Congestive heart failure Drug interactions

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Congestive Heart Failure Microchapters

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Systolic Dysfunction
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HFpEF
HFrEF

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Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
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Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
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Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure Drug interactions On the Web

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Directions to Hospitals Treating Congestive heart failure Drug interactions

Risk calculators and risk factors for Congestive heart failure Drug interactions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview[edit | edit source]

Polypharmacy is common in the management of the patient with congestive heart failure. Efforts should be made to assure that there are few if any adverse drug interactions. It should be noted that the volume of drug distribution and the clearance of drugs in heart failure is often altered due to impaired renal function, poor drug absorption due to gut edema, and impaired drug metabolism due to hepatic insufficiency.

Drug Interactions[edit | edit source]

Digoxin[edit | edit source]

The volume of distribution of digoxin is reduced in congestive heart failure as is the renal clearance and the dose should be adjusted accordingly. Verapamil and amiodarone can increase serum digoxin levels. Hypokalemia can exacerbate digoxin toxicity.

Triple therapy with in Angiotensin-converting enzyme inhibitor, an Angiotensin Receptor Blocker, and Spironolactone[edit | edit source]

The combination of these three agents can lead to severe hyperkalemia and the use of all three agents together is not recommended.

Warfarin[edit | edit source]

The dose of warfarin that is required in patients with congestive heart failure is often lower than usual.

References[edit | edit source]

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