Used in the Therapy of Congestive Heart Failure

DRUGS USED IN THE THERAPY OF CONGESTIVE HEART FAILURE (CHF)... 

Are beta-blockers useful in the therapy of congestive heart failure and cardiomyopathy ... 

Drugs Used in the Therapy of Congestive Heart Failure (CHF) 137... 

Cardiotoxicity is a serious, rare adverse effect of mitox-antrone. The incidence of congestive heart failure was 0.15% in patients with normal left ventricular ejection fraction and 2.18% in those who had asymptomatic left ventricular ejection fraction of less than 50% at baseline.46 Therefore, mitoxantrone should not be used in patients with baseline cardiomyopathy, even if asymptomatic. The risk of cardiotoxicity is dose-related. The maximum lifetime dose of mitoxantrone is 140 mg/m2, or about 3 years of MS therapy. The use of cyclooxygenase-2 inhibitors should be avoided in patients receiving mitoxantrone because of a potential for worsening cardiac toxicity.46... 

Therapy of congestive heart failure. By lowering peripheral resistance, diuretics aid the heart in ejecting blood (reduction in afterload, pp. 132, 306) cardiac output and exercise tolerance are increased. Due to the increased excretion of fluid, EEV and venous return decrease (reduction in preload, p. 306). Symptoms of venous congestion, such as ankle edema and hepatic enlargement, subside. The drugs principally used are thiazides (possibly combined with K+-sparing diuretics) and loop diuretics. 

With increases in knowledge of digitalis action in therapy of congestive heart failure the use of sparteine was discarded. Sparteine fell into disuse, but with the successful use of quinidine in auricular fibrillation sparteine was again revived for therapy of stubborn cases of A.F. Sparteine has continued to be employed in auricular arrhythmias for many years and may still be tried occasionally. 

Brunton s findings were quickly applied to the therapy of patients with heart disease. Drummond (102) used a tincture of Erythrophleum in two cases of congestive heart failure due to rheumatic mitral stenosis or insufficiency. He noted a desirable decrease in pulse rate, a disappearance of pulse deficit, an increase in blood pressure, and diuresis. Overdosage did cause a temporary cessation of urine flow. Drummond believed that Erythrophleum would be useful in therapy to slow the pulse rate, make the heart rhythm more regular, and increase the force of cardiac systole but but implied that digitalis acted with greater certainty and regularity. 

The influence of sodium chloride on water retention is illustrated in many medical conditions. Diets low in salt assist in the control of edema in acute hemorrhagic nephritis, nephrosis, congestive heart failure, hypo-proteinemia, and cirrhosis of the liver. Recently diets very low in salt (sodium content, 200 to 300 mg.) have been used in the therapy of hypertension, with beneficial results in a percentage of cases. The role of sodium in disease states has been reviewed recently by Danowski. ... 

Catalytic transfer hydrogenation was applied as a key step in the syntheses of (31-adrenergic receptor agonists, (/f)-tembamide, (/ )-aegeline, (/f)-octopamine, and (R)-denopamine (Scheme 30.31). °° Many optically active 2-amino-l-arylethanols are used in the therapy of asthma, bronchitis, and congestive heart failure. ° ... 

As noted earlier, lithium is contraindicated in patients with unstable congestive heart failure or the sick sinus node syndrome ( 307, 328). In older patients or those with prior cardiac histories, a pretreatment ECG should be obtained. Except for the potential adverse interactions with diuretics, the concomitant use of other cardiac drugs is generally safe. Because verapamil may lower serum levels of lithium, however, more careful monitoring may be required to assure continued therapeutic effects (329). Some data also indicate that verapamil may predispose to lithium neurotoxicity. Conversely, increased lithium levels leading to toxicity has occurred with methyidopa and enalapril. When antihypertensive therapy is necessary, b-blockers are a reasonable choice when lithium is coadministered. 

Anticoagulant therapy is also sometimes used in cases of congestive heart failure and in the treatment of polycythemia vera (elevation of the packed cell volume or the hemoglobin level) where not contraindicated. 

Use of AASs as a therapy for cardiovascular disease, particularly to increase skeletal muscle strength in patients who have congestive heart failure, a condition in which fluid congestion occurs as a result of heart failure, is also being studied. AASs have been proposed for treatment in the cachexia, or wasting that accompanies certain cancers, as well. 

The calcium channel blockers generally are considered seconder third-line options for preventive treatment when other drugs with established clinical benefit are ineffective or contraindicated. Verapamil is the most widely used calcium chaimel blocker for preventive treatment, but it provided only modest benefit in decreasing the frequency of attacks in two placebo-controlled studies." The therapeutic effect of verapamil may not be noted for up to 8 weeks after initiation of therapy. Side effects of verapamil may include constipation, hypotension, bradycardia, atrioventricular block, and exacerbation of congestive heart failure. Evaluations of nifedipine, nimodipine, diltiazem, and nicardipine have yielded equivocal results. ... 

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