Clinical Pharmacy Chapter One Heart Failure. Rowa’ Al-Ramahi. DEFINITION. Heart failure (HF) is a clinical syndrome caused by the inability of the heart to pump sufficient blood to meet the metabolic needs of the body.
The therapeutic goals for chronic HF are to:
2. Angiotensin-Converting Enzyme Inhibitors worsen HF include compete blood count; serum electrolytes (including calcium and magnesium); renal, hepatic, and thyroid function tests; urinalysis; lipid profile; and hemoglobin A1C.
3 worsen HF include compete blood count; serum electrolytes (including calcium and magnesium); renal, hepatic, and thyroid function tests; urinalysis; lipid profile; and hemoglobin A1C.. β-Blockers
1. Angiotensin II Receptor Blockers
2. theoretical advantage over either agent alone through more complete blockade of the deleterious effects of angiotensin II. However, clinical trial results indicate that the addition of an ARB to optimal HF therapy offers marginal benefits at best with increased risk of adverse effects. Addition of an ARB may be considered in patients who remain symptomatic despite receiving optimal conventional therapyAldosterone Antagonists
3. serious hyperkalemia and worsening renal function are much higher than observed in clinical trials. This may be due in part to failure of clinicians to consider renal impairment, reduce or stop potassium supplementation, or monitor renal function and potassium closely once the aldosterone antagonist is initiated. Thus, aldosterone antagonists must be used cautiously and with careful monitoring of renal function and potassium concentration. They should be avoided in patients with renal impairment, recent worsening of renal function, high-normal potassium levels, or a history of severe hyperkalemia.Digoxin
4. Nitrates and Hydralazine concentration of 0.5 to 1 ng/mL. Higher plasma levels are not associated with additional benefits but may increase the risk of toxicity. Most patients with normal renal function can achieve this level with a dose of 0.125 mg/day. Patients with decreased renal function, the elderly, or those receiving interacting drugs (e.g., amiodarone) should receive 0.125 mg every other day. In the absence of supraventricular tachyarrhythmias, a loading dose is not indicated because digoxin is a mild inotropic agent that produces gradual effects over several hours, even after loading. Blood samples for measuring plasma digoxin concentrations should be collected at least 6 hours, and preferably 12 hours or more, after the last dose.
MECHANICAL CIRCULATORY SUPPORT
Intraaortic Balloon Pump
Ventricular Assist Devices