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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