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
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