B.8 Pharmacological basis of therapy CHF Flashcards
All patients with Left ventricular systolic dysfunction should receive a ACEI and a beta-blocker ?
True/false
True
All patients with oedema should receive diuretics
True
What is the first-line treatment of chronic heart failure?
ACEI alongside a beta-blocker
What are ACEIs useful in chronic heart disease?
Reduce arterial and venous vasoconstriction (reduce afterload and preload of the heart)
Reduce salt/water retention, hence reduce the circulatory volume
Inhibits RAS, prevent cardiac remodeling
If the patient cannot take ACEI, what medication can be given as an alternative?
AT1 receptor antagonist
What is used to relieve pulmonary and peripheral oedema in CHF
Diuretics
loop diuretics
What are the benifits of diuretics?
Reduce circulatory volume Reduce preload
Relieve pulmonary and peripheral oedema
What are the risks of diuretics?
Especially thiazide diuretics can cause hypokalaemia
What is an effective agent of reversing left ventricular hypertrophy?
Spironolactone - mineralcorticosterioud (aldosterone) receptor antagonist.
What does digoxin do?
Acts as a positive inotrope by inhibiting NA+/K+ ATPase, Na+ accumulates in myocytes, exchanged with Ca2+ leading to increased contractility.
Describe how digoxin works on a pharmacological level.
- Digoxin is a cardiac glycoside
2> Inhibits sodium-potassium pump
- Na+ starts to accumulate inside the cell
- Body responds:
Activation of Na+ CA2+ exchange
- Na+ builds up and thrown out
- Ca2+ comes into the cell
5. This increases contractility
How does digoxin work when used to treat AV?
Impairs AV conduction and increases vagal activity (via CNS)
Is bradycardia beneficial in heart failure with AF
yes, as it slows the heart rate and improved cardiac filling
