DRUGS USED IN HEART FAILURE

POSITIVE INOTRPES
CARDIAC MOA USES SE NOTES
GLYCOSIDES
DIGOXIN inhibits Na/K HF Narrow Reduced clearance
DIGITOXIN ATPase. Nodal therapeutic with Quinidine,
arrhythmias index Amiodarone,
Increase Cyclosporine,
intracellular Arrythmias Diltiazem &
Ca increasing Verapamil.
cardiac Vomiting
contractility Arrhythmogenesis
Diarrhea increased by
hypoK, hypoMg &
Visual hyperCa
changes

DIGITALIS TOXICITY CORRECTION OF DIGITALIS

TOXICITY
o Increase by hypoK, hypoMg & o Correction of K/Mg deficiency
hyperCa o Antiarrhythmic drugs
- Loop diuretics & thiazides  drug of choice: LIDOCAINE
may significantly reduce  electronic pacemaker may be
serum K & precipitate required in severe cases
Digitalis Toxicity o Digoxin Antibodies
- Digitalis-induced vomiting  Fab fragments; Digibind
may deplete serum Mg &  may save patients who would
similarly facilitate toxicity otherwise die

NARROW THERAPEUTIC INDEX

WALA C PaPa V DiTo

 Warfarin
 Aminoglycosides
 Lithium
 Amphotericin B
 Carbamazepine
 Phenobarbital
 Phenytoin
 Vancomycin
 Digoxin
 Theophylline
 BETA AGONIST MOA USES SE NOTES
DOBUTAMINE (B1
SELECTIVE)
Not appropriate for
chronic failure
because of
Increase cAMP tolerance, lack of
and force of Acute HF Arrythmias oral efficacy &
contraction significant
DOPAMINE arrhythmogenic
effects

Parenteral
PDE INHIBITORS MOA USES SE NOTES
INAMIRINONE

Increase cAMP
by inhibiting
its breakdown Should not be used
by in chronic failure
phosphodiester Acute HF Arrythmias because they
MILRINONE ase. increase morbidity
& mortality
increase
intracellular
Ca;
vasodilation
VASODILATORS
MOA USES SE NOTES
NITROPUSSIDE Rapid, For acute severe Excessive IV infusion
powerful failure with hypotension
vasodilation congestion
reduces Thiocyanate
preload and and Cyanide
afterload toxicity

HYDRALAZINE + Poorly Chronic HF in HA Oral

ISDN understood African
reduction in Americans Tachycardia
mortality

MISCELLANEOUS
BNP ANALOGUE MOA USES SE NOTES
NESIRITIDE Atrial peptide Acute severe Hypotension Parenteral
vasodilation decompensated
failure Renal Damage
Diuretic
DIURETICS MOA USES SE NOTES
FUROSEMIDE Reduces Acute and Ototoxicity Oral and Parenteral
preload and Chronic HF
edema by Hypovolemia
powerful Acute
diuretic action pulmonary Hypokalemia
on thick edema
ascending limb
in nephron.

Vasodilating
effect on
pulmonary
vessels.
SPIRONOLACTON Antagonist of Chronic HF Hyperkalemia Oral
E aldosterone in Aldosteronism
kidney Gynecomastia
EPLERENONE Same w/ Spiro Same w/ Spiro Hyperkalemia Same w/ Spiro
DIURETICS: FIRST LINE therapy for both systolic & diastolic failure

ACE & ARBS MOA USES SE NOTES

CAPTOPRIL Blocks HF Cough Oral and short half-
angiotensin- life but Large doses
converting HPN Renal damage used
enzyme
DM Hyperkalemia
Reduces Ang II
levels CI in preggy

Decreases
vascular tone
and
aldosterone
secretion
ACE and ARBs: FIRST DRUGS therapy for Chronic Heart Failure

What drugs have been shown to improve SURVIVAL in cases of HF?

ABA, buhay kapa!
ACE inhibitors Beta blockers Aldosterone antagonist
 BB MOA USES SE NOTES
CARVEDILOL blocking the CF Cardiac Oral
LABETALOL effects of the depression
BISOPROLOL hormone
NEBIVOLOL epinephrine,
METOPROLOL also known as
adrenaline.

Beta blockers
cause the heart
to beat more
slowly and
with less force,
which lowers
blood pressure.
SACUBITRIL MOA USES SE NOTES
BRAND NAME: neprilysin CHF Cough combination with
ENTRESTO inhibitor valsartan to reduce
Renal damage the risk of
Increases BNP cardiovascular
levels Hyperkalemia events in patients
with chronic heart
failure and reduced
ejection fraction.

SACUBUTRIL is a prodrug that is activated to SACUBRTRILAT

Enzyme NEPRILYSIN (responsible for the degradation of ANP&BNP- two BP lowering

peptides that work mainly by reducing blood volume.

This enzyme also degrades BRADYKININ - an inflammatory mediator exerting potent

vasodilatory action