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

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

3. 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

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

5. 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

6. 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

7. 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

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

9. n Hallucinations n Visual Disturbances n Atrioventricular Blocks

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

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

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

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

14. 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

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

16. 3 Increased Sodium And Water Retention 3 Increased Cardiac Workload 3 Decreased Cardiac Pump Performance

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

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

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

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

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

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

25. 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

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

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

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

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

30. n Oranges n Potatoes n Lima Beans n Carrots

31. n Veal n Chicken n Turkey n Liver n Beef n Milk

32. n Peanuts n Sardines n Halibut

33. 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

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

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

36. 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

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

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

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

40. 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

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

42. 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

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

44. Spironolactone Adverse Side Effects l Diarrhea l Drowsiness l Lethargy

45. l Headaches l Impotence l Mental Confusion

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

47. l Amenorrhea l Hirsuitism l Deepening Of The Voice

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

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

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

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

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

53. 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

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

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

56. n Nausea n Vomiting n Acidosis n Elevated BUN

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

58. Osmotic Diuretics n Mannitol (Osmitrol)

59. 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

60. l Pharmacologically Inert l Resists Metabolic Alteration

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

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

63. n Blurred Vision n Headache n Confusion

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

65. 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.

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

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

68. Clinical Considerations n Hypotension & syncopal episodes