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Pharmacological Management of Congestive Heart Failure PowerPoint Presentation

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Description : Check out this medical presentation on Congestive Heart Failure, which is titled "Pharmacological Management of Congestive Heart Failure", to know about the major drug groups used in treatment of heart failure, mechanism of action of digitalis and its major effects, the nature and mechanism of digitalis toxic effects, the clinical implications of diuretics, vasodilators, ACE inhibitors and other drugs that lack positive inotropic effects in heart failure, and the strategies used in the treatment of heart failure.

Tags : Congestive Heart Failure, Pharmacological Management, Congestive Heart Failure, drug groups, treatment, digitalis

Published on : Jul 01, 2021 | Views : 1179 | Downloads : 6

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Slide 1-

Pharmacological Management of Congestive Heart Failure Dr. Naser Ashraf Department of Basic Medical Sciences College of Medicine Majmaah University
Slide 2-

Objectives List major drug groups used in treatment of heart failure Explain mechanism of action of digitalis and its major effects Explain the nature and mechanism of digitalis toxic effects Describe the clinical implications of diuretics, vasodilators, ACE inhibitors and other drugs that lack positive inotropic effects in heart failure Describe the strategies used in the treatment of heart failure
Slide 3-

What is heart failure
Slide 4-

Compensatory responses during heart failure Heart failure ↓ FOC ↓ COP ↑ Sympathetic discharge ↓ Renal perfusion Vasoconstriction β1 activation ↑ preload ↑ afterload ↑ FOC ↑ HR ↑ Renin release ↓ GFR Cardiac remodelling Ventricular dilation Back pressure Oedema Na & water retention (Oedema) ↑ AT-II ↑ AT-1 ↑ Aldosterone Initially ↑CO Later ↓ CO
Slide 5-

Drugs Used in Heart Failure Diuretics -blockers Vasodilators Aldosterone Antagonists Inotropics
Slide 6-

Inotropic drugs Cardiac glycosides: Digoxin, digitoxin Sympathomimetic amines: Dopamine , dobutamine Phosphodiesterase inhibitors: Amrinone , milrinone Like the carrot placed in front of the donkey
Slide 7-

Vasodilators Arteriolar: hydralazine , minoxidil, nicorandil Venodilators: nitrates Arteriolar and venodilators: ACE inhibitors, angiotensin receptor blockers Increase the donkey’s efficiency
Slide 8-

Diuretics Loop diuretics: furosemide, torsemide Thiazide diuretics: hydrochlorthiazide K+ Sparing diuretics: Spironolactone (Also is aldosterone antagonist) Amiloride Reduce the number of sacks on the wagon
Slide 9-

Beta Blockers Metoprolol, bisoprolol, carvedilol Limit the donkey’s speed, thus saving energy
Slide 10-

Inotropic Agents Cardiac glycosides: Digoxin William Withering 1785 Foxglove plant
Slide 11-

Chemistry of cardiac glycosides Aglycone Responsible for pharmacodynamic activity Sugar influence pharmacokinetics
Slide 12-

Digitalis Mechanism of the +ve inotropic action: ca++ ATPase ca++ Na+ Normally Digitalis In therapeutic dose leads to partial inhibition of Na+/K+ ATPase enzyme Na+ Na+ Na+ Na+ Na+ Na+  intracellular Na+ resulting in: Na + /ca + + exchange ca++ Na+ K+ ca++ ca++ ca++ sarcoplasmic reticulum ca++ ca++ ca++ ca++ ca++ ca++ ca++ ca++    troponin Actin Myosin  Force Of Contractility
Slide 13-

CARDIAC ↑force of contraction & Cardiac Output  Heart rate  Refractory period (RP) & ↑ Conduction velocity (CV) in atria/ventricles ↑ RP &  CV in AV node Increased automaticity ECG: ↑PR interval ,  QT interval EXTRA CARDIAC Kidney: Due to improvement in circulation and renal perfusion Retained salt and water is gradually excreted CNS: Nausea, vomiting Pharmacological actions
Slide 14-

