DRUGS USED IN THE

TREATMENT OF CONGESTIVE
HEART FAILURE

Dr.dr. Asep Sukohar, M.Kes

Dept of pharmacology and therapy

Medical school Lampung University
CONGESTIVE HEART FAILURE
CHF is a condition in which the heart is unable to
pump suffient blood to meet the needs of the body.
Underlying disease:
Hypertensiv Heart Disease
Coronary Heart Disease
Valvular Heart Disease
Cardiomyopathy
Congenital Heart Disease
Others
 Underlying disease

Cardiac Failure

Venous pressure Cardiac output

Sympathetic activity Blood pressure

Renal blood flow

Renin, angiotensin II

Aldosteron

capillary filtration Sodium retention

Edema
DRUG USED TO TREAT CHF

I. INTROPIC AGENT
Increase the strength of contraction of
cardiac muscle
II. DIURETICS
Decrease ECF volume
III. VASODILATOR
Reduce the load on the myocardium
 I. INTROPIC AGENT
1. CARDIAC GLICOSIDES
- Digoxin
- Digitoxin
- Quabain
1. ADRENERGIC AGONIST
- Dobutamin
- Dopamin
1. PHOSPNO DIESTERASE INHIBITORS
- Amrinone
- Milrinone
 DIGOXIN

Therapeutic use of digoxin is confounded by

1.variable pharmacokinetics
2.Numerious drug interaction
3.Naroow theurapeutic index

Digoxin comentry is associated with high

mortallity
DIGOXIN
MECHANISM OF ACTION
D. inhibit Na+ - K+ exchange by Na+/K+
ATPase
- intracellular Na+
- intracellular Ca++

(+) inotropic

CO
Modifying autonomic neural discharge
PHARMACOKINETICS

First Pass Metabolism, by microba in

intestinum
Distributed to all tissue included
CNS
Metabolism : 30%, is activated by
enzyme liver
SIDE EFFECT & TOXIC OF DIGOXIN
Gastrointestinal
Anorexia, nausea, vomiting, abdominal pain
Neurologic
Malaise fatigue, confusion, facial pain,
insomnia, depression, vertigo, colored
vision (green or yellow halos around light)
Cardiac
Arrhytmia
Ventricular fibrillation and cardiac arrest
(are the most common cause of death)
 FACTORS PREDISPOSING TO
DIGITALIS TOXICITY
Electrolite Disturbances
Hypokalemia
Hypomagnesia
Hypercalcemia
Drugs
Thiazid
Renal Failure
Management of :
1. Phenytoin
Lidocain
blocker
2. Monoclonal digoxin : specitic antibodies
(F. ab fragments)
 DRUG INTERACTION
Increased digitalis Amiodarone
Erythromycin base
Concentration may Quinidine
occur during Tetracycline
Concurrent therapy Verapamil

Enhanced potential
for cardiotoxicity

Corticosteroids
Decreased levels of Thiazide diuretics
Blood potassium Loop diuretics
 INDICATION
Congestive Heart Failure (systolic CHF)
Arrhythmias
Supraventricular Arrhytmias

CONTRAINDICATION:
AV heart block
 BETA ADRENERGIC AGONIST
DOPAMINE

Adrenergic dopamin receptor

Effect Effect Effect

II. DOBUTAMIN
Asynthetic analog of dopamin
Dopamine increase Cardiac Output with
little change in the HR and does not
significantly elevated oxygen demands
of the myocard.
 DOPAMIN - DOBUTAMIN

Indication:
Refractory Heart Failure
Severe acute myocardial failure
(after cardiac surgery)
Cardiogenic shock
EFFECT OF DIURETIC ON CHF

Relieve peripheral edema

Relieve pulmonary congestion
symptoms: orthopnea, paroxysmal
nocturnal dyspnea.
Decreased plasma volume
preload cardiac load and O2
afterload demand
BP
Hypokalemia
 VASODILATOR
I. 1. ACEI (angiotensin converting enzym inhibitor)
*captropil
*lisinopril

2. ARB (angiotensin Receptor Blocking agent)

*losartan
*valsartan
II. Others

Nitrat organic (isosorbid-nitroglicerin)

 ACE INHIBITOR

Captopril Quinapril
Enalapril Rapipril
Lisinopril Fosinopril
Benazepril
MECHANISM OF ACTION
 MECHANISM OF ACTION

Angiotensin I bradikinin active

ACEI 1

ARB Angiotensin 2 bradikinin active

Vasodilatation level of bradikinin
retention of Na-water *Vasodilatation
Outflow of symphatetic *Cough
*Angioneurotic E

PRELOAD
AFTER LOAD
 ADR
Skin rash, dysgeusia and proteinuria
Angioedema
Neutropenia, agranulocytosis,
glomerulonephritis (rare)
 INDICATION

CHF in a symptomatic patient (left

ventricular dysfunction)
Patient who have had a recent
myocardial infarction
 DOPAMINE
1. Heart : inotropic (cardiac contracitas)
2. Renal
Dilare renal and splanenic arteriole
Increase blood flow (RBF)
Vascular and smooth muscle
inhigh dose
DOBUTAMINE
Little change in HR
SVR=systemic vascular resistance