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Chapter 17: Pharmacotherapy of Heart Failure

INTRODUCTION

This chapter will be most useful after having a basic understanding of the material in Chapter 28, Pharmacotherapy of Heart Failure in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. In particular, the reader is directed to the following table:

  • Table 28-3, Vasodilator Drugs Used to Treat Heart Failure, which shows drugs used as vasodilators to treat heart failure including their mechanism of action and their effects on preload and afterload

LEARNING OBJECTIVES

  • Know the stages of heart failure and the treatments that are recommended at each stage.

  • Understand the rationale for the use of drugs that prevent and slow the progression of heart failure.

  • Understand the mechanism of action of inotropic drugs and how they are used to maintain left ventricular function.

  • Identify the major side effects and adverse drug reactions of the drugs used to treat heart failure.

DRUGS IN THIS CHAPTER

  • Bisoprolol (ZEBETA)

  • Candesartan (ATACAND)

  • Captopril (CAPOTEN, others)

  • Carvedilol (COREG, others)

  • Digoxin (LANOXIN, others)

  • Dobutamine (DOBUTREX, others)

  • Dopamine

  • Enalapril (VASOTEC, others)

  • Eplerenone (INSPRA, others)

  • Furosemide (LASIX, others)

  • Hydralazine (APRESOLINE)

  • Hydralazine and isosorbide dinitrate (BIDIL)

  • Inamrinone (INOCOR)

  • Isosorbide dinitrate (ISORDIL, SORBITRATE, others)

  • Labetalol (NORMODYNE, TRANDATE, others)

  • Lisinopril (PRINIVIL, ZESTRIL, others)

  • Losartan (COZAAR)

  • Metoprolol (LOPRESSOR, TOPROL XL, others)

  • Milrinone (PRIMACOR IV)

  • Minoxidil (LONITEN)

  • Nesiritide (NATRECOR)

  • Nitroglycerin (trinitroglycerin, NITROSTAT, NITRO-BID, others)

  • Nitroprusside (NITROPRESS, others)

  • Spironolactone (ALDACTONE)

  • Thiazide diuretics (many, see Chapter 15)

  • Valsartan (DIOVAN)

MECHANISMS OF ACTIONS OF DRUGS USED TO TREAT HEART FAILURE (SEE FIGURE 17-1)
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MECHANISMS OF ACTIONS OF DRUGS USED TO TREAT HEART FAILURE (SEE FIGURE 17-1)
DRUG CLASS DRUG MECHANISM OF ACTION
Angiotensin-Converting Enzyme (ACE) Inhibitors Captopril, enalapril, lisinopril, others (see Chapter 15) Prevent the conversion of AngI to active AngII by inhibiting angiotensin converting enzyme (ACE)
Angiotensin Receptor (AT1) Blockers (ARBs) Losartan, candesartan, valsartan, others (see Chapter 15) Competitive (but insurmountable) inhibitors of angiotensin AT1 receptors
Specific β Adrenergic Receptor Antagonists Metoprolol, carvedilol, labetalol, bisoprolol, others (see Chapter 7)

Block β adrenergic receptors in the heart, thereby protecting the heart from the cytotoxic effects of high circulating catecholamines

Blockade of β adrenergic receptors in the juxtaglomerular complex reduces renin secretion, thereby reducing plasma AngII
Na+/K+-ATPase Inhibitors (Cardiac Glycosides) Digoxin Inhibit the Na+/K+-ATPase in cardiac myocytes which ultimately increases accumulation of intracellular Ca2+ by slowing Ca2+ efflux through the Na+-Ca2+ exchanger (see Figure 17-2)
Diuretics (various mechanisms, see Chapter 15) Thiazides, loop diuretics (furosemide, others), K+-sparing diuretics (see Chapter 15) Reduce extracellular fluid volume and ventricular filling pressure by increasing water and sodium excretion
Vasodilators (various mechanisms, Table 17-1) Hydralazine, organic nitrates, others (see Chapter 15) Reduce afterload and preload (filling pressure)
Aldosterone antagonists Spironolactone, eplerenone Block the pathophysiological effects of ...

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