Rug Therapy For Heart Failure: Dr. Santhosh Ramakrishna
Rug Therapy For Heart Failure: Dr. Santhosh Ramakrishna
Rug Therapy For Heart Failure: Dr. Santhosh Ramakrishna
HEART FAILURE
body.
Inc Renin
Dec GFR
release
Cardiomegaly
Reflex tachycardia
Decreased urine formation
Decrease exercise tolerance and muscle
fatique
DRUG THERAPY OF HEART
FAILURE
CLASSIFICATION
Drugs with +ve Drugs without +ve
ionotropic effects ionotropic effects
Cardiac Glycosides- Diuretics-
Digoxin, Digitoxin, Furosamide,
Oubain Hydrochlorothiazide,
Bypiridines- Spironolactone
Milrinone, Inamrinone, ACE Inhibitors-
Levosimendan Enalapril, Losartan
Beta Agonists- (AT1 Blocker)
Dopamine, Vasodilators-
Dobutamine, Hydralazine, Sod.
Dopexamine Nitroprusside,
Isosorbide Di Nitrate
Vasopresssin
Receptor
CARDIAC GLYCOSIDES
Non Glycoside
Sugar sugar
Plants-
Digitalis lanata,
Strophanthus kombe,
Strophanthus gratus,
Thevetia nerifolia ,
(1) CARDIOVASCULAR
&
Stroke Volume
and fibrillation
Conduction velocity:
2) Atrial flutter.
4) Atrial fibrillation.
tachycardia.
ADVERSE EFFECTS
Cardiac
Bradycardia,
Coupled Beats,
Recent M I,
Partial or complete heart block,
W P W syndrome,
Constrictive pericarditis,
Ventricular tachycardia,
Hypokalemia,
Hypothyroidism ,
Children & Elderly,
Renal & hepatic diseases
INTERACTIONS
Diuretics
Calcium: synergises with digitalis → precipitates
toxicity.
Quinidine: reduces binding of digoxin to tissue
protein as well as its renal and biliary clearance by
inhibiting efflux transporter P-glycoprotein → plasma
concentration of digoxin is doubled → toxicity can
occur.
Verapamil, diltiazem, captopril, propafenone and
amiodarone also increase plasma concentration of
digoxin to variable extents.
Adrenergic drugs: can induce arrhythmias in
INTERACTIONS
Digoxin absorption may be reduced by
metoclopramide, sucralfate, antacids, neomycin,
sulfasalazine.
renal functions
DIURETICS
Loop diuretics
Decreases edema and improves cardiac performance
Loss of electrolytes mainly potassium, calcium and
magnesium is a major problem, also hypokalemia,
alkalosis and Carbohydrate intolerance
Resistance develops on prolonged use
Potassium sparing diuretics
No digitalis toxicity, prevents remodelling
Can be used in loop diuretic resistance cases
Main ADR are hyperkalemia and gynecomastia
ACE INHIBITORS
(ENALAPRIL,RAMIPRIL)
First choice of drugs in HF
Tolvaptan- V2 antagonist
V1 vasoconstriction action
V2 antidiuretic action