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

Cardiac Glycosides n Digitoxin (Crystodigin) n Digoxin (Lanoxin)

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

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

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

n Glycosides Enhance Vagal Tone Over The Heart l Slows The Heart Rate l Slows The AV Node Conduction Velocity & Increases The AV Nodal Refractory Period

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

Adverse Side Effects Of The Cardiac Glycosides n Fatigue n Delirium n Anorexia n Headaches

n Hallucinations n Visual Disturbances n Atrioventricular Blocks

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

Glycosides - Medical Uses n Atrial Flutter n Atrial Fibrillation n Paroxysmal Tachycardia n Congestive Heart Failure

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

l Moexipril (Univasc) l Quinapril (Accupril) l Ramipril (Altace) l Trandolapril (Mavik)

CHF - How Does It Occur ? n The Heart As A Pump Is Weakened 3 Myocardial Infarction 3 Ischemic Heart Disease 3 Valve Dysfunction & Disease 3 Hypertension --> To Hypertrophy 3 Idiopathic Cardiomyopathy

n The Failing Heart Causes : 3 Low Blood Flow Systemically 3 Aldosterone Is Released 3 Renin Is Released

3 Increased Sodium And Water Retention 3 Increased Cardiac Workload 3 Decreased Cardiac Pump Performance

ACE Inhibitors Mechanism Of Action n Blocks Converting Enzyme From Changing Angiotensin I to Angiotensin II n Prevents A Rise In Peripheral Resistance (Vasoconstriction)

l Reduces Afterload On The Heart l Reduces Work Of The Heart

ACE Inhibitors Adverse Side Effects n GI Distress n Dizziness n Skin Rashes n Hypotension

ACE Inhibitors - Medical Uses l Hypertension l Congestive Heart Failure l Diabetic Nephropathy

Diuretics n High Ceiling Loop Diuretics n Benzothiadiazide Diuretics n Potassium Sparing Diuretics n Mannitol - Osmotic Diuretic

High Ceiling Loop Diuretics n Furosemide (Lasix) n Ethacrynic Acid (Edecrin) n Bumetanide (Bumex) n Torsemide (Demadex)

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

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

High Ceiling Loop Diuretics Adverse Side Effects l Electrolyte Imbalances l Hypokalemia *** l Hyponatremia l Hypocalcemia l Hypomagnesemia

n Urinary Loss Of Blood Ions l Natriuresis l Kaliuresis n Orthostatic Hypotension n Dehydration

Potassium Rich Foods n Dates n Bananas n Raisins n Apricots n Tomatoes

n Oranges n Potatoes n Lima Beans n Carrots

n Veal n Chicken n Turkey n Liver n Beef n Milk

n Peanuts n Sardines n Halibut

High Ceiling Loop Diuretics Medical Uses l Congestive Heart Failure l Severe Pneumonia l Prevent Acute Renal Failure l Control Of Hypertension l Control Of General Edema l Control Of Acute Pulmonary Edema

Benzothiadiazides l Hydrochlorothiazide (Hydrodiuril) l Chlorothiazide (Diuril) l Clorthalidone (Hygroton) l Benzthiazide (Aquapres) l Bendroflumethiazide (Naturetin)

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

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

Thiazides : Adverse Side Effects l Loss Of Blood Ions l Hypokalemia l Hyponatremia l Hypomagnesemia l Loss Of Iodine

n Loss Of Blood Ions In The Urine l Kaliuresis l Natriuresis l Chloruresis

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

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

Potassium Sparing Diuretics l Spironolactone (Aldactone) l Triamterene (Dyrenium) l Amiloride (Midamor)

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

Spironolactone Mechanism Of Action l Excretion Of : l Sodium l Chloride l Water l Retention of Potassium

Spironolactone Adverse Side Effects l Diarrhea l Drowsiness l Lethargy

l Headaches l Impotence l Mental Confusion

Spironolactone Adverse Side Effects l Hyponatremia l Hyperkalemia l Gynecomastia l Irregular Menses

l Amenorrhea l Hirsuitism l Deepening Of The Voice

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

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

l Severely Depleted Blood Potassium Levels l Hypertensive Due To Water Retention l Muscle Weakness

Spironolactone - Medical Uses n Hypokalemia n Essential Hypertension n Congestive Heart Failure n Cirrhosis Of The Liver & Ascites

Spironolactone Adverse Side Effects n Excessive Loss Of Water n Mild Metabolic Acidosis n Higher Incidence Of Breast Cancer n Sore Breasts And Nipples

Triamterene And Amiloride Mechanism Of Action l Inhibit The Reabsorption Of Sodium In The Distal Tubule And Collecting Ducts By Disrupting The Aldosterone-Dependent Na+-K+ Pump

l Potassium Is Spared Because Sodium Is Wasted - A Reciprocal Relationship

Triamterene And Amiloride Adverse Side Effects n Hyponatremia n Hyperkalemia n Hypotension

n Nausea n Vomiting n Acidosis n Elevated BUN

Triamterene And Amiloride Medical Uses n Congestive Heart Failure n Cirrhosis Of The Liver n Hypertension

Osmotic Diuretics n Mannitol (Osmitrol)

Mannitol - A Perfect Diuretic n An Osmotic Diuretic Should Have The Following Qualities : l Freely Filterable At The Glomerulus l Undergo Limited Or No Reabsorption By The Renal Tubule

l Pharmacologically Inert l Resists Metabolic Alteration

Mannitol - Mechanism Of Action n Mannitol Exerts An Osmotic Draw For Water, Sodium, And Potassium

Mannitol - Adverse Side Effects n Transient Fluid Overload n Pulmonary Edema n Tachycardia n Mental Detachment

n Blurred Vision n Headache n Confusion

Mannitol - Medical Uses n Acute Renal Failure n Reduction Of Cranial Pressure n Stimulate Diuresis In Drug Intoxications n Reduction Of Intraocular Pressure

Clinical Considerations n The diuretics may increase blood glucose in diabetic patients. This causes hyperglycemia secondary to suppression of insulin release in Type II diabetics.

Clinical Considerations n Watch the patient for dehydration and electrolyte imbalance.

Clinical Considerations n Ototoxicity leading to loss of hearing, loss of balance, and vertigo.

Clinical Considerations n Hypotension & syncopal episodes