Pharmacokinetic properties
Slide 15-

Cardiac Glycosides (Digitalis) Two glycosides: Short acting Digoxin (t½: 1.5 days) Long acting Digitoxin (t½: 5 days) Severely limited Use Used
Slide 16-

Congestive heart failure Cardiac arrhythmias Atrial fibrillation Atrial flutter Paroxysmal supraventricular tachycardia Uses of digoxin
Slide 17-

Adverse effects of digoxin Extra-Cardiac GIT: Nausea & vomiting (first to appear) CNS: Vomiting Restlessness, Disorientation, Visual disturbance Endocrine: Gynaecomastia Cardiac Bradycardia (first cardiac toxic sign) Pulsus bigemini Atrial extra-systole  flutter  fibrillation Ventricular extra-systole  tachycardia  fibrillation Partial heart block  complete block
Slide 18-

Stop digitalis Oral or parenteral potassium supplements For ventricular arrhythmias: Lidocaine IV drug of choice For supraventricular arrhythmia: Propranolol may be given IV or orally For AV block and bradycardia Atropine 0.6 -1.2 mg IM Digoxin antibody Treatment of toxicity
Slide 19-

Amrinone & milrinone are selective phosphodiesterase III inhibitors ↑ cAMP levels The PDE III isoenzyme is specific for intracellular degradation of cAMP in heart, blood vessels and bronchial smooth muscles. Inodilators IV administration for short term treatment of severe heart failure Milrinone is more potent than amrinone and does not produce thrombocytopenia Phosphodiesterase inhibitors in heart failure
Slide 20-

ATP cAMP 5’AMP Adenylyl cyclase Phosphdiesterase III Milrinone Preservation of cAMP Myocardial & Vascular smooth muscles Activation of Protein kinase Phosphorylation of Ca++ Channels Elevated Cytosolic Ca++ Relaxation of Resistance & Capacitance vessels Positive inotropism  CO Pre-load After-load Increased Ca++ Flow Inodilatation Mechanism of Action of Inodilators
Slide 21-

Other inotropic drugs Dopamine Dobutamine
Slide 22-

Almost all symptomatic Patients treated with a diuretic High ceiling diuretics (loop diuretics) preferred Low dose therapy for maintainence They increase salt and water excretion & reduce blood volume Reduce preload & venous pressure Improve cardiac performance & relieve edema Role of diuretics in heart failure
Slide 23-

Angiotensin converting enzyme inhibitors Captopril, enalapril, ramipril, lisinopril Act by Reduction of after load Reduction of preload Reversing the compensatory changes ACE inhibitors are the most preferred drugs for treatment of Congestive cardiac failure ACE Inhibitors in heart failure
Slide 24-

Angiotensinogen Angiotensin I Angiotensin II Angiotensin III AT2 AT1 Renin Angiotensin Converting Enzyme (ACE) Angiotensin Receptor Blocker ACE inhibitor Synthesis Blocker Receptor Blocker
Slide 25-

Losartan , candesartan, valsartan, telmisartan Block AT1 receptor on the heart, peripheral vasculature and kidney As effective as ACE inhibitors Used mainly in patients who cannot tolerate ACE inhibitors because of cough, angioedema, neutropenia Angiotensin receptor blockers in heart failure
Slide 26-

Approach to the Patient with Heart Failure Assessment of LV function (echocardiogram) EF < 40% Assessment of volume status Signs and symptoms of fluid retention No signs and symptoms of fluid retention Diuretic (titrate to euvolemic state) ACE Inhibitor b-blocker Digoxin
Slide 27-

Drugs used in heart failure Chronic heart failure Diuretics Aldosterone receptor antagonist ACE inhibitors Angiotensin receptor blockers Cardiac glycosides Vasodilators Acute heart failure Diuretics Vasodilators Dopamine, dobutamine Amrinone
Slide 28-

Summary Reduce the number of sacks on the wagon Limit the speed, thus saving energy Like the carrot placed in front Increase the efficiency Inotrops Vasodilators  blockers Diuretics, ACE inhibitors