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Drugs For Right & Left Sided Heart Failure. Cardiac Glycosides Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) Diuretics. Cardiac Glycosides. Digitoxin (Crystodigin) Digoxin (Lanoxin). Cardiac Glycosides : Mechanism Of Action.

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drugs for right left sided heart failure
Drugs For Right & Left Sided Heart Failure
  • Cardiac Glycosides
  • Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)
  • Diuretics
cardiac glycosides
Cardiac Glycosides
  • Digitoxin (Crystodigin)
  • Digoxin (Lanoxin)
cardiac glycosides mechanism of action
Cardiac Glycosides : Mechanism Of Action
  • Inhibits Na+-K+ ATPase And Impairs The Active Transport Of Sodium & Potassium - Intracellular Sodium Concentrations Rise
slide4
High Intracellular Na+ Deranges The Na+-Ca2+ Pump Which Allows Intracellular Ca2+ Concentrations To Rise
slide5
Calcium Channels May Open Up And Allow Extracellular Calcium To Flow Into The Cell
  • The Heart Will Beat More Forcibly And With Greater Velocity
slide6
Glycosides Enhance Vagal Tone Over The Heart
    • Slows The Heart Rate
    • Slows The AV Node Conduction Velocity & Increases The AV Nodal Refractory Period
glycosides net effect on the heart
Glycosides Net Effect On The Heart
  • Heart Rate Is Slowed
  • Cardiac Contraction Is Greater
  • Ejection Fraction Is Improved
  • Increased Ejection Velocity
  • The Heart Is A Better Pump
adverse side effects of the cardiac glycosides
Adverse Side Effects Of The Cardiac Glycosides
  • Fatigue
  • Delirium
  • Anorexia
  • Headaches
slide9
Hallucinations
  • Visual Disturbances
  • Atrioventricular Blocks
ekg changes associated with the cardiac glycosides
EKG Changes Associated With The Cardiac Glycosides
  • Prolonged P-R Interval
  • Inversion Of T-Wave
  • S-T Segment Depression
glycosides medical uses
Glycosides - Medical Uses
  • Atrial Flutter
  • Atrial Fibrillation
  • Paroxysmal Tachycardia
  • Congestive Heart Failure
angiotensin converting enzyme inhibitors
Angiotensin Converting Enzyme Inhibitors
  • Captopril (Capoten)
  • Enalapril Maleate (Vasotec)
  • Lisinopril (Prinivil, Zestril)
  • Benazepril (Lotensin)
  • Fosinopril (Monopril)
slide13
Moexipril (Univasc)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)
chf how does it occur
CHF - How Does It Occur ?
  • The Heart As A Pump Is Weakened
    • Myocardial Infarction
    • Ischemic Heart Disease
    • Valve Dysfunction & Disease
    • Hypertension --> To Hypertrophy
    • Idiopathic Cardiomyopathy
slide15
The Failing Heart Causes :
    • Low Blood Flow Systemically
    • Aldosterone Is Released
    • Renin Is Released
slide16
Increased Sodium And Water Retention
  • Increased Cardiac Workload
  • Decreased Cardiac Pump Performance
ace inhibitors mechanism of action
ACE InhibitorsMechanism Of Action
  • Blocks Converting Enzyme From Changing Angiotensin I to Angiotensin II
  • Prevents A Rise In Peripheral Resistance (Vasoconstriction)
slide20
Reduces Afterload On The Heart
  • Reduces Work Of The Heart
ace inhibitors adverse side effects
ACE InhibitorsAdverse Side Effects
  • GI Distress
  • Dizziness
  • Skin Rashes
  • Hypotension
ace inhibitors medical uses
ACE Inhibitors - Medical Uses
  • Hypertension
  • Congestive Heart Failure
  • Diabetic Nephropathy
diuretics
Diuretics
  • High Ceiling Loop Diuretics
  • Benzothiadiazide Diuretics
  • Potassium Sparing Diuretics
  • Mannitol - Osmotic Diuretic
high ceiling loop diuretics
High Ceiling Loop Diuretics
  • Furosemide (Lasix)
  • Ethacrynic Acid (Edecrin)
  • Bumetanide (Bumex)
  • Torsemide (Demadex)
high ceiling loop diuretics mechanism of action
High Ceiling Loop DiureticsMechanism Of Action
  • Loop Diuretics Exert Their Effect At The Proximal Tubule And Ascending Loop
  • Blocks The Re-Absorption of Sodium, Potassium & Chloride Ions
high ceiling loop diuretics adverse side effects
High Ceiling Loop DiureticsAdverse Side Effects
  • Electrolyte Imbalances
    • Hypokalemia ***
    • Hyponatremia
    • Hypocalcemia
    • Hypomagnesemia
slide28
Urinary Loss Of Blood Ions
    • Natriuresis
    • Kaliuresis
  • Orthostatic Hypotension
  • Dehydration
potassium rich foods
Potassium Rich Foods
  • Dates
  • Bananas
  • Raisins
  • Apricots
  • Tomatoes
slide30
Oranges
  • Potatoes
  • Lima Beans
  • Carrots
slide31
Veal
  • Chicken
  • Turkey
  • Liver
  • Beef
  • Milk
slide32
Peanuts
  • Sardines
  • Halibut
high ceiling loop diuretics medical uses
High Ceiling Loop DiureticsMedical Uses
  • Congestive Heart Failure
  • Severe Pneumonia
  • Prevent Acute Renal Failure
  • Control Of Hypertension
  • Control Of General Edema
  • Control Of Acute Pulmonary Edema
benzothiadiazides
Benzothiadiazides
  • Hydrochlorothiazide (Hydrodiuril)
  • Chlorothiazide (Diuril)
  • Clorthalidone (Hygroton)
