DRUGS FOR HEART FAILURE

Diuretics

See Table 7.4 and pages 348-350.

β-blockers

Mechanism of action

The p-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas and liver are blocked. They decrease heart rate, reduce the force of cardiac contraction and lower blood pressure. These effects reduce myocardial oxygen demand and give more time for coronary perfusion.

Indications

Main indicators are angina, myocardial infarction, arrhythmias, stable heart failure, hypertension, alleviation of symptoms of anxiety, prophylaxis of migraine, prevention of variceal bleeding and symptomatic treatment of hyperthyroidism (no effect on thyroid function tests).

Preparations and dose

Most β-blockers are equally effective, but there are differences between them which may affect the choice in particular diseases or individual patients, e.g. atenolol and metoprolol are used in angina; sotalol in the management of supraventricular and ventricular arrhythmias; propranolol in the treat-ment of hyperthyroidism, prevention of variceal bleeding and prophylaxis of migraine (usually); and bisoprolol and carvedilol in the management of heart failure (usually specialist initiated).

Propranolol

Tablets: 10 mg, 40 mg, 80 mg, 160 mg; Oral solution: 5 mg/mL; Inịection 1 mg/mL.

Oral

■ Portal hypertension: initially 40 mg twice daily, increased according to heart rate; maximum 160 mg twice daily

■ Angina: initially 40 mg two to three times daily; maintenance 120240 mg daily

■ Arrhythmias: anxiety, hyperthyroidism, migraine prophylaxis, essential tremor, 10-40 mg three times daily

■ Hypertension: initially 80 mg twice daily, increased at weekly intervals as required; maintenance 160-320 mg daily.

Intravenous Arrhythmias and thyrotoxic crisis: 1 mg over 1 minute; if nec-essary repeat at 2-minute intervals; maximum 10 mg.

Atenolol

Tablets: 25 mg, 50 mg, 100 mg.

Oral

■ Angina: 25-100 mg daily in one or two doses

■ After MI: 25-100 mg daily

■ Hypertension: 25-50 mg daily.

Intravenous For arrhythmias: 2.5 mg at a rate of 1 mg/min, repeated at 5-minute intervals to a maximum of 10 mg, or by infusion 150 μg/kg over 20 minutes, repeated every 12 hours if required.

Bisoprolol

Tablets: 1.25 mg, 2.5 mg, 3.75 mg, 5 mg, 7.5 mg, 10 mg.

■ Hypertension and angina, usually 5-10 mg once daily; maximum 20 mg daily.

■ Heart failure, initially 1.25 mg daily titrated up at weekly intervals over 8-10 weeks to maximum 10 mg daily.

Metoprolol

Tablets: 50 mg, 100 mg; Injection: 1 mg/mL.

Oral

■ After MI: 100 mg twice daily

■ Angina, arrhythmias, anxiety, thyrotoxicosis, migraine prophylaxis, essential tremor: 50-100 mg two to three times daily

■ Hypertension: 50-100 mg twice daily.

Intravenous For arrhythmias: up to 5 mg at a rate of 1-2 mg/min, repeated after 5 minutes to a maximum of 10-15 mg.

Sotalol

Tablets: 40 mg, 80 mg, 160 mg; Injection: 10 mg/mL.

Sotalol use is limited to the treatment of ventricular arrhythmias or the prevention of supraventricular arrhythmias.

Oral 80 mg daily in one to two divided doses, increased gradually at intervals of 2-3 days to usual dose of 160-320 mg daily.

Intavenous Over 10 minutes: 20-120 mg with ECG monitoring repeated at 6-hourly intervals if necessary.

Side-effects

Side-effects include bradycardia, exacerbation of intermittent claudication, lethargy, nightmares, hallucinations, deterioration of glucose tolerance and interference with metabolic and autonomic responses to hypoglycaemia in diabetics.

Contraindications

These comprise asthma, severe peripheral arterial disease, second- or third-degree heart block, marked bradycardia, hypotension, phaeochromocytoma (apart from specific use with alpha-blockers).

Ebook Essentials of Kumar and Clark's Clinical Medicine, 5e

1. Ethics and communication

Ethics and communication

2. Infectious diseases

Infectious diseases

3. Gastroenterology and nutrition

Gastroenterology and nutrition

4. Liver, biliary tract and pancreatic disease

Liver, biliary tract and pancreatic disease
LIVER BIOCHEMISTRY AND LIVER FUNCTION TESTS
SYMPTOMS AND SIGNS OF LIVER DISEASE
JAUNDICE
HEPATITIS
NON - ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
CIRRHOSIS
COMPLICATIONS AND EFFECTS OF CIRRHOSIS
LIVER TRANSPLANTATION
TYPES OF CHRONIC LIVER DISEASE AND CIRRHOSIS
PRIMARY SCLEROSING CHOLANGITIS
BUDD - CHIARI SYNDROME
LIVER ABSCESS
LIVER DISEASE IN PREGNANCY
LIVER TUMOURS
GALLSTONES
THE PANCREAS
CARCINOMA OF THE PANCREAS
NEUROENDOCRINE TUMOURS OF THE PANCREAS

5. Haematological disease

Haematological disease
ANAEMIA
Assessment and treatment of suspected neutropenic sepsis
HAEMOLYTIC ANAEMIA
INHERITED HAEMOLYTIC ANAEMIAS
ACQUIRED HAEMOLYTIC ANAEMIA
MYELOPROLIFERATIVE DISORDERS
THE SPLEEN
BLOOD TRANSFUSION
THE WHITE CELL
HAEMOSTASIS AND THROMBOSIS
THROMBOSIS
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6. Malignant disease

