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 one or 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. I personally haven't seen a huge difference between the two. 01:58 Metolazone is another diuretic agent that is given in acute situations. 02:05 I discussed this in our hypertension lecture. Go to the hypertension lecture and have a look at the heart failure cocktail that I mentioned there. 02:15 Potassium sparing diuretics are also used as well. Amiloride, spironolactone, and triamterene. 02:23 Once again, I covered these medications in the hypertension lecture. 02:26 But these are very good to reduce afterload and to reduce hypervolemia.
The lecture Vasodilators – Heart Failure and Angina Management by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:
Which statement correctly describes hydralazine?
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