ClassDrugPharmacodynamicsPharmokineticsAdverse EffectsDrug-Drug Int.Drug-disease Int.
UsesChronic or acute 
CHFCardiac glycosidesDigoxinPositive inotropic effect leading to increased cardiac output for CHF, CNS actions 
(vagal stimulation) to counteract atrial fibrillation.  n!ibits Na"# $%Pase, increasing Ca&& flux t!roug! Na& c!annel.
 Decrease in intracellular #&small t!erapeutic index, indistinct t!erapeutic endpoints, long t'() (*+"*, !rs).  -ral 
bioavailabilit. /+"0+1, elimination b. 2idne. (measure clearance).  %oxic doses3 4C5 c!anges, #& loss (causing fatigue), 
anorexia, vomiting, altered vision, confusion.  %reat 6( 7 potassium, lidocaine (for arr.t!mias)8uinidine and verapamil bloc2 
upta2e into cells, increasing plasma concentration, so reduce digoxin dose /+1.  $"7 bloc2 if used 6it! 9uinidine, verapamil, 
or :"bloc2ers.  H.po2alemia if used 6it! #"6asting diuretics.  %reat 6( 7 potassium to displace from $%Pase or 6it! anti"
digoxin abs.;enal insufficienc.3 possible !.po2alemiaAtrial fi!rillation "ith ra#id ventricular res#onse $!ut does not 
return to sinus rhythm%& CHF $decreases mor!idity& not mortality% !y shrinking the heart& diuresis& decreasing !lood 
volume.bot!Diureticst!ia<ides, loop diuretics (furosamide), or #& sparing diuretics (spironolactone)See appropriate 
worksheet for further details, spironolactone antagonizes aldosteroneFatigue, !.potension, a<otemia, 
!.po2alemia!.per2alemia if used 6it! $C4 in!ibitor (monitor serum # levels)$void NS$DS 6!en using #"sparing diuretics 
to prevent !.per2alemia.CHF' relieves congestion and edema& reduces diastolic stress on ventricular "all.
 (#ironolactone also reduces sym#athetic tone& !arorece#tor dysfunction& fi!rosis.bot!, spironolactone for 
c!ronicClassDrugPharmacodynamicsPharmokineticsAdverse EffectsDrug-Drug Int.Drug-disease Int.UsesChronic or 
acute CHFVasodilatorsACE inhi!itors& sodium nitro#russide& I) nitroglycerin& hydrala*ine + isosor!ide 
dinitrateSee appropriate worksheet for further details$C4 in!ibitors3 !.potension, renal insufficienc., coug!CHF' reduces 
#reload and afterload to im#rove ventricular contraction efficiency and em#tying.  ACE inhi!itors im#rove mor!idity
and mortality $#revents cardiac structural changes induced !y ang II%.bot!Beta blockersSee appropriate worksheet
for further detailsCHF' im#roves mor!idity and mortality.  Administer to all #atients that can tolerate it.  ,akes months.
 Also use ACE inhi!itor.c!ronicIV inotropesdopamine, dobutaminedopamine: intermediate doses induces N release 
dobutamine: alpha and beta agonistdopamine acts as an alp!a"' adrenergic agonist, causing vasoconstrictionCHF' 
im#roved contractility    =AVOID CALCIUM-CHANNEL BLOCKER AND !RO!H"LAC#IC UE O$ 
AN#IARR"#HMIC