Heart failure drug table

what diuretics are used in heart failure?

Furosemide, other loop diuretics; spironolactone; eplerenone; flozins: empagliflozin, dapagliflozin, canagliflozin

furosemide / loop diuretics MOA

Reduce preload and edema by powerful diuretic action on the thick ascending limb in the nephron; vasodilating effect on pulmonary vessels

furosemide / loop diuretics clinical applications

Acute and chronic heart failure, especially acute pulmonary edema; other edematous conditions; hypercalcemia

furosemide / loop diuretics pharmacokinetics

Oral, parenteral; duration 2-4 h

furosemide / loop diuretics toxicities & interactions

Ototoxicity; hypovolemia; hypokalemia

spironolactone MOA

Antagonist of aldosterone in kidney plus poorly understood reduction in mortality

spironolactone clinical applications

Chronic heart failure; aldosteronism

spironolactone pharmacokinetics

Oral; duration 24-48 h

spironolactone toxicities & interactions

Hyperkalemia; gynecomastia

how is eplerenone different from spironolactone?

Similar to spironolactone but lacks gynecomastia effect

what flozins are used in heart failure?

Empagliflozin; dapagliflozin; canagliflozin

what are flozins used for in heart failure?

SGLT2 inhibitors used to reduce the risk of cardiovascular death in type 2 diabetics; beneficial in HFrEF even without diabetes

what ACE inhibitors and receptor blockers are used in heart failure?

Captopril; benazepril; enalapril; losartan; candesartan; sacubitril

captopril MOA

Blocks angiotensin-converting enzyme; reduces Ang II levels; decreases vascular tone and aldosterone secretion; reduces mortality

captopril clinical applications

Heart failure; hypertension; diabetes

captopril pharmacokinetics

Oral; short half-life but large doses used; duration 12-24 h

captopril toxicities & interactions

Cough; renal damage; hyperkalemia; contraindicated in pregnancy

how are benazepril and enalapril described?

Like captopril

how are losartan and candesartan described?

Angiotensin receptor blockers; benefits not documented as well as those of ACE inhibitors

what is sacubitril?

Neprilysin inhibitor; increases BNP levels; used in combination with valsartan for heart failure

what positive inotropic drugs are used in heart failure?

Cardiac glycosides: digoxin; sympathomimetics: dobutamine

digoxin MOA

Inhibits Na+/K+ ATPase sodium pump; increases intracellular Na+, decreases Ca expulsion, and increases cardiac contractility

digoxin clinical applications

Chronic heart failure; nodal arrhythmias

digoxin pharmacokinetics

Oral, parenteral; duration 40 h

digoxin toxicities & interactions

Arrhythmogenic; nausea; vomiting; diarrhea; visual changes; rare endocrine changes

dobutamine MOA

Beta1-selective sympathomimetic; increases cAMP and force of contraction

dobutamine clinical application

Acute heart failure

dobutamine pharmacokinetics

Parenteral; duration a few minutes

dobutamine toxicity

Arrhythmias

what beta blockers are used in heart failure?

Carvedilol; metoprolol; bisoprolol

what is the MOA of beta blockers in heart failure?

Poorly understood reduction of mortality, possibly by decreasing remodeling

beta blockers clinical application in heart failure

Chronic heart failure

what are the pharmacokinetics of beta blockers in heart failure?

Oral; duration varies

what is the toxicity of beta blockers in heart failure?

Cardiac depression

what vasodilators are used in heart failure?

Nitroprusside; hydralazine + isosorbide dinitrate; nesiritide; sacubitril + losartan

nitroprusside MOA

Rapid, powerful vasodilation reduces preload and afterload

nitroprusside clinical application

Acute severe decompensated failure

nitroprusside pharmacokinetics

IV infusion; duration a few minutes

nitroprusside toxicities & interactions

Excessive hypotension; thiocyanate and cyanide toxicity

hydralazine + isosorbide dinitrate MOA

Poorly understood reduction in mortality

hydralazine + isosorbide dinitrate clinical application

Chronic failure in African Americans

hydralazine + isosorbide dinitrate pharmacokinetics

Oral

hydralazine + isosorbide dinitrate toxicities & interactions

Headache; tachycardia

nesiritide MOA

Atrial peptide vasodilator; diuretic

nesiritide clinical application

Acute severe decompensated failure

nesiritide pharmacokinetics

Parenteral; duration a few minutes

nesiritide toxicities & interactions

Renal damage; hypotension

sacubitril + losartan MOA

Neprilysin inhibitor + ARB

sacubitril + losartan clinical application

Chronic heart failure

sacubitril + losartan pharmacokinetics

Oral; duration hours

sacubitril + losartan toxicities & interactions

Hypotension; angioedema