm (jgn buat COPD dan ASMA)
Precaution: BRADICARDIA, BREATHING PROBLEMS, BAD HEART FAILURE, BLOOD
SUGAR MASKING (HYPOGLICEMIA)

 Calcium channel blocker (lowers HR & BP)

Nifedipine(BP DECLINES), Cardizem (HR N BP), verapamil(HR n BP)
CCB blocks the moves ca -> relaxes smooth muscle.
- Neg. Chrono (rate)(low resistance)
- Neg. ino (force) (low workload)
- Neg. dromo (beats) (low cardiac ouput)
Precaution: COUNT HR (below 60)& BP(below 100 systolic or big drops), CHANGES
POSITION SLOWLY, BAD HEADACHE

 Digoxin (lowers HR) TOXIN

Cardiac glycoside
- POSITIVE INOTROPIC DRUG) -> Deep/increases contraction
- Neg. crono
Precaution: APICAL PULSE (LOW HR), TOXICITY (OVER 2.0)-> vision changes, nausea,
dizzy, Potassium below 3.5 incrcease toxicity
 BUN, creatinine (over 1.3 high risk toxicity)

 Dilators (vasodilators)
Nitroglycerin
- Decrease BP
- Dilates vessel
- Decrease vascular resistance (lower preload & outload)
More O2.
Nitroglycerine, Nitroprusside, Hydralazine, isosorbide, Minoxidil (only severe HF)
Precaution: NO VIAGRA(SUPER LOW BP), IF BP BELOW 90 OR 100 OR DROPS BY 30,
ES: headache, orthostatic hypotension, hot flushing
 Diuretics (lowers BP)
For acute/worsening HF
- Decrease BP
- Drain fluid
- Dehydrate
Digunakan terutama pada bb naik, worsening crackles, edema
K wasting and sparing
 K wasting: furosemide(loop), hydrochlorotiazide (DRIED)
Works by blocking the reabsorbsion of sodium in kidney
Only if the K is normal!!
Precaution: low potassium -> low pumps of heart! (flat T wave, ST depression, U
wave)
Furosemide -> too fast:ototoxic, hypotension, too much: nephrotoxic,
hypokamlenia
 K sparing: spironolactione
Blocks aldosterone directly, to let fluid out of body.
Precaution: high potassium -> high pumps of heart! (peaked T wave, ST
elevation)
Precaution for both: BP (LOW), BUN & CREATININE, POTASSIUM IMBALANCE
Education:Take in the morning, Dizzy -> orthostatic hypotension, DAILY Weights (2-3
pounds), sunburn risk, Low sodium diet
AVOID OTC Meds: Cough & flu, Antacids, Acetaminophen, Nsaids (karna high
amount sodium of these drugs)