Wk 3 notes 3 - TREATMENT OF HEART FAILURE Multiple drugs...

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TREATMENT OF HEART FAILURE Multiple drugs are usually needed to control the signs and symptoms of Congestive Heart Failure (CHF). The major categories used are angiotensin converting enzyme inhibitors (ACE-I), diuretics (loop and thiazides), beta adrenergic receptor antagonists (beta blockers), cardiac glycosides and nitrates. A medication regimen must be individualized for the patient, with adjustments made depending on their responses to drug therapy and keeping in mind drug interactions. Major categories are addressed below followed by other drugs that may be used in certain circumstances or as alternatives when major drugs are not tolerated or are contraindicated. Angiotensin-Converting Enzyme (ACE) Inhibitors List of ACE Inhibitors Used in Chronic Congestive Heart Failure benazepril (Lotensin) captopril (Capoten) enalopril (Vasotec) fosinopril (Monopril) lisinopril (Prinivil) (Zestril) moexipril (Univasc) quinapril (Accupril) ramipril (Altace) trandolapril (Mavik) Pharmacodynamics of the ACE Inhibitors in the Management of Chronic Congestive Heart Failure The ACE inhibitor drugs block angiotensin-converting enzyme which converts the inactive protein, angiotensin I into the very active protein, angiotensin II. In this way, the actions of angiotensin II (peripheral arterial vasoconstriction and stimulation of aldosterone secretion) are blocked. ACE inhibitors, therefore, have a dual mechanism by which they improve cardiac pumping performance; 1) they reduce peripheral arterial resistance and, thereby, decrease left ventricular afterload and 2) they decrease aldosterone-stimulated increase in blood volume which lowers left ventricular preload and wall stress. These mechanisms achieve the objectives of reduction in cardiac work load, reduction of blood volume, restriction of sodium reabsorption, and improvement of cardiac ejection fraction (i.e., the percentage of end-diastolic ventricular volume that is ejected into the aorta with each systole). Advantages of ACE Inhibitors in Chronic Congestive Heart Failure - Administered orally; advantageous in a drug that must be administered daily and for long periods (i.e., possibly a lifetime) of time. - Administered once daily - (only captopril is administered BID); once daily therapy 1
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TREATMENT OF HEART FAILURE is advantageous from a compliance point of view. - Multiple mechanisms of action; with the complex nature of the pathophysiology of congestive heart failure, it is an advantage to use a drug that can work in several ways to achieve the desired therapeutic endpoints. - Does not produce reflex tachycardia; the mechanism for this is unclear but this is an advantage in patients who would not tolerate tachycardia (such as patients with ischemic heart disease). - In addition to relieving symptoms and reducing morbidity, have been shown to
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This note was uploaded on 05/19/2011 for the course NURSING 517/617 taught by Professor Lipstate during the Spring '11 term at University of Louisiana at Lafayette.

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Wk 3 notes 3 - TREATMENT OF HEART FAILURE Multiple drugs...

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