Drugs for CCF with their mechanism of action.

1. Individual Drugs….
P . Akshay Khumar

2.  Increased Preload
 Increased Afterload
 Decreased Cardiac Output
 Decreased renal blood flow Na and Water
retention Oedema

3.  Diuretics: Loop,Thiazides,Aldosterone antagonists
 Vasodialators: Arteriolar,Venodilators,Both
 Vasopressin receptor antagonists
 Phosphodiesterase inhibitors
 Natriuretic peptides
 Beta Blockers
 Symapatomimetic amines
 Cardiac glycosides

4. Diuretics
Na and water excretion
Reduce ECF
Decrease Preload
Improves Cardiac Efficacy

5.  Thiazides act on Early DCT. Blocks Na-Cl
symport leading loss of Na and cl
 Late distal tubule has Na-K exchange and hence
more K is lostHypokalemia,Hypercalcemia
 Loop diuretics block luminal side of Na-k-cl
cotransportHyponatremia,Hypokalemia,
Hypocalcemia

6.  ACE inhibitors decrease PVR,Aldosterone
production and reverse hypertrophy. A/E-
Cough
 Arteriloar dilators PVR Afterload
Perfusion
 VenodilatorsPeripheral pooling of blood 
Preload

7.  ADHreceptorsRetention of water and
Na ECF Load
 Hence we block the Receptors

8. Milrinone
Inhibits Phosdiesterase III
cAMP
Positive Inotropic and Vasodilator effects

9. Nesiritide
(r form of Brain Natriuertic Peptide)
Vasodilator
A/E- Hypotension

10. Beta Blockers
Mediates the action of catecholamines on Heart
Increase the ejection fraction
 Decrease the frequency of arrhythmias
 Carvedilol has antioxidant properties
 Must be used under careful surveillance

11. Dopamine
 Catecholamine
Has dose dependent action
Low dose Moderate High dose
• Dilates Renal
Vessels
• Inc.GFR and
Urine output
• Stimulates B1
Receptors
• Inc FOC
• Inc CO
Generalised
Vasoconstriction

12. Dobutamine
 Synthetic catecholamine
 Acts on B1,B2 and A1 receptors
 Increases FOC
 PVR not affected because A1-Vasoconstriction
and B2-Vasodilatation
 A/E- Hypertension,Tachycardia and tolerance

13.  Increased FOC and CO

14.  Has Cardiac and Extra Cardiac Actions
 Cardic:
Positive Inotropic (FOC)
Negative Chronotropic (HR)
Negative Dromotropic
 Extracardiac:
GIT: Anorexia,Nausea,VomittingCTZ
Kidney:Diuresis
CNS: Sympathetic Stimulation,Confusion