drugs for right & left sided heart failure n cardiac glycosides n angiotensin-converting enzyme...

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

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Drugs For Right & Left Sided Heart Failure

Drugs For Right & Left Sided Heart Failure

Cardiac GlycosidesCardiac Glycosides Angiotensin-Converting Enzyme Angiotensin-Converting Enzyme

Inhibitors (ACE Inhibitors)Inhibitors (ACE Inhibitors) DiureticsDiuretics

Cardiac GlycosidesCardiac Glycosides

Digitoxin (Crystodigin)Digitoxin (Crystodigin) Digoxin (Lanoxin)Digoxin (Lanoxin)

Cardiac Glycosides : Mechanism Of Action

Cardiac Glycosides : Mechanism Of Action

Inhibits Na+-K+ ATPase And Inhibits Na+-K+ ATPase And Impairs The Active Transport Of Impairs The Active Transport Of Sodium & Potassium - Intracellular Sodium & Potassium - Intracellular Sodium Concentrations RiseSodium Concentrations Rise

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

Calcium Channels May Open Up Calcium Channels May Open Up And Allow Extracellular Calcium And Allow Extracellular Calcium To Flow Into The CellTo Flow Into The Cell

The Heart Will Beat More Forcibly The Heart Will Beat More Forcibly And With Greater VelocityAnd With Greater Velocity

Glycosides Enhance Vagal Tone Glycosides Enhance Vagal Tone Over The HeartOver The HeartSlows The Heart RateSlows The Heart RateSlows The AV Node Conduction Slows The AV Node Conduction

Velocity & Increases The AV Velocity & Increases The AV Nodal Refractory PeriodNodal Refractory Period

Glycosides Net Effect On The Heart

Glycosides Net Effect On The Heart

Heart Rate Is SlowedHeart Rate Is Slowed Cardiac Contraction Is GreaterCardiac Contraction Is Greater Ejection Fraction Is ImprovedEjection Fraction Is Improved Increased Ejection VelocityIncreased Ejection Velocity The Heart Is A Better PumpThe Heart Is A Better Pump

Adverse Side Effects Of The Cardiac GlycosidesAdverse Side Effects Of The Cardiac Glycosides

FatigueFatigue DeliriumDelirium AnorexiaAnorexia HeadachesHeadaches

HallucinationsHallucinations Visual DisturbancesVisual Disturbances Atrioventricular BlocksAtrioventricular Blocks

EKG Changes Associated With The Cardiac Glycosides

EKG Changes Associated With The Cardiac Glycosides

Prolonged P-R IntervalProlonged P-R Interval Inversion Of T-WaveInversion Of T-Wave S-T Segment DepressionS-T Segment Depression

Glycosides - Medical UsesGlycosides - Medical Uses

Atrial FlutterAtrial Flutter Atrial FibrillationAtrial Fibrillation Paroxysmal TachycardiaParoxysmal Tachycardia Congestive Heart FailureCongestive Heart Failure

Angiotensin Converting Enzyme Inhibitors

Angiotensin Converting Enzyme Inhibitors

Captopril (Capoten)Captopril (Capoten) Enalapril Maleate (Vasotec)Enalapril Maleate (Vasotec) Lisinopril (Prinivil, Zestril)Lisinopril (Prinivil, Zestril) Benazepril (Lotensin)Benazepril (Lotensin) Fosinopril (Monopril)Fosinopril (Monopril)

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

CHF - How Does It Occur ?CHF - How Does It Occur ?

