9. Heart failure - management

Question 1

Name 5 drugs used to treat HF.

Answer 1

1- ACE inhibitors
2- AngII receptor blockers
3- Diuretics - MRAs (mineralocorticoids/aldosterone R antagonists)
4- B-blockers
5- ARNI (angiotensin R neprilysin inhibitor): valsartan and sacubitril

Question 2

Name 2 drugs used in HF to treat cardiovascular comorbidities.

Answer 2

1. anticoagulants, e.g. low-dose aspirin (75mg/day)

2. statins

Question 3

What is the effect and action of ACE inhibitors?

Answer 3

• Effect: decreased BP by vasodilation and diuresis
• Action: inhibits ACE… prevents conversion of AngI to AngII… prevents activation of RAAS and resulting vasoconstriction and Na+/H2O retention

Question 4

What is the effect and action of AngII receptor blockers?

Answer 4

• Effect: decreased BP by vasodilation and diuresis

- Action: bind to AngII receptors (AT1R)… prevent vasoconstriction and aldosterone-mediated Na+/H2O retention.

Question 5

What is the effect and action of diuretics?

Answer 5

• Effect: decreased BP by diuresis

- Action: antagonise aldosterone by binding at minerlocorticoid receptors… inhibit Na+/H2O retention.

Question 6

What is the effect and action of beta-blockers?

Answer 6

• Effect: decreased BP by vasodilation, and decreased HR and contractility
• Action: bind to B adrenoRs… antagonise NA… prevents SNS activation.

Question 7

What is the effect and action of ARNI?

Answer 7

• Effect: decreased BP by vasodilation and diuresis
• Action:
  • VALSARTAN: blocks AT1Rs… antagonises AngII… prevents vasoconstriction and aldosterone-mediated Na+/H2O retention.
  • SACUBITRIL: inhibits neprilysin enzyme… prevents degradatoin of vasoactive peptides inc. natriuretic peptides and bradykinin.

Question 8

What is the effect and action of aspirin?

Answer 8

• Effect: anticoagulant to reduce risk of emboli and strokes in IHD
• Action: irreversibly blocks formation of thromboxane A2 in platelets… inhibits platelet aggregation

Question 9

What is the effect and action of statins?

Answer 9

• Effect: decreases cholesterol to reduce effect of coronary artery atherosclerosis in HF
• Action: inhibition of HMG-CoA reductase… inhibits cholesterol synthesis