Drugs Used in Heart Failure_各论课件讲解材料.pptVIP

Drugs Used in Heart Failure 2009 guideline Management of Chronic Heart Failure III. Clinical Pharmacology of Drugs Used in Heart Failure 2013 guideline Evidence-Based Treatment Across the Contineum of LVD and HF Control Volume Reduce Mortality Salt Restriction* Diuretics* Digoxin* ?-Blocker ACEI or ARB Aldosterone Antagonist  Treat Residual Symptoms CRT ? an ICD* Hyd/ISDN* *For select indicated patients. ICD* Treat Comorbidities Aspirin* Warfarin* Statin* Enhance Adherence Education Disease Management Performance Improvement Systems Thanks! References Golan DE, et al. Principles of Pharmacology. Lippincott Williams Wilkins. 2004. Murphy JE. Clinical Pharmacokinetics, 4th edition. 2006. 2013 ACCF/AHA Guideline for the Management of Heart Failure /content/128/16/e240 1) Sodium Removal: by dietary salt restriction or a diuretic In mild failure, it is reasonable to start with a thiazide diuretic, switching to more powerful agents as required. Hypokalemia can be treated with potassium supplementation or through the addition of a potassium-sparing diuretic such as spironolactone. Management of Chronic Heart Failure III. Clinical Pharmacology of Drugs Used in Heart Failure 2) ACEI ARB In patients with left ventricular dysfunction but no edema, an ACE inhibitor should be used first. Additional studies suggest that ACE inhibitors are also valuable in asymptomatic patients with ventricular dysfunction. The angiotensin II receptor antagonists (eg, losartan, valsartan, etc) produce beneficial hemodynamic effects similar to those of the ACE inhibitors. Management of Chronic Heart Failure III. Clinical Pharmacology of Drugs Used in Heart Failure 3) Vasodilators Vasodilators include arteriolar dilators, venous dilators, and drugs with nonselective vasodilatory effects. The choice of agent should be based on the patients signs and symptoms and hemodynamic measurements. high filling pressures--------venous dilators low left ventricular output------arteriolar dilator chr