The Heart As A Pump Is WeakenedThe Heart As A Pump Is WeakenedMyocardial InfarctionMyocardial InfarctionIschemic Heart DiseaseIschemic Heart DiseaseValve Dysfunction & DiseaseValve Dysfunction & DiseaseHypertension --> To HypertrophyHypertension --> To HypertrophyIdiopathic CardiomyopathyIdiopathic Cardiomyopathy

The Failing Heart Causes :The Failing Heart Causes :Low Blood Flow SystemicallyLow Blood Flow SystemicallyAldosterone Is ReleasedAldosterone Is ReleasedRenin Is ReleasedRenin Is Released

Increased Sodium And Water Increased Sodium And Water RetentionRetention

Increased Cardiac WorkloadIncreased Cardiac WorkloadDecreased Cardiac Pump Decreased Cardiac Pump

PerformancePerformance

ACE InhibitorsMechanism Of Action

ACE InhibitorsMechanism Of Action

Blocks Converting Enzyme From Blocks Converting Enzyme From Changing Angiotensin I to Changing Angiotensin I to Angiotensin IIAngiotensin II

Prevents A Rise In Peripheral Prevents A Rise In Peripheral Resistance (Vasoconstriction)Resistance (Vasoconstriction)

Reduces Afterload On The HeartReduces Afterload On The Heart Reduces Work Of The HeartReduces Work Of The Heart

ACE InhibitorsAdverse Side Effects

ACE InhibitorsAdverse Side Effects

GI DistressGI Distress DizzinessDizziness Skin RashesSkin Rashes HypotensionHypotension

ACE Inhibitors - Medical UsesACE Inhibitors - Medical Uses

HypertensionHypertension Congestive Heart FailureCongestive Heart Failure Diabetic NephropathyDiabetic Nephropathy

DiureticsDiuretics

High Ceiling Loop DiureticsHigh Ceiling Loop Diuretics Benzothiadiazide DiureticsBenzothiadiazide Diuretics Potassium Sparing DiureticsPotassium Sparing Diuretics Mannitol - Osmotic DiureticMannitol - Osmotic Diuretic

High Ceiling Loop DiureticsHigh Ceiling Loop Diuretics

Furosemide (Lasix)Furosemide (Lasix) Ethacrynic Acid (Edecrin)Ethacrynic Acid (Edecrin) Bumetanide (Bumex)Bumetanide (Bumex) Torsemide (Demadex)Torsemide (Demadex)

High Ceiling Loop DiureticsMechanism Of Action

High Ceiling Loop DiureticsMechanism Of Action

Loop Diuretics Exert Their Loop Diuretics Exert Their Effect At The Proximal Tubule Effect At The Proximal Tubule And Ascending LoopAnd Ascending Loop

Blocks The Re-Absorption of Blocks The Re-Absorption of Sodium, Potassium & Chloride Sodium, Potassium & Chloride IonsIons

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

High Ceiling Loop DiureticsAdverse Side Effects

High Ceiling Loop DiureticsAdverse Side Effects

Electrolyte ImbalancesElectrolyte ImbalancesHypokalemia ***Hypokalemia ***HyponatremiaHyponatremiaHypocalcemiaHypocalcemiaHypomagnesemiaHypomagnesemia

Urinary Loss Of Blood IonsUrinary Loss Of Blood IonsNatriuresisNatriuresisKaliuresisKaliuresis

Orthostatic HypotensionOrthostatic Hypotension DehydrationDehydration

Potassium Rich FoodsPotassium Rich Foods

DatesDates BananasBananas RaisinsRaisins ApricotsApricots TomatoesTomatoes

OrangesOranges PotatoesPotatoes Lima BeansLima Beans CarrotsCarrots

VealVeal ChickenChicken TurkeyTurkey LiverLiver BeefBeef MilkMilk

PeanutsPeanuts SardinesSardines HalibutHalibut

High Ceiling Loop DiureticsMedical Uses

High Ceiling Loop DiureticsMedical Uses

Congestive Heart FailureCongestive Heart Failure Severe PneumoniaSevere Pneumonia Prevent Acute Renal FailurePrevent Acute Renal Failure Control Of HypertensionControl Of Hypertension Control Of General EdemaControl Of General Edema Control Of Acute Pulmonary EdemaControl Of Acute Pulmonary Edema

