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Pharmacology

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Most medications improve the functional ability of the heart, making it easier to perform activities of daily living and to exercise. This is often accomplished by improving cardiac output, reducing filling pressure and neurohormone levels. The choice of medication depends on many factors, including the type of HF, the stage that it’s at and its etiology [15]. It is important to remember that an in-depth understanding of the pathophysiology underlying the illness is important before deciding on which drug therapy to pursue.

Polypharmacy - Today’s drug based heart failure treatment plans involve a plethora of medications that must be taken at various time intervals and doses. This results in a very complex set of instructions that the patient must follow. The term “polypharmacy“ was coined to describe this practice, and it has been linked with non-adherence to treatment instructions [46].

 

Common heart failure medications:

 Diuretics

Examples: furosemide, bumetanide, ethacrynic acid

 

Lowers the volume of blood in the circulatory system which in turn, lowers blood pressure, making it easier for the heart to pump

Most work by removing potassium (K+)

Side effects: Low blood pressure, dehydration, kidney dysfunction

 Inotropes

Examples: Digoxin, Milrinone, Dobutamine

Increases the force of contraction

Reduces heart size

Improves some arrhythmias

Side effects: toxicity, nausea, irregular heart beats, stomach pain, greenish-yellow vision

 Calcium channel blockers

Vasodilator - lowers blood pressure

Increased mortality and prevalence of recurrent CHF with chronic use

Should only be used in patients with diastolic dysfunction

Usually used in patients whose heart failure is caused by high blood pressure and who are not responding to ACE-Inhibitors [1]

 Beta-Blockers

Examples: carvedilol, metoprolol

Prevents adrenaline from binding to beta I receptors in the myocardium which limits the rate of contraction, allowing time for the ventricles to fill

Increases exercise capacity 

Appears to be cardioprotective in patients with depressed LV function [1]

Side effects: slow heart rate, low blood pressure, asthma

 Angiotension-converting enzyme (ACE) - inhibitor

Examples: captopril, enalapril, lisinopril

 

Vasodilator

Blocks the formation of angiotension II which raises blood pressure by constricting blood vessels and retaining sodium

Reduces preload, afterload, right atrial pressure, and pulmonary capillary wedge pressure

May reverse hemodynamic instability and symptoms [1]

Side effects: persistant dry cough, low blood pressure, kidney failure

Angiotensin II receptor blockers

 

Vasodilator - lowers blood pressure

Usually given to patients who cannot handle the side effects of ACE-Inhibitors

 Isosorbide Dinitrate and Hydralazine[1]

These two drugs are given in a fixed dose combination

In the African American Heart Failure Trial, this drug reduced mortality in black people by 43%

Does not appear to affect white people

 

 

 

Medications to Avoid

Non-steroidal anti-inflammatory drugs (NSAID’s)

  • Ibuprofen

     

  • Naproxen

  • Indomethacin, piroxicam, ketoprofen, diclofenac, celecoxib, rofecoxib, moloxicam

1.

Why are these drugs potentially harmful to congestive heart failure patients?

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1. http://www.emedicinehealth.ca

15. Stromberg A, Martensson J. Gender differences in patients with heart failure. European Journal of Cardiovascular Nursing. 2003;2:7-18.

46. Vinson JM, Rich MW, Sperry JC, et al. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc. 1990;38:1290-1295.

All references for this section