Treatments for Heart Failure
Stage A: ACEIs are drug of choice; ARBs are considered but more expensive
Stage B: ACEI in all patients, ARB for those who cannot tolerate an ACEI, BBs in
most
Stage C: ACEI and BBs (nonselective) in all patients, Diuretics, digoxin,
Spironolactone
Stage D: Stage C treatment, Inotropes: dobutamine, Ventricular assist device,
transplantation, hospice
ACEIs- Can lower vascular resistance without decreasing cardiac output or
glomerular filtration rate
-Strong evidence for CV and cerebrovascular risk reduction, HF, and
slowing renal disease
-Improves oxygenation to heart muscle, decreases innapropriate remodeling
of heart muscle after MI or with heart failure, reduces affects of diabetes on the
kidneys
-Improves insulin sensitivity, does not affect glucose metabolism or raise
serum lipid levels
-Use with young causcasian patients, patients w/ angina, diabetic patients
(prevents or slows nephropathy), HF patients
-African American and Asians have 4 to 4 times greater risk of developing
angioedema
Common ACE inhibitors:
Benanzopril
Captopril
Enalapril
Fosinopril
Lisinopril
Moexipril
Angiotensin II Receptor Blockers
-Prevent binding of AT II to receptors in kidney, brain, heart, and arterial walls
, -Inhibit the renin-angiotensin-aldosterone system and cause fall in peripheral
resistance
-Evidence supports use in kidney disease until late stage and heart failure, but not
renal protective like ACEI
-No bradykinin-mediated cough like ACEI
-Cost of generic ACE inhibitors provides significant advantage over branded
ARBs (generics now available for some)
-Considered alternatives for patients who cannot tolerate ACE or become resistant
-Many combined with hydrochlorothiazide
Drug therapies for Dyslipidemia:
-HMG CoA reductase inhibitors
-Lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin
Fibrates: fibric acid derivatives
-Gemfibrozil, micronized fenofibrate, clofibrate
Bile acid sequestrants
-Cholestyramine, colestipol, colesevelam
Niacin (has lost its luster)
Ezetimibe (Zetia): most effective in combination with statin
-Active liver disease is a contraindication for all except the bile acid sequestrants
GI
GERD and PUD
UTI
Inflammatory Processes
Hormone and Osteoporosis
A woman who has migraine with aura:
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Smartstudies. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.49. You're not tied to anything after your purchase.
