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CHF BY SAYAMDEEP ROY B.PHARM

congestive heart failure & its treatment.
Various drugs used , their mechanism of action & adverse effect.

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CHF BY SAYAMDEEP ROY B.PHARM

  1. 1. PREPARED BY-SAYAMDEEP ROY B.PHARM 3rd YEAR, 6th SEM REG NO.-112080210015 ROLL NO.-20801911015
  2. 2.  CHF  ETIOLOGY OF CHF  EPIDEMIOLOGY OF CHF IN INDIA  PATHOPHYSIOLOGY OF CHF  SYMPTOM ,MANAGEMENT OF CHF  VARIOUS DRUGS USED IN CHF  MECHANISM OF ACTION, ADVERSE EFFECT OF THE DRUGS  REFERENCE
  3. 3.  Heart failure (HF) is a complex, progressive disorder in which the heart is unable to pump sufficient blood to meet the need of the body. HF is due to an impaired ability of the heart to adequately fill with and/or eject blood. It is often accompanied by abnormal increases in blood volume and interstitial fluid in cardio-pulmonary system, hence the term ‘congestive’.
  4. 4.  Intrinsic pump failure  Increased workload on the heart  Impaired filling of cardiac chamber  Systolic dysfunction  Diastolic dysfunction  Poor supply of O2 & nutrients
  5. 5. 1 2
  6. 6. PATHOPHYSIOLOGY OF CHF CONGESTIVE HEART FALIURE Angiotensinoge ACE n
  7. 7. SYMPTOMS OF CHF
  8. 8.  Weigh yourself daily.  Try to read food labels.  Follow a low-sodium diet. Keep total sodium intake to less than 2,000 mg (2g) per day.  Exercise.  Take prescribed medicine.  Do not take NSAIDS—Advil® (Ibuprofen), Aleve® (Naproxen), Orudis® (Ketoprofen), or other anti-inflammatory drugs.  Avoid: Alka-Seltzer®, Metamucil Instant®, and all effervescent drugs.  Lose weight (if overweight).  Get support of friends and family.  Quit smoking.  Limit alcohol (if your heart failure is caused by alcohol, avoid it completely).  Take care of other medical conditions such as high blood pressure and diabetes.  Consult with a registered doctor.
  9. 9. DRUGS USED IN CHF  RENIN-ANGIOTENSIN SYSTEM BLOCKERS ACE inhibitors ARBs  ß-BLOCKERS  DIURETICS thiazides High ceiling K+sparing /loop diuretics  VASODILATORS mixed dilator Venodilator Arteriolar dilator  CARDIAC GLYCOSIDES / INOTROPIC AGENTS  ALDOSTERONE ANTAGONISTS
  10. 10.  ACE inhibitors – CAPTOPRIL ENALAPRIL QUINAPRIL RAMIPRIL  ANGIOTENSIN RECEPTOR BLOCKER-LOSARTAN VALSARTAN TELMISARTAN  β-BLOCKERS-ATENOLOL PROPRANOLOL CARVEDILOL METOPROLOL  HIGH CEILING /LOOP DIURETICS-FUROSEMIDE TORSEMIDE  K+ SPARING-SPIRONOLACTONE  THIAZIDE DIURETICS-HYDROCHLOROTHIAZIDE  VENODILATOR-ISOSORBIDE DINITRATE GLYCERYL TRINITRATE  ARTERIOLAR DILATOR-HYDRALAZINE MINOXIDIL  MIXED DILATOR-SODIUM NITROPRUSSIDE  CARDIAC GLYCOSIDE-DIGITOXIN DIGOXIN PHOSPHODIESTERASE III (PDE III) INHIBITOR-MILRINONE AMRINONE
  11. 11. RENIN (from kidney) ANGIOTENSIN CONVERTING ENZYME
  12. 12. ANGIOTENSIN CONVERTING ENZYME (ACE)
  13. 13.  These include postural hypotension, renal insufficiency, hyperkalemia, angioedema, and a persistent dry cough. The potential for symptomatic hypotension with ACE inhibitor therapy requires careful monitoring. ACE inhibitors should not be used in pregnant women, because they are fetotoxic.
  14. 14. These include postural hypotension, renal insufficiency, hyperkalemia, angioedema. ARBs are contraindicated in pregnancy.
