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Heart Failure (AVOID (NSAIDS, corticosteroids, Class I and II…
Heart Failure
AVOID
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Class I and II antiarrythmic agents, except amiodarone and dofetilide)
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Ace Inhibitors: Benzapril, Captopril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perinodopril
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monitoring
Scr, BP, and K* in one to two weeks after starting or increasing dose
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Digoxin (Lanoxin)
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MOA
inhibits Na-K adenosine triphosphate and altering Na/Ca exchange; increasing systolic cytoplasmic calcium
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place in therapy
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signs and symptoms of HF when on standard therapies including ACE inhibitors or ARBs and Beta blockers
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Vasodilator Therapy
Sodium Nitroprusside
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Indication
warm and wet adhf, alternative to inotropes in cold and wet, hypertensive crisis
Nesiritide
clinical effects
hemodynamic effects (decrease PCWP and SCR, increase CL, minimal changes in HR)and neurohormonal effects (decrease NE, ET-1 and aldosterone)
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indication
warm and wet adhf, alternative to inotropes in cold and wet,
IV nitroglycerin
adverse effects
hypotension, reflex tachyardia, headache, tachyphylaxis
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Clinical effects
preferential venous vasodilator, can arterial vasodilate at high doses
indication
warm and wet adhf, ACS, hypertensive crisis
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Diuretics
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Benefits
short term: decreased JVD, decreases pulm congestion, decreased peripheral edema
intermediate term: decrease symptoms, improve cardiac function, increase exercise tolerrance
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Loop Diuretics
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increased secretion of H20, Na, Cl, Mg, and K
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Aldosterone Receptor Antagonists (Spironolactone, Epleronone)
MOA
blocks effects of aldosterone in the kidneys, heart and vasculature
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WHEN TO USE
Acute MI, clinical HF signs and symptoms
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Chronic HF therapy
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ACE inhibitors
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increases in SCr (decrease in GFR or 20% or more) from ACEI use are not associated with worse outcomes
Digoxin
avoid discontinuation unless there is a compelling reason because digoxin withdrawal has been associate with worsening of HF symptoms
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