Dr. Ravelo
- The drugs that will be discussed are the - As the heart failure continues, it becomes chronic
Pharmacologic treatment that we can use to temper there is what we call as the cardiac remodeling
the compensatory mechanism of the body in - Because of the increase in wall stress the heart
Effects of Digoxin
- Increase Ca, increase force of contraction
- It also exert electric effect on the heart
- Preload venous return - They decrease the action potential duration
- Afterload Reduction or After load unloaders this o shortening to atrial and ventricular
address the problem of arterial circulation refractoriness
o In the Atrium and Ventricle there would be
a reduce in action potential duration
Summary
- So the drug (Digoxin) exert a positive inotrophic
- Affected GIT because of Digoxin can cause:
activity by Na-K ATPase inhibition
o Anorexia, nausea, vomiting, and diarrhea
- And decrease the heart rate by parasympathetic
that can lead to potassium deficiency
effect on the AV node nd
o That can lead to 2 toxicity which is
arrhythmia
Decrease in Heart Rate Effect of Digoxin
- In CNS it can cause
- This is also the reason why Digoxin can be used as an
o Disorientation, hallucination, and visual
anti-arrhythmic agent
disturbances
- It is used to treat supra-ventricular tachyarrhythmia
- Thus they are not the drugs for Chronic Heart Failure
- They also lack oral efficacy
C. Bipyridines
- It is said that its inotrophic effect is greater that its
- Phosphodiesterase Inhibitors
chronotrophic effect
- This is the reason why Dobutamine is used in the
treatment of Heart Failure
- Since we are not increasing the heart rate, but rather
we are increasing the force of contraction
- Thus, the heart cannot get tired easily
D. Diuretics
- Kinetics:
- It is metabolized by acetylation
- They are issues for patients who have polymorphism
- There are rapid acetylators and slow acetylators
- If you are rapid acetylators you will metabolized
acetylene faster
- They are both venodilators and arteriolar dilators - Adverse Effect:
- Veins are more sensitive to the effect of nitrates - Lupus-like Syndrome
o The veins will be the one that will respond - If you are slow acetylators then chances of having
to the nitrates adverse effect is high
G. Beta Blockers
- They may act both on beta 1 and beta 2 receptors
- There are beta blockers that are partial antagonistic
and there are also beta blockers with alpha blocking
properties (review 4 types of beta blockers)
- Propanolol it prevents reflux tachycardia induce by
- They outweigh their negative inotrophic effect
vasodilators (because of the baroreceptors)
- They are used because of their NEGATIVE
CHRONOTROPHIC effect
- Beta blockers will block beta 1 in the heart
decreasing force of contraction and the heart rate
- They are also blocking the beta 1 receptors in the JG
cells thereby reducing renin
o Resulting to decrease activity of RAAS
Note:
- These drugs can worsen CHF if not done cautiously
at low doses
Loop Diuretics
- Prototype: furosemide
- Most potent diuretics available
- Inhibit NaCl reabsorption in the thick ascending loop
DIURETICS of henle (Na+/K+/2Cl- transporter)
- Act by reduction of blood volume and direct vascular - Do not reduce PVR (Peripheral vascular resistance)
effects to the same extent as thiazides
- Deplete body sodium stores - Commonly used in patients with fluid overload
- Often provide adequate treatment for mild to
moderate hypertension Furosimide Toxicity
- In more severe hypertension, in combination with - Hypokalemic metabolic alkalosis
sympathoplegic and vasodilators - Ototoxicity- dose related, usually reversible
- Hyperuricemia
Different Types - Hypomagnesemia not good for patients taking
- Thiazide diuretics Digoxin
- Loop diuretics - Skin rash, eosinophilia, interstitial nephritis
- Potassium-sparing diuretics - Cross-reactivity in patients sensitive to sulfonamide