Refrence books Harrison principles of internal medicine Davidson principles and practice of medicine K. D. Tripathi medical pharmacology

1. Drugs used in heart
failure
PH1.29 Describe the mechanisms of action, types,
doses, side effects, indications and
contraindications of the drugs used in congestive
heart failure
Roll no 2187

2. Classification

3. Mechanism of action

4. Natriuretic peptides analogues
Mechanism of action – diuresis
• Cause excretion of sodium and water
• Cause vasodilation
• Thus reduce the preload and afterload
Eg. Nesiritide

5. Secubitril
It is a nephrolysin inhibitor
• Nephrolysin
1. It causes degradation of natriuretic peptides
2. It also cause angiotensin breakdown
# Thus by inhibiting this enzyme
angiotensin level in the body will increase.
So we combine secubitril with ARB
This combination is called ARNI (secubitril +
valsartan)
• Recommend in treatment of resistant heart
failure

6. Treatment of acute heart
failure

7. Acute decompensated heart
failure

8. Chronic heart failure

9. Heart failure with preserved
ejection fraction

10. Drugs therapy
for HFrEF

11. ACE inhibitors
• Plays central role in management
• Interrupt vicious circle of neurohumoral
activation in heart failure
• Substantially improve the effort tolerance in
moderate to sever heart failure
Adverse effects
1. Symptomatic hypotension
2. Impaired renal function ( in renal artery
stenosis and pre-existing renal disease)
3. Hyperkalemia

12. Angiotensin receptor blockers
• Acts by inhibiting action of angiotensin 2 on
heart, peripheral vasculature and kidney
• Have similar effects like ACEi and are
generally better tolerated
• Useful in patients who can not tolerate ACEi
• Started at low dose and titrated upward
Adverse effects
All Similar to ACEi

13. Vasodilators
• Valuable in CHF where ACEi and ARB are
contraindicated
• They reduces preload and afterload
• Use is limited by pharmacological tolerance and
hypotension

14. Beta adrenoceptor blocker
• Given in small incremental doses
• Increases ejection fraction, improve symptoms
and reduces the frequency of hospitalization
and reduces mortality in CHF
Dose regimen for bisoprolol
( starting dose- 1.25mg daily and increased
graduallyover 22 week to maintenance dose of
10mg daily)
• Beta blockers are more effective in reducing
mortality than ACEi with relative risk of 33%
and 20% respectively

15. Ivabradine
• Acts on If inward current in SA node, resulting
in decreased HR
• Given to patient who can not take beta blockers
or whose heart rate remains high despite beta
blockade
• Ineffective in patients with Af

16. Digoxin
• Can be used to provide rate control in patient
with heart failure and atrial fibrillation