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

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

Thiazides - Mechanism Of ActionThiazides - Mechanism Of Action

Act In The Distal TubuleAct In The Distal Tubule Inhibit Reabsorption Of Sodium Inhibit Reabsorption Of Sodium

And PotassiumAnd Potassium Stimulate The Reabsorption Of Stimulate The Reabsorption Of

CalciumCalcium Loss Of Water As UrineLoss Of Water As Urine

Thiazides : Adverse Side EffectsThiazides : Adverse Side Effects

Loss Of Blood IonsLoss Of Blood IonsHypokalemiaHypokalemiaHyponatremiaHyponatremiaHypomagnesemiaHypomagnesemiaLoss Of IodineLoss Of Iodine

Loss Of Blood Ions In The UrineLoss Of Blood Ions In The UrineKaliuresisKaliuresisNatriuresisNatriuresisChloruresisChloruresis

Thiazides : Adverse Side EffectsThiazides : Adverse Side Effects

Hyperuricemia (Gout)Hyperuricemia (Gout) Weakness & FatigueWeakness & Fatigue HypercholesterolemiaHypercholesterolemia HypertriglyceridemiaHypertriglyceridemia Hyperglycemia (Insulin Hyperglycemia (Insulin

Suppression)Suppression)

Thiazides - Medical UsesThiazides - Medical Uses

Control HypertensionControl Hypertension Congestive Heart FailureCongestive Heart Failure Control Edema Due To :Control Edema Due To :

Hepatic DiseaseHepatic DiseaseRenal DiseaseRenal DiseaseCorticosteroid TherapyCorticosteroid TherapyEstrogen TherapyEstrogen Therapy

Potassium Sparing DiureticsPotassium Sparing Diuretics

Spironolactone (Aldactone)Spironolactone (Aldactone) Triamterene (Dyrenium)Triamterene (Dyrenium) Amiloride (Midamor)Amiloride (Midamor)

Spironolactone - Mechanism Of Action

Spironolactone - Mechanism Of Action

Competitively Binds The Competitively Binds The Aldosterone Receptor Preventing Aldosterone Receptor Preventing The Hormone From Binding To Its The Hormone From Binding To Its ReceptorReceptor

Aldosterone's Normal Steroid-Aldosterone's Normal Steroid-Nuclear DNA Transcription Is Nuclear DNA Transcription Is HaltedHalted

SpironolactoneMechanism Of Action

SpironolactoneMechanism Of Action

Excretion Of :Excretion Of :SodiumSodiumChlorideChlorideWaterWater

Retention of Retention of PotassiumPotassium

SpironolactoneAdverse Side Effects

SpironolactoneAdverse Side Effects

DiarrheaDiarrhea DrowsinessDrowsiness LethargyLethargy

HeadachesHeadaches ImpotenceImpotence Mental ConfusionMental Confusion

SpironolactoneAdverse Side Effects

SpironolactoneAdverse Side Effects

HyponatremiaHyponatremia HyperkalemiaHyperkalemia GynecomastiaGynecomastia Irregular MensesIrregular Menses

AmenorrheaAmenorrhea HirsuitismHirsuitism Deepening Of The VoiceDeepening Of The Voice

Spironolactone - Medical UsesSpironolactone - Medical Uses

Heart FailureHeart Failure Primary HyperaldosteronismPrimary Hyperaldosteronism Cirrhosis Of The LiverCirrhosis Of The Liver Essential HypertensionEssential Hypertension Nephrotic SyndromeNephrotic Syndrome

Spironolactone - Medical UsesSpironolactone - Medical Uses

Primary Aldosteronism (Conn's Primary Aldosteronism (Conn's Disease)Disease)Aldosterone Secreting Adrenal Aldosterone Secreting Adrenal

