Featured Post

LIST | Persons who can go out during mandatory COVID community quarantine

On Wednesday, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases revealed a complete list of persons exempted f...

Thursday, February 20, 2020

MED | PLE Pharmacology Review - Congestive Heart Failure (CHF) Drugs Mnemonics

So as I was studying for the 2019 Physician Licensure Examination or PLE, I made it a point to make drafts of some of the things I learned that I can immediately recall from the notes and tables I got during my review period.

Writing this here somehow enabled me to at least aggregate what I know and identify the weak areas that I still need to be familiar with to better prepare myself for the Pharmacology part of the PLE. Please take note that I was just an average performing student in school, but at this moment, I tried to catch up on the lessons and at the same time, aimed to be helpful to others given the limited knowledge and resources that I have.

Today's topic is about drugs used in congestive heart failure (CHF).

Side note:
  • Left-sided heart failure will usually present with orthopnea, pulmonary congestion and paroxysmal nocturnal dyspnea
  • Right-sided heart failure will come with symptoms of bipedal edema, neck vein engorgement, and hepatomegaly.
Some points to remember:
  • Because the heart is failing, cardiac output is decreased relative to the requirement of the body.
  • So the goals is to either
    • Push the heart to contract stronger (positive inotropes)
    • To lower the resistance the heart must pump against (also called afterload) for less stress (vasodilators)
    • Use other drugs to help alleviate accompanying heart failure symptoms
Enlisted below are the drugs used in congestive heart failure (CHF). Please do note that I only included what I feel are important or must-knows, given that I only have a limited amount of time. Take these with a grain of salt.


1. Cardiac Glycoside (DIGOXIN)

MOA: inhibits Na-K ATPase, increases contractility
Side effects: narrow therapeutic index, arrhythmia, yellow halos
Note: arrhythmogenesis risk increases with HYPOKALEMIA (from use of loop diuretics or thiazides), HYPOMAGNESEMIA, HYPERCALCEMIA

Mnemonics: Narrow Therapeutic Index Drugs

2. Beta-agonist (DOPAMINE, DOBUTAMINE)

Note: useful in ACUTE heart failure, not recommended in CHRONIC heart failure due to arrhythmogenic effects

3, PDE inhibitors (MILRINONE)

MOA: inhibits phosphodiesterase breakdown, increases cAMP, vasodilation
Side effects: bronchospasm, HYPOKALEMIA
Note: acts as an "ino-lator" (inotropes + vasodilator), increases morbidity and mortality in CHRONIC heart failure patients



2. HYDRALAZINE, ISOSORBIDE DINITRATE - reduces mortality in African Americans
Note: ISDN should not be taken with PDE inhibitor Sildenafil to prevent severe hypotension


1. Ace inhibitors (-PRILS) and ARBs (-SARTANS) - FIRST LINE for CHRONIC heart failure
Note: Valsartan usually combined with SACUBITRIL (when activated, inhibits neprilysin, an enzyme that degrades BP-lowering peptides, in effect, lowering the BP)

2. Diuretics - first line for ACUTE and CHRONIC heart failure (systolic and diastolic)
  • FUROSEMIDE - loop diuretic, used to immediately address pulmonary congestion and severe bipedal edema, WOF hypokalemia
  • SPINOROLACTONE - K-sparing diuretic, acts as an non-selective aldosterone antagonist via competitive inhibition at the DCT, reduced mortality in CHRONIC CHF when added to loop diuretics

3. Beta blockers (-OLOLs) - slows progression of CHRONIC CHF, NOT useful in ACUTE CHF

4. Brain Natriuretic Peptide (BNP) analog (NESIRITIDE) - for ACUTE DECOMPENSATED heart failure
Note: BNP is secreted by the cardiomyocytes in response to ventricule stretch from increased ventricular blood volume

Mnemonics: Drugs that Improve Survival in chronic Heart Failure

I guess that's it. If I ever committed any mistake here, please let me know. I am no expert on these matters. Just like you, I've gone through the strenuous, anxiety-inducing days of the review. I just jotted down what I learned from my Topnotch lecturers and reviewer notes. Hope this  short review  on CHF drugs has helped you in some way.

Don't be scared. Carry on. :) Check out this brief PLE Pharmacology review on Anti-arrhythmic drugs.


  1. Wow, What a Excellent post. I really found this to much informatics. It is what i was searching for.I would like to suggest you that please keep sharing such type of info.Thanks dark web sites

  2. Wow, cool post. I'd like to write like this too - taking time and real hard work to make a great article... but I put things off too much and never seem to get started. Thanks though. гидра онион

  3. All very similar, the essential focal point of society is still to do with medications, tobacco and liquor.private label manufacturing