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Cardiac Drugs in Heart Failure Patients

Cardiac Drugs in Heart Failure Patients . Zoulikha Zair 28 th May 2013. N.B. some drugs overlap with treatment of hypertension….bonus revision wise!!!!. Question. What are the NICE guidelines for the pharmacological treatment of left ventricular heart failure?. Answer.

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Cardiac Drugs in Heart Failure Patients

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  1. Cardiac Drugs in Heart Failure Patients ZoulikhaZair 28th May 2013 N.B. some drugs overlap with treatment of hypertension….bonus revision wise!!!!

  2. Question • What are the NICE guidelines for the pharmacological treatment of left ventricular heart failure?

  3. Answer NICE guidelines for treatment of LV heart failure: • Diuretic - relief of congestive symptoms and fluid retention AND • First line: • ACE-inhibitors or • Beta-Blockers • Second line: • Add • Aldosterone antagonist • Angiotensin receptor antagonist • Hydralazine with nitrate • Third line: • Consider digoxin

  4. Question • How do ACE-inhibitors work? • What are their side effects? • Name a commonly used ACE-inhibitors

  5. Answer • ACE – inhibitor  vasodilator • Inhibits bradykinin breakdown (vasodilator) • Inhibits angiotensin converting enzyme  inhibits angiotensin II production • Side effects – dry cough, elevated K levels, birth defects, low blood pressure • Ramipril

  6. Question • How do ARBs work? • What are their side effects? • Name a commonly used ARB

  7. Answer • Inhibit action of Angiotensin II • Reduce vascular resistance • Restore tissue perfusion • Reduce afterload • Reduce aldosterone production • Natriuresis • Hypotension, renal impairment, hyperkalaemia, angioedema • Losartan

  8. Question • How do beta-blockers work? • Name a selective beta1 blocker • What are the unwanted side effects?

  9. Answer • Beta blockers reduce sympathetic stimulation of the heart by blocking beta-1 adrenergic receptors (Gs coupled cAMP increase) in the heart • Reduced sympathetic stimulation also reduces arterial pressure and decrease cardiac contractility • Dobutamine • Unwanted side effects – increase left ventricular dimensions, cold periphery and heart failure

  10. Question • What is the mechanism of action for aldosterone antagonists? • What are the side effects of aldosterone? • Name an aldosterone antagonist

  11. Answer • Blocks action of aldosterone at DCT • Increase Na+ and water excretion • K+-sparing diuretic • Especially effective combined with ACE-I / ARB • Hyperkalaemia, gynaecomastia (only in some), hypotension, hypernatraemia, GI upset, impotence • Eplerenone, spirnonolactone

  12. Question • What is the mechanism of action for hydralazine? • What are the side effects of hydralazine?

  13. Answer • Unknown mechanism of action • Dilates arteries & arterioles,  afterload • s/e: Tachycardia, GI upset, headache, lupus-like syndrome

  14. Questions • How do nitrovasodilators work? • What are the unwanted side effects and problems?

  15. Answers • Metabolised to NO  activate guanylatecyclase increase in cGMP fall in intracellular free calcium  vascular relaxation increase in venous capacitance  fall in central venous pressure  reduce preload  reduction in ventricular dimensions and cardiac output • Side effect – headache due to dilatation of intracranial arteries • Also problem with quickly developing tolerance that can lead to abnormal constriction of coronary arteries following withdrawal • Either inactivated enzyme that converts GTN to NO or desensitisation of blood vessels to NO

  16. Vascular Drugs

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