Drugs For Right & Left Sided Heart Failure

1. Drugs For Right & Left Sided Heart Failure • Cardiac Glycosides • Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) • Diuretics

2. Cardiac Glycosides • Digitoxin (Crystodigin) • Digoxin (Lanoxin)

3. Cardiac Glycosides : Mechanism Of Action • Inhibits Na+-K+ ATPase And Impairs The Active Transport Of Sodium & Potassium - Intracellular Sodium Concentrations Rise

4. High Intracellular Na+ Deranges The Na+-Ca2+ Pump Which Allows Intracellular Ca2+ Concentrations To Rise

5. Calcium Channels May Open Up And Allow Extracellular Calcium To Flow Into The Cell • The Heart Will Beat More Forcibly And With Greater Velocity

6. Glycosides Enhance Vagal Tone Over The Heart • Slows The Heart Rate • Slows The AV Node Conduction Velocity & Increases The AV Nodal Refractory Period

7. Glycosides Net Effect On The Heart • Heart Rate Is Slowed • Cardiac Contraction Is Greater • Ejection Fraction Is Improved • Increased Ejection Velocity • The Heart Is A Better Pump

8. Adverse Side Effects Of The Cardiac Glycosides • Fatigue • Delirium • Anorexia • Headaches

9. Hallucinations • Visual Disturbances • Atrioventricular Blocks

10. EKG Changes Associated With The Cardiac Glycosides • Prolonged P-R Interval • Inversion Of T-Wave • S-T Segment Depression

11. Glycosides - Medical Uses • Atrial Flutter • Atrial Fibrillation • Paroxysmal Tachycardia • Congestive Heart Failure

12. Angiotensin Converting Enzyme Inhibitors • Captopril (Capoten) • Enalapril Maleate (Vasotec) • Lisinopril (Prinivil, Zestril) • Benazepril (Lotensin) • Fosinopril (Monopril)

13. Moexipril (Univasc) • Quinapril (Accupril) • Ramipril (Altace) • Trandolapril (Mavik)

14. CHF - How Does It Occur ? • The Heart As A Pump Is Weakened • Myocardial Infarction • Ischemic Heart Disease • Valve Dysfunction & Disease • Hypertension --> To Hypertrophy • Idiopathic Cardiomyopathy

15. The Failing Heart Causes : • Low Blood Flow Systemically • Aldosterone Is Released • Renin Is Released

16. Increased Sodium And Water Retention • Increased Cardiac Workload • Decreased Cardiac Pump Performance

17. ACE InhibitorsMechanism Of Action • Blocks Converting Enzyme From Changing Angiotensin I to Angiotensin II • Prevents A Rise In Peripheral Resistance (Vasoconstriction)

20. Reduces Afterload On The Heart • Reduces Work Of The Heart

21. ACE InhibitorsAdverse Side Effects • GI Distress • Dizziness • Skin Rashes • Hypotension

22. ACE Inhibitors - Medical Uses • Hypertension • Congestive Heart Failure • Diabetic Nephropathy

23. Diuretics • High Ceiling Loop Diuretics • Benzothiadiazide Diuretics • Potassium Sparing Diuretics • Mannitol - Osmotic Diuretic

24. High Ceiling Loop Diuretics • Furosemide (Lasix) • Ethacrynic Acid (Edecrin) • Bumetanide (Bumex) • Torsemide (Demadex)

25. High Ceiling Loop DiureticsMechanism Of Action • Loop Diuretics Exert Their Effect At The Proximal Tubule And Ascending Loop • Blocks The Re-Absorption of Sodium, Potassium & Chloride Ions

26. Loss Of These Ions In The Glomerular Filtrate Is Followed By Quantities Of Water

27. High Ceiling Loop DiureticsAdverse Side Effects • Electrolyte Imbalances • Hypokalemia *** • Hyponatremia • Hypocalcemia • Hypomagnesemia

28. Urinary Loss Of Blood Ions • Natriuresis • Kaliuresis • Orthostatic Hypotension • Dehydration

29. Potassium Rich Foods • Dates • Bananas • Raisins • Apricots • Tomatoes

30. Oranges • Potatoes • Lima Beans • Carrots

31. Veal • Chicken • Turkey • Liver • Beef • Milk

32. Peanuts • Sardines • Halibut

33. High Ceiling Loop DiureticsMedical Uses • Congestive Heart Failure • Severe Pneumonia • Prevent Acute Renal Failure • Control Of Hypertension • Control Of General Edema • Control Of Acute Pulmonary Edema

34. Benzothiadiazides • Hydrochlorothiazide (Hydrodiuril) • Chlorothiazide (Diuril) • Clorthalidone (Hygroton) • Benzthiazide (Aquapres) • Bendroflumethiazide (Naturetin)

35. Methyclothiazide (Aquatensen) • Polythiazide (Renese) • Indapamide (Lozol) • Hydroflumethiazide (Diucardin) • Metalozone (Zaroxolyn) • Quinethazone (Hydromax) • Trichlormethiazide (Diurese)

36. Thiazides - Mechanism Of Action • Act In The Distal Tubule • Inhibit Reabsorption Of Sodium And Potassium • Stimulate The Reabsorption Of Calcium • Loss Of Water As Urine

37. Thiazides : Adverse Side Effects • Loss Of Blood Ions • Hypokalemia • Hyponatremia • Hypomagnesemia • Loss Of Iodine

38. Loss Of Blood Ions In The Urine • Kaliuresis • Natriuresis • Chloruresis

39. Thiazides : Adverse Side Effects • Hyperuricemia (Gout) • Weakness & Fatigue • Hypercholesterolemia • Hypertriglyceridemia • Hyperglycemia (Insulin Suppression)

40. Thiazides - Medical Uses • Control Hypertension • Congestive Heart Failure • Control Edema Due To : • Hepatic Disease • Renal Disease • Corticosteroid Therapy • Estrogen Therapy

41. Potassium Sparing Diuretics • Spironolactone (Aldactone) • Triamterene (Dyrenium) • Amiloride (Midamor)

42. Spironolactone - Mechanism Of Action • Competitively Binds The Aldosterone Receptor Preventing The Hormone From Binding To Its Receptor • Aldosterone's Normal Steroid-Nuclear DNA Transcription Is Halted

43. SpironolactoneMechanism Of Action • Excretion Of : • Sodium • Chloride • Water • Retention of Potassium

44. SpironolactoneAdverse Side Effects • Diarrhea • Drowsiness • Lethargy

45. Headaches • Impotence • Mental Confusion

46. SpironolactoneAdverse Side Effects • Hyponatremia • Hyperkalemia • Gynecomastia • Irregular Menses

47. Amenorrhea • Hirsuitism • Deepening Of The Voice

48. Spironolactone - Medical Uses • Heart Failure • Primary Hyperaldosteronism • Cirrhosis Of The Liver • Essential Hypertension • Nephrotic Syndrome

49. Spironolactone - Medical Uses • Primary Aldosteronism (Conn's Disease) • Aldosterone Secreting Adrenal Cortical Tumor

50. Severely Depleted Blood Potassium Levels • Hypertensive Due To Water Retention • Muscle Weakness