抗充血性心衰药(英文版)课件
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Drugs for Congestive Cardiac failure
Congestive heart failure
Heart failure is the progressive inability of the heart to supply adequate blood flow to vital organs.
Causes of heart failure includes Coronary artery disease (CAD), Hypertension, Diabetes, Mitral valve disease and Chronic alcohol.
Pathophysiological mechanisms of heart failure and major sites of drug action
ACE inhibitors improve mortality, morbidity, exercise tolerance, left ventricular ejection fraction.
Captopril, Lisinopril, Enalapril, Ramipril, Quinapril.
Drugs for CCF
Vasodilators – ACE Inhibitors Diuretics Beta blockers Digoxin Other Cardiac Inotropes –
Dobutamine, Milrinone
Drugs for CCF
Angiotensin Converting Enzyme (ACE) Inhibitors :
Angiotensin II (AT-1). No inhibition of ACE or Cough.
Drugs for CCF
Vasodilators : Isosorbide dinitrate and hydralazine
also used specially in patients who cannot tolerate ACE inhibitors. Amlodipine and prazosin are other vasodilators can be used in CCF.
It is classically accompanied by significant fluid retention.
It is a leading cause of mortality and morbidity.
The most common symptoms of CCF includes shortness of breath, edema and fatigue.
Adverse effects : Dry irritating persistent cough Hyperkalemia Angioedema Fetal toxicity
Drugs for CCF
Angiotensin Receptor AT-1 blockers (ARB) :
Losartan, Irbesartan, Candesartan Competitiv源自文库 antagonists of
Drugs for CCF
Diuretics : Adverse effects : Loop diuretics and thiazides cause
hypokalemia. Potassium sparing diuretics help in
reducing the hypokalemia due to these diuretics.
Vasoconstriction
Elevated cardiac filling pressure
Angiotensin-R blockers Aldosterone
Sodium and water retention
Diuretics
Spironolactone
Cardiac remodeling
Reduction in venous tension (preload) Reduction in aldosterone secretion Inhibition of cardiac and vascular
remodeling
Drugs for CCF
Angiotensin Converting Enzyme (ACE) Inhibitors :
Drugs for CCF
Diuretics : These are useful in reducing the
symptoms of volume overload by decreasing the extra cellular volume decreasing the venous return
Heart failure digoxin
Renin
Angiotensin Ⅰ ACE inhibitors
AngiotensinⅡ
Reduced cardiac output β -blockers, digoxin Sympathetic nervous system activation Vasodilators
ACE Inhibitors for CCF
ACE Inhibitors for CCF
Drugs for CCF
Angiotensin Converting Enzyme (ACE) Inhibitors :
Reduction in arterial resistance (afterload)
Drugs for CCF
Diuretics : Loop diuretics like furosemide and
bumetanide are the most effective and commonly used. Thiazides are effective in mild cases only.
Congestive heart failure
Heart failure is the progressive inability of the heart to supply adequate blood flow to vital organs.
Causes of heart failure includes Coronary artery disease (CAD), Hypertension, Diabetes, Mitral valve disease and Chronic alcohol.
Pathophysiological mechanisms of heart failure and major sites of drug action
ACE inhibitors improve mortality, morbidity, exercise tolerance, left ventricular ejection fraction.
Captopril, Lisinopril, Enalapril, Ramipril, Quinapril.
Drugs for CCF
Vasodilators – ACE Inhibitors Diuretics Beta blockers Digoxin Other Cardiac Inotropes –
Dobutamine, Milrinone
Drugs for CCF
Angiotensin Converting Enzyme (ACE) Inhibitors :
Angiotensin II (AT-1). No inhibition of ACE or Cough.
Drugs for CCF
Vasodilators : Isosorbide dinitrate and hydralazine
also used specially in patients who cannot tolerate ACE inhibitors. Amlodipine and prazosin are other vasodilators can be used in CCF.
It is classically accompanied by significant fluid retention.
It is a leading cause of mortality and morbidity.
The most common symptoms of CCF includes shortness of breath, edema and fatigue.
Adverse effects : Dry irritating persistent cough Hyperkalemia Angioedema Fetal toxicity
Drugs for CCF
Angiotensin Receptor AT-1 blockers (ARB) :
Losartan, Irbesartan, Candesartan Competitiv源自文库 antagonists of
Drugs for CCF
Diuretics : Adverse effects : Loop diuretics and thiazides cause
hypokalemia. Potassium sparing diuretics help in
reducing the hypokalemia due to these diuretics.
Vasoconstriction
Elevated cardiac filling pressure
Angiotensin-R blockers Aldosterone
Sodium and water retention
Diuretics
Spironolactone
Cardiac remodeling
Reduction in venous tension (preload) Reduction in aldosterone secretion Inhibition of cardiac and vascular
remodeling
Drugs for CCF
Angiotensin Converting Enzyme (ACE) Inhibitors :
Drugs for CCF
Diuretics : These are useful in reducing the
symptoms of volume overload by decreasing the extra cellular volume decreasing the venous return
Heart failure digoxin
Renin
Angiotensin Ⅰ ACE inhibitors
AngiotensinⅡ
Reduced cardiac output β -blockers, digoxin Sympathetic nervous system activation Vasodilators
ACE Inhibitors for CCF
ACE Inhibitors for CCF
Drugs for CCF
Angiotensin Converting Enzyme (ACE) Inhibitors :
Reduction in arterial resistance (afterload)
Drugs for CCF
Diuretics : Loop diuretics like furosemide and
bumetanide are the most effective and commonly used. Thiazides are effective in mild cases only.