Presentation on theme: "Drugs for CCF Heart failure is the progressive inability of the heart to supply adequate blood flow to vital organs. It is classically accompanied by significant."— Presentation transcript:
2 Drugs for CCFHeart failure is the progressive inability of the heart to supply adequate blood flow to vital organs.It is classically accompanied by significant fluid retention.It is a leading cause of mortality and morbidity.
3 Drugs for CCFThe most common symptoms of CCF includes shortness of breath, edema and fatigue.Causes of heart failure includes Coronary artery disease (CAD), Hypertension, Diabetes, Mitral valve disease and Chronic alcohol.
13 Drugs for CCF Angiotensin Converting Enzyme (ACE) Inhibitors : Reduction in arterial resistance (afterload)Reduction in venous tension (preload)Reduction in aldosterone secretionInhibition of cardiac and vascular remodeling
15 Drugs for CCF Angiotensin Receptor AT-1 blockers (ARB) : Losartan, Irbesartan, CandesartanCompetitive antagonists of Angiotensin II (AT-1).No inhibition of ACE or Cough.
16 Drugs for CCF Vasodilators : Isosorbide dinitrate and hydralazine also used specially in patients who cannot tolerate ACE inhibitors.Amlodipine and prazosin are other vasodilators can be used in CCF.
25 Drugs for CCF Beta blockers for CCF : Start at low dose and monitor for bradycardiaCarvedilol and Metoprolol are the most commonly used for CCF amongst beta blockers
26 Drugs for CCF Cardiac glycosides : Digoxin : Inhibition of Na/K ATPase pump increase intracellular sodium concentration – eventually increase cytosolic calcium.It restores the vagal tone and abolishes the sympathetic over activity.
29 Drugs for CCF Cardiac glycosides : Digoxin : Increase the refractoriness of AV node thus decrease ventricular response to atrial rate.Digoxin is used as a first-line drug in patients with congestive heart failure who are in atrial fibrillation.
30 Drugs for CCF Digoxin : Adverse effects / Precautions : Nausea, vomiting, gynecomastia, visual disturbances and psychosis.Ventricular bigeminy, AV block and bradycardia.Amiodarone and verapamil can increase the plasma concentration of digoxin by inhibiting its excretion.Quinidine, verapamil, and amiodarone increases plasma levels of digoxin (by displacing tissue binding sites and depressing renal digoxin clearance) so plasma digoxin must be monitored carefully.
31 Drugs for CCF Digoxin toxicity treatment: Toxicity can be treated with higher than normal doses of potassium.Digoxin antibody (digibind) is used specifically to treat life-threatening digoxin overdose.Digitalis-induced progressive elevation of the serum potassium concentration also suggests imminent cardiac arrest. If the potassium concentration exceeds 5 mEq/L in the setting of severe digitalis intoxication, therapy with DIGIBIND is indicated.
32 Drugs for CCF Cardiac Inotropes : Phosphodiesterase III Inhibitors Positive inotropic and vasodilator – INO-DILATOR ; Eg., MilrinoneDobutamine is a beta-1 agonist which increase contractility and cardiac output.Milrinone (Primacor) is a phosphodiesterase III inhibitor.Chronotropic, arrhythmogenic, and vasodilative effects are negligible with dobutamine.
33 Drugs for CCF Conclusion : ACE inhibitors are cornerstone in the treatment of CCF.Beta blockers are used in selected patients (mild/moderate failure, low dose)Diuretics and digoxin are other drugs useful in CCF in select patients.
34 STAGE DISABILITY CLASS 1 MILD CLASS 2 CLASS 3 MODERATE CLASS 4 SEVERE No symptoms Can perform ordinary activities without any limitationsCLASS 2Mild symptoms - occasional swelling Somewhat limited in ability to exercise or do other strenuous activitiesCLASS 3MODERATENoticeable limitations in ability to exercise or participate in mildly strenuous activitiesComfortable only at restCLASS 4 SEVEREUnable to do any physical activity without discomfort Some HF symptoms at rest