DRUGS USED IN THE

TREATMENT OF
CONGESTIVE HEART
FAILURE
CHF :
COP does not meet the needs of the tissue.

The therapeutic goal: ( COP)
- the cardiac muscle strength
- ECF vol. (diuretic)

Note: vasodilator the load on myocardium
Cardiac Failure
Venous pressure Cardiac output
Sympathetic activity Blood pressure
Renal blood flow
Renin, angiotensin II
Aldosteron
Sodium retention capillary filtration
Edema
contractility
of cardiac
muscle CO
Inotropic
Agents
ECF volume
preload
edema
Diuretics
afterload
CO
Vasodilator
Furosemid
Diuretics
ACEI
CCB
Vasodilators
Therapeutic use of glycosides is
confounded by:
1. Variable pharmacokinetics
2. Numerous drug interaction
3. Narrow therapeutic index
>< membrane Modifying Sympathetic
Na
+
/K
+
ATP ase activity


Intracellular Na
+
& Ca
+



Myofibril contraction rate of impulse
(inotropic +) by SA-node
(chronotropic -)



Cardiac output
depress High level
conduction via AV-node


-Adrenoceptor

V.Constriction PR


GIT
Anorexia, nausea, vomiting, abdominal pain

VISUAL
Disturbed color vision (green or yellow halo around lights)

PSYCHIATRIC
Delirium, fatigue, malaise, confusion, dizziness, Abn dream

RESPIRATORY
Ventilatory response to hypoxia

CARDIAC
Dysrhytmia,
Ventricular fibrillation and cardiac arrest are the most
common causes of death
Serum electrolyte abnormalities:
Hypokalemia
Hypomagnesia
Hypercalcemia
Acid base imbalance
Thyroid (hypothyroid)
Renal failure
Digitalis level may

Amiodarone
Erythromycin base
Quinidine
Tetracycline
Verapamil
Enhanced potential
for cardiotoxicity
levels of
Blood K
+
Corticosteroids
Thiazide diuretics
Loop diuretics
I. Dopamine

Stimulated effect on the:
receptor inotropic
chronotropic
Dopamine receptor blood flow to the
kidney, viscera
receptor vasoconstriction
Indication: - Refractory Cardiac Failure
- Cardiogenic Shock
II. Dobutamin

Asynthetic analog of dopamin
Cardiac Output

Indication:
- Refractory Heart Failure
- Severe acute myocardial failure
(after cardiac surgery)
- Cardiogenic shock
I. Loop Diuretics:
Furosemid, Bumetamid
II. Thiazide Diuretics:
Chlorothiazide, Hydrochlorothiazide
III. Potassium Sparing Diuretics:
Spironolactone

EFFECT
Relieve peripheral edema
Relieve pulmonary congestion symptoms:
orthopnea, paroxysmal nocturnal dyspnea.
Decreased plasma preload cardiac load and
O
2
demand afterload BP
Hypokalemia


Angiotensin II bradikynin sympathetic activities


Vasodilatation aldosteron


afterload water & Na retention
preload

CO hypertrophy edema
remodeling heart & vasc.
DOC HT
CHF (left ventricular dysfunction)
Patient who have had a recent myocardial
infarction
Losartan
Condersartan
Valsartan
Iberstan

Eprosartan
Tazosartan
Telmisartan
Zolasartan



Vasodilator --- Ind: HT with heart disfunctions
Golongan:
1. Verapamil
2. Diltiazem
3. Dihidropiridin
- Nifedipine
- Amlodipine
- Ticlodipine
- Etc ...