Cortical TumorCortical Tumor

Severely Depleted Blood Severely Depleted Blood Potassium LevelsPotassium Levels

Hypertensive Due To Water Hypertensive Due To Water RetentionRetention

Muscle WeaknessMuscle Weakness

Spironolactone - Medical UsesSpironolactone - Medical Uses

HypokalemiaHypokalemia Essential HypertensionEssential Hypertension Congestive Heart FailureCongestive Heart Failure Cirrhosis Of The Liver & AscitesCirrhosis Of The Liver & Ascites

SpironolactoneAdverse Side Effects

SpironolactoneAdverse Side Effects

Excessive Loss Of WaterExcessive Loss Of Water Mild Metabolic AcidosisMild Metabolic Acidosis Higher Incidence Of Breast Higher Incidence Of Breast

CancerCancer Sore Breasts And NipplesSore Breasts And Nipples

Triamterene And AmilorideMechanism Of Action

Triamterene And AmilorideMechanism Of Action

Inhibit The Reabsorption Of Sodium Inhibit The Reabsorption Of Sodium In The Distal Tubule And Collecting In The Distal Tubule And Collecting Ducts By Disrupting The Ducts By Disrupting The Aldosterone-Dependent Na+-K+ Aldosterone-Dependent Na+-K+ PumpPump

Potassium Is Spared Because Potassium Is Spared Because Sodium Is Wasted - A Reciprocal Sodium Is Wasted - A Reciprocal RelationshipRelationship

Triamterene And AmilorideAdverse Side Effects

Triamterene And AmilorideAdverse Side Effects

HyponatremiaHyponatremia HyperkalemiaHyperkalemia HypotensionHypotension

NauseaNausea VomitingVomiting AcidosisAcidosis Elevated BUNElevated BUN

Triamterene And AmilorideMedical Uses

Triamterene And AmilorideMedical Uses

Congestive Heart FailureCongestive Heart Failure Cirrhosis Of The LiverCirrhosis Of The Liver HypertensionHypertension

Osmotic DiureticsOsmotic Diuretics

Mannitol (Osmitrol)Mannitol (Osmitrol)

Mannitol - A Perfect DiureticMannitol - A Perfect Diuretic

An Osmotic Diuretic Should Have An Osmotic Diuretic Should Have The Following Qualities :The Following Qualities :Freely Filterable At The Freely Filterable At The

GlomerulusGlomerulusUndergo Limited Or No Undergo Limited Or No

Reabsorption By The Renal Reabsorption By The Renal TubuleTubule

Pharmacologically InertPharmacologically InertResists Metabolic AlterationResists Metabolic Alteration

Mannitol - Mechanism Of ActionMannitol - Mechanism Of Action

Mannitol Exerts An Osmotic Mannitol Exerts An Osmotic Draw For Water, Sodium, And Draw For Water, Sodium, And PotassiumPotassium

Mannitol - Adverse Side EffectsMannitol - Adverse Side Effects

Transient Fluid OverloadTransient Fluid Overload Pulmonary EdemaPulmonary Edema TachycardiaTachycardia Mental Detachment Mental Detachment

Blurred VisionBlurred Vision HeadacheHeadache ConfusionConfusion

Mannitol - Medical UsesMannitol - Medical Uses

Acute Renal FailureAcute Renal Failure Reduction Of Cranial PressureReduction Of Cranial Pressure Stimulate Diuresis In Drug Stimulate Diuresis In Drug

IntoxicationsIntoxications Reduction Of Intraocular Reduction Of Intraocular

PressurePressure

Clinical ConsiderationsClinical Considerations

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

Clinical ConsiderationsClinical Considerations

Watch the patient for dehydration Watch the patient for dehydration and electrolyte imbalance.and electrolyte imbalance.

Clinical ConsiderationsClinical Considerations

Ototoxicity leading to loss of Ototoxicity leading to loss of hearing, loss of balance, and hearing, loss of balance, and vertigo.vertigo.

Clinical ConsiderationsClinical Considerations

Hypotension & syncopal episodesHypotension & syncopal episodes