  15. 15. ß-blocker inhibits the changes that occurs due to activation of Sympathetic Nervous System Decrease Heart Rate Inhibition of renin secretion from kidney Decreased Angiotensin II formation Increased Cardiac Output
  16. 16. ß-blocker is not a drug of choice in CHF , because it have various adverse effects--  BRADYCARDIA  INCREASED FREQUENCY OF URINATION Etc.
  17. 17. DIURETIC S Decrease circulating volume of heart Decrease venous return to heart (preload) Improve ventricular efficiency Decrease cardiac workload & O2 demand of heart Decrease afterload by decreasin g plasma volume Decrease the blood pressure Removin g periphera l edema & pulmonar y congesti on
  18. 18. Some adverse effects are – THIAZIDE GROUP- LOSS OF Na+ LOOP DIURETICS GROUP- LOSS OF ELECTROLYTE INSTEAD OF THIS-  INCREASED FREQUENCY OF URINATION,  HYPOTENSION, Etc.
  19. 19. MECHANISM OF ACTION OF VENODILATORS ORGANIC NITRATES (GLYCERYL TRINITRATE , ISOSORBIDE DINITRATE) Metabolized in vascular endothelial cell 5-NITROSOTHIOL NITRIC OXIDE GUANYLYL CYCLASE GTP cGMP Decreased Ca2+ entry in Vascular cell RELAXATION DEPHOSPHORYLATION OF MYOSIN LIGHTCHAIN KIASE (MLCK) DUE TO ABSENCE OF PHOSPHORYLATED MLCK, MYOSIN IS NOT ACTIVATED NO ACTIN MYOSIN INTERACTION
  20. 20. METABOLIZED IN ENDOTHELIAL CELLS AND RBC GTP RELAXATION OF VASCULAR MUSCLE DEPHOSPHORYLATION OF MYOSIN LIGHTCHAIN KIASE (MLCK) DUE TO ABSENCE OF PHOSPHORYLATED MLCK, MYOSIN IS NOT ACTIVATED NO ACTIN MYOSIN INTERACTION
  21. 21. MECHANISM OF ACTION OF PHOSPHODIESTERASE III (PDE III) INHIBITOR PDE III ATP cAMP 5’AMP PDE III inhibitor (milrinone , amrinone) Increase Ca2+ influx in myocardial muscle Increase force of contraction of heart (positive inotropic effect)
  22. 22. Some adverse effects are--  THROMBOCYTOPENIA  NAUSEA  DIARRHOEA  ABDOMINAL PAIN  LIVER DAMAGE  FEVER  CARDIAC ARRHYTHMIA
  23. 23. Na+-K+ATPase transport system moves Na+ ion out of the cell & brings 2k+ion in to the cell Na+-k+ ATPase transporter molecule is blocked by cardiac glycosides increased intracellular accumulation of Na+ions Exchange of Na+ions with Ca2+ion through Na+-Ca2+ antiporter system is increased Ca2+ entry through L-type Ca2+ Increase intra cellular concentration of Ca2+ ion Ca2+ ion stored in Sercoplasmic Reticulum (SR) Ca2+ release from SR Ca2+ binds to troponin c to form troponin c-Ca2+ complex which activate actin Actin-myosin interaction Increased cardiac muscle contraction channel
  24. 24. Occurrence of adverse drug reaction is common due to its narrow therapeutic index. Some adverse effects are -- Extra cardiac adverse effects-anorexia, nausea, vomiting, diarrhoea, fatigue, headache, mental confusion, restlessness, depression, blurred vision Cardiac adverse effect-all types of cardiac arrhythmia occurs like ventricular extrasystole, ventricular tachycardia etc.
  25. 25. REFERENCE • ESSENTIALS OF MEDICAL PHARMACOLOGY KD TRIPATHI 6th edition , pp.-493-507 • LIPPINCOTT’S ILLUSTRATED REVIEWS PHARMACOLOGY RICHARD FINKEL, LUIGI X. CUBEDDU, MICHELLE A. CLARK 6th edition , pp.-151-157

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congestive heart failure & its treatment. Various drugs used , their mechanism of action & adverse effect.

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