00:01
Let's talk about direct vasodilators.
Nitrates like nitroprusside and nitroglycerin are often used.
00:08
And nesiritide is a new drug that is a natriuretic peptide.
It causes vasodilation and volume reduction at the same time.
00:15
We give it as an IV infusion in acute heart failure only.
So, they are not used in chronic heart failure patients.
00:24
Other direct vasodilators include hydralazine
and isosorbide dinitrate.
00:29
You can use both in combination. They do reduce
mortality in African American patients in a major study
that was released in the United States some years ago.
00:41
Calcium channel blockers are also sometimes used,
but not in heart failure. These are more angina type medications.
00:48
Remember that the dihydropyridine and the non-dihydropyridine
drugs differ in that one works on the heart and one doesn't.
00:57
There is no use in reducing inotropy,
so that's not particularly helpful.
01:01
Peripheral vasodilation can help in terms of calcium channel
blockers, but it also causes a reflex tachycardia,
so we don't use it as much in heart failure.
01:16
Loop diuretics are a mainstay in heart failure treatment.
I won't go into too much detail about diuretics as a whole
because I've discussed them in detail
in the hypertension lecture.
01:27
But to make a long story short,
furosemide is probably used the most in acute heart failure,
and it can also be used,
and easily titrated in chronic heart failure too.
01:38
If a patient is allergic to furosemide,
we sometimes use ethacrynic acid.
01:45
Other diuretics include the thiazide diuretics
like hydrochlorothiazide and indampamide.
01:51
Indampamide, by some measures, are better tolerated.
01:54
Amongst the thiazide diuretics, indampamide or chlorthalidone
is superior
to hydrochlorothiazide for hypertension.
02:02
Chlorthalidone is the preferred thiazide
diuretic for hypertension
due to prolonged half-life and proven reduction of
cardiovascular disease risk.
02:11
Potassium-sparing diuretics are also used
as well.
02:15
Amiloride, spironolactone, and triamterene.
02:18
Once again, I covered these medications in the
hypertension lecture
But these are really good to reduce afterload and
to reduce hypervolemia.