Congestive heart failure is defined as the heart's inability to maintain adequate blood flow to meet the body's needs. There are several classes of drugs used to treat congestive heart failure, including inotropic drugs like digoxin that increase contractility, phosphodiesterase inhibitors like milrinone that increase calcium levels and contractility, vasodilators that produce nitric oxide to dilate blood vessels, aldosterone antagonists like spironolactone that cause sodium and water loss, ACE inhibitors like enalapril and ARBs that inhibit the renin-angiotensin-aldosterone system, beta blockers like carvedilol that block the effects of catecholamines, and di

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CONGESTIVE HEART FAILURE
It may be defined as the inabilityof the heart to maintain the co
adequete to meet the metabolic demands of the body at all times.
DRUGS FOR CHF

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INOTROPIC DRUGS
CARDIAC GLYCOSIDES
●
Example:Digoxin
Ouabain
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MAO: Inhibition of Na+/K+ ATPase
Concentration of intercellular Na ions.
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Pharmacological action in: Heart,kidney,CNS,blood ves
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Dose:oral dose(Digitoxin: 0.05mg-0.2,Digoxine:0.2mg)
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Kinetics:oral absorption,distribution all over the
body,excreted in urine
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Drug interaction:Digitalis+Diuretics=Hypokalaemia
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ADR:Digitalis toxicity
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Treatment :Further dose must be stopped

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PHOSPHODIESTERASE INHIBITORS
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Eg:Inamrinone
Milrinone
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MOA:
●
●
●
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ADR:Thrombocytopenia,nausea,diarrhoea.
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Dose: 50µg/Kg.
Phosphodiesterase inhibited by drugs
It increases intra cellular Camp
It increases the Ca concentration
It increases the cardiac contractility

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VASODIALOTORS
●
3 TYPES: Venodialators
Arteriolar dialators
Arteriolar+venodialotors
●
MOA: Drug produce NO
Activate Guanosyl cyclase
GTP cGMP Dephosphorylati
Vas
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ADR:Thrombing headache
Flushing of face

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ALDOSTERONE ANTAGONIST
●
Examlpe : Spironolactone
Eplerenone
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MOA : Inhibits Aldosterone
Causes Na and water loss
Decreases BP
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ADR :Hyper kalaemia
Hyponatremia
Low heart rate
Fatigue

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RENIN ANGIOTENSIN INHIBITORS
ACE INHIBITORS
●
Eg: Enalapril
Ramipril
MOA:
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It inhibits the angiotensin converting enzyme which con
Angiotensin I to Angiotensin II
ADR :
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Postural HTN
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Dry cough

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ANGIOTENSIN AT1RECEPTOR BLOCKERS
●
Eg: Losartan
Candesartan
● MOA: It binds to AT1receptor and blocks Angiotensin
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ADR:
Kidney damage
High K level

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β-ADRENERGIC BLOCKER
Example:
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Metaprolol
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Bisoprolol
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Nebivolol
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Carvedilol
MOA:Block the adverse cardiac defects of
Catecholamine
ADR:Bronchospasm,heart failure,bradycardia.

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DIURETICS
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HIGH CEILING
●
Eg: Furosemide
Bumetanide
●
MOA:Inhibit Na+,K+,Cl- Co
transporter
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ADR:Muscle
cramps,thirst,weakness,di
zziness,diarrhea
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THIAZIDE LIKE
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Eg:Hydrochlorothiazide
Metolazone
Xipamide
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MOA:Inhibit Na+,Cl- Co
transporter
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ADR: Hyponatremia,
hypokalemia, decline in
renal function.

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