  • Benzthiazide (Aquapres)
  • Bendroflumethiazide (Naturetin)
slide35
Methyclothiazide (Aquatensen)
  • Polythiazide (Renese)
  • Indapamide (Lozol)
  • Hydroflumethiazide (Diucardin)
  • Metalozone (Zaroxolyn)
  • Quinethazone (Hydromax)
  • Trichlormethiazide (Diurese)
thiazides mechanism of action
Thiazides - Mechanism Of Action
  • Act In The Distal Tubule
  • Inhibit Reabsorption Of Sodium And Potassium
  • Stimulate The Reabsorption Of Calcium
  • Loss Of Water As Urine
thiazides adverse side effects
Thiazides : Adverse Side Effects
  • Loss Of Blood Ions
    • Hypokalemia
    • Hyponatremia
    • Hypomagnesemia
    • Loss Of Iodine
slide38
Loss Of Blood Ions In The Urine
    • Kaliuresis
    • Natriuresis
    • Chloruresis
thiazides adverse side effects39
Thiazides : Adverse Side Effects
  • Hyperuricemia (Gout)
  • Weakness & Fatigue
  • Hypercholesterolemia
  • Hypertriglyceridemia
  • Hyperglycemia (Insulin Suppression)
thiazides medical uses
Thiazides - Medical Uses
  • Control Hypertension
  • Congestive Heart Failure
  • Control Edema Due To :
    • Hepatic Disease
    • Renal Disease
    • Corticosteroid Therapy
    • Estrogen Therapy
potassium sparing diuretics
Potassium Sparing Diuretics
  • Spironolactone (Aldactone)
  • Triamterene (Dyrenium)
  • Amiloride (Midamor)
spironolactone mechanism of action
Spironolactone - Mechanism Of Action
  • Competitively Binds The Aldosterone Receptor Preventing The Hormone From Binding To Its Receptor
  • Aldosterone's Normal Steroid-Nuclear DNA Transcription Is Halted
spironolactone mechanism of action43
SpironolactoneMechanism Of Action
  • Excretion Of :
    • Sodium
    • Chloride
    • Water
  • Retention of Potassium
spironolactone adverse side effects
SpironolactoneAdverse Side Effects
  • Diarrhea
  • Drowsiness
  • Lethargy
slide45
Headaches
  • Impotence
  • Mental Confusion
spironolactone adverse side effects46
SpironolactoneAdverse Side Effects
  • Hyponatremia
  • Hyperkalemia
  • Gynecomastia
  • Irregular Menses
slide47
Amenorrhea
  • Hirsuitism
  • Deepening Of The Voice
spironolactone medical uses
Spironolactone - Medical Uses
  • Heart Failure
  • Primary Hyperaldosteronism
  • Cirrhosis Of The Liver
  • Essential Hypertension
  • Nephrotic Syndrome
spironolactone medical uses49
Spironolactone - Medical Uses
  • Primary Aldosteronism (Conn's Disease)
    • Aldosterone Secreting Adrenal Cortical Tumor
slide50
Severely Depleted Blood Potassium Levels
  • Hypertensive Due To Water Retention
  • Muscle Weakness
spironolactone medical uses51
Spironolactone - Medical Uses
  • Hypokalemia
  • Essential Hypertension
  • Congestive Heart Failure
  • Cirrhosis Of The Liver & Ascites
spironolactone adverse side effects52
SpironolactoneAdverse Side Effects
  • Excessive Loss Of Water
  • Mild Metabolic Acidosis
  • Higher Incidence Of Breast Cancer
  • Sore Breasts And Nipples
triamterene and amiloride mechanism of action
Triamterene And AmilorideMechanism Of Action
  • Inhibit The Reabsorption Of Sodium In The Distal Tubule And Collecting Ducts By Disrupting The Aldosterone-Dependent Na+-K+ Pump
triamterene and amiloride adverse side effects
Triamterene And AmilorideAdverse Side Effects
  • Hyponatremia
  • Hyperkalemia
  • Hypotension
slide56
Nausea
  • Vomiting
  • Acidosis
  • Elevated BUN
triamterene and amiloride medical uses
Triamterene And AmilorideMedical Uses
  • Congestive Heart Failure
  • Cirrhosis Of The Liver
  • Hypertension
osmotic diuretics
Osmotic Diuretics
  • Mannitol (Osmitrol)
mannitol a perfect diuretic
Mannitol - A Perfect Diuretic
  • An Osmotic Diuretic Should Have The Following Qualities :
    • Freely Filterable At The Glomerulus
    • Undergo Limited Or No Reabsorption By The Renal Tubule
slide60
Pharmacologically Inert
  • Resists Metabolic Alteration
mannitol mechanism of action
Mannitol - Mechanism Of Action
  • Mannitol Exerts An Osmotic Draw For Water, Sodium, And Potassium
mannitol adverse side effects
Mannitol - Adverse Side Effects
  • Transient Fluid Overload
  • Pulmonary Edema
  • Tachycardia
  • Mental Detachment
slide63
Blurred Vision
  • Headache
  • Confusion
mannitol medical uses
Mannitol - Medical Uses
  • Acute Renal Failure
  • Reduction Of Cranial Pressure
  • Stimulate Diuresis In Drug Intoxications
  • Reduction Of Intraocular Pressure
clinical considerations
Clinical Considerations
  • The diuretics may increase blood glucose in diabetic patients. This causes hyperglycemia secondary to suppression of insulin release in Type II diabetics.
clinical considerations66
Clinical Considerations
  • Watch the patient for dehydration and electrolyte imbalance.
clinical considerations67
Clinical Considerations
  • Ototoxicity leading to loss of hearing, loss of balance, and vertigo.
clinical considerations68
Clinical Considerations
  • Hypotension & syncopal episodes