Common Heart Failure Medications

Goal for Heart Failure treatment is to increase the pump action of the heart while decreasing the workload:

Medications with positive inotropic effect that will INCREASE contractility of the heart:

• Digoxin
  • Watch out for signs/symptoms of toxicity
  • Be aware of many drug interactions
  • Not commonly used
• Beta adrenergic agonists
  • IV dobutamine
  • Used as short term treatment of acute flare ups
• PDE Inhibitors (phoshodiestrase inhibitors)
  • Also have vasodilation effect
  • milrinone
    • Given IV
    • Will increase susceptibility of calcium into heart cells to increase pumping action.

Drugs that decrease afterload, or cardiac output by dilating the arteries and relaxing the arterioles:

• Angiotensin-Converting Enzyme Inhibitors (ACEIs)
• ACEIs are the first line drug of choice for treatment
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
• Angiotensin-Receptor Blockers (ARBs)
  • Valsartan (Diovan)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
• Both ACEIs and ARBs will decrease the blood flow to the kidneys by suppressing the renin-angiotensin system

Drugs that decrease the preload by increasing the ventricular muscle stretch and contraction:

• Diuretics

  • Increase elimination of sodium and water by decreasing blood volume.  They will decrease preload and systemic and pulmonary congestion
• Loop Diuretics
  • Prevent sodium, chloride and water reabsorption at the loop of Henle in the kidneys
  • Patient may also be on a potassium for replacement
  • ALWAYS MONITOR POTASSIM LEVELS
    • Furosemide (Lasix)
    • Torsemide (Demadex)
    • Bumetanide (Bumex)
• Postassium Sparring Diuretics
  • These diuretics will hold on the potassium
  • Still monitor Potassium, due to build up
    • Spironlactone (Aldactone)

• Beta Blockers

  • Can have a negative inotropic effect by causing too low of blood pressure, orthostatic hypotension, and bradycardia
    • Metoprolol (Toprol, Lopressor, Toprol XL)
    • Atenolol (Tenormin)

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