Question

Choose four medications that might be used for the treatment of heart failure. Discuss the pathophysiologic mechanism of action for each medication, along with side effects and interactions. What are the consequences of noncompliance with treatment regimens and what patient education is needed?

Answer 1

Heart failure is otherwise called congestive heart failure where there is a chronic progressive condition in which the heart is unable to pump enough blood it as before to meet the demands of the body.

The mainly used medications for heart failure are :

*ACE Inhibitors

*Beta-Blockers

*Diuretics

*Aldosterone Antagonists

*Angiotensin Receptor Blockers

*Isosorbide Dinitrate and Hydralazine

*Digoxin

$\rightarrow$ Benazepril is an angiotensin-converting enzyme (ACE) inhibitor

#Pathophysiologic mechanism of action:

It relaxes the blood vessels   $\rightarrow$ decrease or lowers blood pressure   $\rightarrow$ decreases oxygen demand from the heart $\rightarrow$   decrease the workload of the heart.

# Side effects:

*Dizziness

*Headache

*Nausea

*Vomiting

*Chest pain

*Fainting

*Constipation

*Fever

*Chills

*Cold Sweat

*Confusion

# interactions :

*Lithium

*Trimethoprim

*Aliskiren

*Sodium phosphate Bowel Cleanser

*NSAID's

*Potassium-Sparing Diuretics

*Potassium Supplements

*Loop Diuretics

* High dose Aspirin

*Canagliflozin

*Drospirenone

*Azathioprine

$\rightarrow$ Atenolol is a Beta Blocker/Beta-adrenergic Blocking Agents)

#Pathophysiologic Mechanism of Action:

Beta-blockers blocks the effects of the hormone adrenaline (epinephrine) $\rightarrow$ reduce the heart beats $\rightarrow$ reduce the blood pressure

#Side effects:

*Tiredness

*Slow heart rate

*Nausea

*Drowsiness

*Cold Extremities

*Diarrhoea/Constipation

*Lightheadedness

*Fatigue

*Lethargy

*Shortness of breath

*Tightness in chest

*Wheezing

# Serious interaction with :

*Acebutolol

*Betaxolol

Bisoprolol

*Carvedilol

*Celiprolol

*Clonidine

*Digoxin

*Diltiazem

*Esmolol

*Labetalol

*Lofexidine

*Metoprolol

*Nadolol

*Propanolol

*Pindolol

*propanolol

*Rivastigmine

*Saquinavir

*Sotalol

*Timolol

*Verapamil

$\rightarrow$ An aldosterone receptor antagonist is also called as anti-mineralocorticoid.

Aldactone is an aldosterone receptor antagonist.

# Pathophysiologic Mechanism of Action

It will act primarily on the competitive binding of receptors at the aldosterone -dependent sodium-potassium exchange site in the distal convoluted renal tubule   $\rightarrow$ Increased amounts and water to be excreted $\rightarrow$ retaining of potassium $\rightarrow$ reduce the high B.P and increase the urine output

#Side - effects:

*Diarrhea/Cramping

*Nausea/Vomiting

*Drowsiness/Lethargy

*Skin rash/Itching

*Redness of the skin

*Fever/a Sore throat

*Unusual hair loss/Excessive hair growth

*Gynecomastia

*

#Interaction:

*Lithium: It reduces the renal clearance of lithium results in lithium toxicity

* NSAID's: The administration of NSAID's with Aldactone the reduces the diuretic effect of the drug

*Acetylsalicylic acid: It inhibited the effects Aldactone

$\rightarrow$ Digoxin

It works directly on the heart muscle.

It slows down the rate at which the heart beats.

It inhibits the activity of an enzyme (ATPase) that controls the movement of calcium, sodium, and potassium into heart muscle $\rightarrow$ Slow down the rate at which the heart beats $\rightarrow$ increases the force of contraction of the muscle of the heart with every beat   $\rightarrow$ heart beat become more efficient   $\rightarrow$ pumping blood around the body.

# Side effects:

*Allergic Reaction

* Loss of appetite

*Stomach Upset/Nausea

*Bradycardia

*Ventricular extrasystole*Venticular arrhythmias (rare but more dangerous)

*Confusion / Sleep disturbances

*Gynecomastia

# Interaction

*When administered in combination with amiodarone, quinidine, cyclosporine, propafenone, and verapamil the effects and toxicity increase

*Diuretics and sympathomimetics also increase the drug toxicity

$\rightarrow$ Consequences of non-compliance to treatment and patient education:

Most of the heart failure cases require hospital admission due to the noncompliance to the therapeutic regimen prescribed by the doctor. In case of a therapeutic regimen for heart failure, they have to follow the pharmacology regimen as well as dietary regimen follows a strict healthy eating behaviour.

Most of the patients will not continue the medicines due to the unpleasant side effects or they consider that the medications have no effect.(or c) In case of asymptomatic, they think that they do not need the medication.

As a health care professional, we have to educate the patient regarding the importance of taking medication and instruct them to follow a healthy eating pattern.instrand explain the importance of activity. Give caution regarding what the problems they may be associated if not taking medication as prescribed.