Drugs

Drugs for Congestive Heart Failure (CHF)

Drugs for Congestive Heart Failure (CHF)

Classification

1. Diuretics

  • Almost all cases of symptomatic CHF are treated with a diuretic.

Loop diuretics

High ceiling diuretics are the diuretics of choice for mobilizing edema fluid; later they may be continued in low doses.

E.g.

  • Furosemide
  • Bumetanide

Thiazides

  • Thiazide alone has very limited role in CHF.

Aldosterone antagonist diuretics

E.g.

  • Spironolactone

2. ACE inhibitors

  • Action: Mixed dilatation (↓ pre & after load)

3. Angiotensin (AT1 receptor) blockers

  • Action: Mixed dilatation (↓ pre & after load)

4. Direct vasodilators

Arterial dilators

  • Primarily ↓ afterload

E.g.

  • Hydralazine
  • Minoxidil
  • Ca++ channel blockers (Nifedipine)
  • K+ channel openers (Nicorandil)

Venodilators

  • Primarily ↓ preload

E.g.

  • Isosorbide dinitrate
  • Glyceryl trinitrate

Arterial + venodilators

E.g.

  • Sodium nitroprusside

5. β-blockers

E.g.

  • Metoprolol Succinate & tartrate
  • Bisoprolol

6. β+α- blockers

E.g.

  • Carvedilol

7. Inotropic agents

  • Action: Positive inotropy and direct vasodilatation

E.g.

  • Digoxin
  • Dobutamine
  • Dopamine

8. Phosphodiesterase III inhibitors

  • Action: Positive inotropy and direct vasodilatation (↓ pre & after load)

E.g.

  • Milrinone
  • Amrinone

Objectives

There are two distinct goals of drug therapy in CHF:

(a) Relief of congestive/low output symptoms and restoration of cardiac performance

  • Inotropic drugs: Digoxin, Dobutamine, Dopamine, Amrinone, Milrinone
  • Diuretics
  • Vasodilators: ACE inhibitors, ARBs, Hydralazine, Nitrate, Nitroprusside
  • β-blockcr: Metoprolol, Bisoprolol, Carvedilol

(b) Arrest/reversal of disease progression & prolongation of survival

  • ACE inhibitors, ARBs
  • β-blockers
  • Aldosterone antagonist: Spironolactone
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