Malignant disease
MYELOABLATIVE THERAPY AND HAEMOPOIETIC STEM CELL TRANSPLANTATION
THE LYMPHOMAS
THE PARAPROTEINAEMIAS
PALLIATIVE MEDICINE AND SYMPTOM CONTROL

7. Rheumatology

Rheumatology
COMMON INVESTIGATIONS IN MUSCULOSKELETAL DISEASE
COMMON REGIONAL MUSCULOSKELETAL PROBLEMS
BACK PAIN
OSTEOARTHRITIS
INFLAMMATORY ARTHRITIS
THE SERONEGATIVE SPONDYLOARTHROPATHIES
Clinical features, Investigations
INFECTION OF JOINTS AND BONES
AUTOIMMUNE RHEUMATIC DISEASES
SYSTEMIC INFLAMMATORY VASCULITIS
DISEASES OF BONE
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8. Water, electrolytes and acid–base balance

WATER AND ELECTROLYTE REQUIREMENTS
BODY FLUID COMPARTMENTS
REGULATION OF BODY FLUID HOMEOSTASIS
PLASMA OSMOLALITY AND DISORDERS OF SODIUM REGULATION
DISORDERS OF POTASSIUM REGULATION
DISORDERS OF MAGNESIUM REGULATION
DISORDERS OF ACID - BASE BALANCE
THERAPEUTICS

9. Renal disease

Renal disease
INVESTIGATION OF RENAL DISEASE
GLOMERULAR DISEASES
NEPHROTIC SYNDROME
URINARY TRACT INFECTION
TUBULOINTERSTITIAL NEPHRITIS
HYPERTENSION AND THE KIDNEY
RENAL CALCULI AND NEPHROCALCINOSIS
URINARY TRACT OBSTRUCTION
ACUTE RENAL FAILURE/ACUTE KIDNEY INJURY
CHRONIC KIDNEY DISEASE
RENAL REPLACEMENT THERAPY
CYSTIC RENAL DISEASE
TUMOURS OF THE KIDNEY AND GENITOURINARY TRACT
DISEASES OF THE PROSTATE GLAND
TESTICULAR TUMOUR
URINARY INCONTINENCE

10. Cardiovascular disease

COMMON PRESENTING SYMPTOMS OF HEART DISEASE
INVESTIGATIONS IN CARDIAC DISEASE
CARDIAC ARRHYTHMIAS
HEART FAILURE
ISCHAEMIC HEART DISEASE
RHEUMATIC FEVER
VALVULAR HEART DISEASE
PULMONARY HEART DISEASE
MYOCARDIAL DISEASE
CARDIOMYOPATHY
PERICARDIAL DISEASE
SYSTEMIC HYPERTENSION
ARTERIAL AND VENOUS DISEASE
ELECTRICAL CARDIOVERSION
DRUGS FOR ARRHYTHMIAS
DRUGS FOR HEART FAILURE
DRUGS AFFECTING THE RENIN - ANGIOTENSIN SYSTEM
NITRATES, CALCIUM - CHANNEL BLOCKERS AND POTASSIUM - CHANNEL ACTIVATORS

11. Respiratory disease


Respiratory disease
TUBERCULOSISnd
DIFFUSE DISEASES OF THE LUNG PARENCHYMA
OCCUPATIONAL LUNG DISEASE
CARCINOMA OF THE LUNG
DISEASES OF THE CHEST WALL AND PLEURA
DISORDERS OF THE DIAPHRAGM

12. Intensive care medicine

Intensive care medicine

13. Drug therapy, poisoning, and alcohol misuse

Drug therapy, poisoning, and alcohol misuse

14. Endocrine disease

Endocrine disease
PITUITARY HYPERSECRETION SYNDROMES
THE THYROID AXIS
MALE REPRODUCTION AND SEX
FEMALE REPRODUCTION AND SEX
THE GLUCOCORTICOID AXIS
THE THIRST AXIS
DISORDERS OF CALCIUM METABOLISM
DISORDERS OF PHOSPHATE CONCENTRATION
ENDOCRINOLOGY OF BLOOD PRESSURE CONTROL
DISORDERS OF TEMPERATURE REGULATION
THERAPEUTICS

15. Diabetes mellitus and other disorders of metabolism

DIABETES MELLITUS
DIABETIC METABOLIC EMERGENCIES
COMPLICATIONS OF DIABETES
SPECIAL SITUATIONS
HYPOGLYCAEMIA IN THE NON - DIABETIC
DISORDERS OF LIPID METABOLISM
THE PORPHYRIAS

16. The special senses

THE EAR
THE NOSE AND NASAL CAVITY
THE THROAT
THE EYE

17. Neurology

COMMON NEUROLOGICAL SYMPTOMS
COORDINATION OF MOVEMENT
THE CRANIAL NERVES
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UNCONSCIOUSNESS AND COMA
STROKE AND CEREBROVASCULAR DISEASE
EPILEPSY AND LOSS OF CONSCIOUSNESS
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HYDROCEPHALUS
HEADACHE, MIGRAINE AND FACIAL PAIN
SPINAL CORD DISEASE
DEGENERATIVE NEURONAL DISEASES
DISEASES OF THE PERIPHERAL NERVES
MUSCLE DISEASES
MYOTONIAS
DELIRIUM
THERAPEUTICS

18. Dermatology

Dermatology

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