Introduction ď‚— Heart failure (HF) is
one of the most common and fatal of the cardiovascular diseases, and its incidence is expected to increase as the population ages. ď‚— On your own!!
Cardiac Glycosides Cardiac glycosides
increase the force of myocardial contraction —Table 16.2 pg. 283 Traditional drugs of choice for HF Extracted from foxglove plants (Digitalis purpura and Digitalis lanata)
Cardiac Glycosides Digitalis helps heart
contract more forcefully and beat slower Narrow margin of safety DP—digoxin (Lanoxin)---pg. 285 Hold if HR < 60 Monitor serum levels
Angiotensin Converting Enzyme (ACE Inhibitors) ACE inhibitors are becoming
first-line drugs for cardiac failure —Table 16.2 pg. 283 Lower peripheral resistance and reduce blood volume diminishes the after-load and increase cardiac output Dilate veins returning blood to heart decreases preload and peripheral edema DP—lisinopril (Prinivil, Zestoric) pg. 286
Vasodilators Vasodilators can help reduce
symptoms of heart failure by decreasing the oxygen demands on the heart—Table 16.2. Minor role in drug therapy for HF. Relax blood vessels and lower BP Many side effects-reserved for clients who cannot tolerate ACE inhibitors DP—isosorbide dinitrate (Isordil) pg. 289
Diuretics Diuretics are effective at
reducing fluid volume and relieving symptoms of heart failure—Table 16.2 pg. 283 Reduce blood volume, edema and congestion. Workload on heart reduced and cardiac output increases. Used in combination with other drugs to treat HF. DP—furosemide (Lasix) pg. 287
Phosphodiesterase Inhibitors Phosphodiesterase inhibitors increase
the force of contraction and cause vasodilation—Table 16.2 pg. 283. Used for short-term control of acute HF. Block enzyme phosphodiesterase in cardiac muscle and smooth muscle Very toxic Reserved for clients not responding to ACE
inhibitors or cardiac glycosides Used generally 2-3 days
DP—milrinone (Primacar) pg. 288
Beta-Adrenergic Blockers Beta-adrenergic blockers
play a minor role in the treatment of HF Reduce cardiac worklooad by decreasing afterload. Usually used in combination with other drugs DP—carvedilol (Coreg) pg. 289