DRUGS FOR HEART FAILURE

Drugs
Catego
ry

Drug

Function

Diuretics

Aldosterone
Antagonists
Eg :
Spironolactone
Thiazide
Eg
:hydrochlorothiaz
e

-binds and inhibit

aldosterone receptor
activation

-Gynaecomastia
-Hyperkalemia

-Reduce salt &

Water retention
(reduce ECF volume)
and ventricular
preload
-Reduce oedema
-Reduce cardiac size

- Hypokalemia
- Hyponatremia
-dehydration &
deterioting renal
function

Angiotensin
converting
enzyme
inhibitors (ACE
I)
Eg : Captopril,
Perindopril,
Enalapril

-Inhibit production of
Angiotensin II
-arterial & venous
dilator
- reduce salt &
water retention

- Dry cough
- can worsen renal
Fx with bilateral
renal artery
stenosis
- Angioneurotic
oedema!
- Hypotension
- Mild
Hyperkalemia

Nitrates
Eg: Isosorbide
dinitrate (oral),
nitroglycerin(trans
dermal),Glyceryl
trinitrate
(sublingual)

-Relax vascular
smooth muscle
-reduce preload &
afterload

Pharmalogucal
tolerance
Restrict use it
as single
agent

Sodium
nitroprusside

-Converted to nitric
oxide, a vasodilator

Short term
use in hospital

Angiotensin II
Receptor
Blockers (ARB)
Eg: Losartan,
Valsartan,
Candesartan

-Block Angiotensin II
receptors on
vascular,
myocardial, adrenal
Glomerulosa cells

*similar to ACEI
But angioedema
and dry cough
less common

Those cannot
tolerate ACEI
can replace
with ARB

Eg: Carvedilol,
Metoprolol (b1),
Bisoprolol,

-competitive
inhibition hear badrenergic receptors

- hypotension
- bradycardia
- depression,

Ask or asthma
history ,
(X) resting HR

Loop Diuretics
Eg: Frusemide

Vasodilat
ors

Beta
Blockers

Adverse
Effect

*Note

In Heart
failure, usually
starts with
thiazide
diuretics first,
then stronger
one likes loop
diuretic if
necessary.

Inotropic
Agents

propranolol (b1 &

b2)

- reduce heart rate

-reduce hear
remodelling (inhibit
catecholamine
mitogenic activity)

- headache,
- dizziness
- insomnia

<60bpm

Cardiac
Glycosides
Eg: Digitoxin,
Ouabain

-increase cardiac
contractility
-increase stroke
volume and cardiac
output

-Pro-arrythmic
drug with
hypokalemia
-severe toxicity
Visual changes
( disturbed colour
vision)
-nausea, vomiting,
anorexia

Intracellular
Na+ ,
Ca
expulsion from
cell,
Ca
concentration
near
contractile
protein,
interaction
actin &myosin
of sarcomere,
myocardial
contractility

MECH: inhibit Na/K

ATPase at cardiac
cell membrane

Phosphodiester
ase Inhibitors/
Bipyridines
Eg: Amrinone,
Milrinone

-inhibit
phosphodiesterase
III enzyme( result in
increase CAMP)
-increase myocardial
contractility
Cause venous and
arterial
vasodilatation

B-adrenoceptor
Stimulants
Eg: Dopamine &
Dobutamine

Dopamine
- low concentration,
act on D1 receptor
on renal,mesenteric
&coronary beds,
vasodilatation,
blood flow
-intermediate cont,
act B1 receptor,
increase SBP
-high cont, activates
a1 , vasoconstriction
Dobutamine
-increase CO
-stimulate B1 & B2
& a1 receptor

*Narrow
therapeutic index,
monitor
occasionally
-toxicity if use for
long term
-nausea,vomiting
-liver enzyme
changes
thrombocytopenia
,
-hypotension
-arrthmias
-Tachycardia
- increase
myocardial
oxygen
consumption

Given IV for
short term,
not active
orally (rapidly
inactivated at
intestinal
mucosa )