Drugs used in CCF

Dr Mozna Talpur
Congestive cardiac failure
In ability of heart to pump sufficient amount of blood
necessary for body.
Causes:
Disease of the myocardium e.g.
 Ischemic disease of the myocardium
Excessive load imposed on the heart e.g.
 Untreated hypertension for long time
 Valvular disease
Compensatory responses
↓Cardiac
output

↓Carotid ↓Renal
sinus firing blood flow
Β-Blockers +
Cardiac glycosides
↑Sympatheti ↑Renin
c discharge release

ACE
↑Angiotensi
↑Force ↑rate ↑Preload inhibitors
n
+ ARBs

↑Preload ↑Afterload Remodeling

Signs and symptoms of the heart failure
Reflex Tachycardia
Dyspnea
Decrease exercise tolerance
Peripheral and pulmonary edema
Cardiomegaly : as an important intrinsic
compensatory mechanism to maintain cardiac
performance .
Frank starling law : When load is imposed on the
heart it will respond by increased contraction
within physiological limits.
Non pharmacological management of
chronic heart failure
Limiting the patient activity
Reduce weight if the patient is obese
Reduce hypertension if the patient has high BP.
Restrict Na+ intake
Management of heart failure should be directed to
Restore normal cardiac output
Treatment of the cause of the heart failure
Drugs used in cardiac failure
Diuretics (Reduce preload)
ACE inhibitors Reduces After load and Na & H2O
Retention
β- blockers ↓ H.R, Reduces remodeling
Vasodilators ↓Preload + After load
β- agonists Positive
Inotropic effect
Cardiac glycosides
Bipyridines: Amrinone, milrinone
Cardiac glycosides
Plant derivative drug. (Digitalis purpurea)
Digoxin is the prototype drug.
3 drugs are important.
Digitalis
Digoxin
Ouabain
 Na+
K +

Digoxin Na+ K+
blocks K+ ATPase pump
binding site

Na+ Na+
Ca++
Group Action
Cardiac actions Abdominal pain
FEAR: Diarrhea
 F = force of contraction Anorexia
 E = excitability Increase
High dose:
 A = AV conduction
Nausea and vomiting
 R = heart RATE Decrease
(CTZ)
Direct effect.
Diuretic action:
Through vagus
Inc Cardiac output and
stimulation. GFR.
Extra cardiac (GIT):
Nausea and vomiting
Digitalization
Loading dose = 2-3 mg in 24 hrs
Followed by 1.5 mg after 6 hrs
Maintenance dose 0.25-0.5mg daily.
Precaution:
Effective dose is ½ of toxic dose and ¼ of lethal dose
(narrow therapeutic index)
Slow clearance so precaution must be taken.
Digoxin over dosage
Cardiac:
Enhance automaticity (ectopic beat)
Increase excitability (Arrythmias)

Bradycardia
Slow A.V conduction
Extra cardiac:
GIT: severe.
CNS: Fatigue, giddiness, headache
Blurred vision, diminished colour perception, disturbed hearing,
Confusion
Delirium. Hallucinations (psychosis)
POTASSIUM
Management of digoxin poisoning
Manage potassium imbalance.
Anti-arrhythmic drug (Lidocaine)
Gut decontamination with activated charcoal (6-8 hrs
after ingestion)
Digoxin specific Fab fragments also known as
digibind.
Bind rapidly to intravascular digoxin.
Digibind-digoxin complex is rapidly removed from
kidneys.