Cardiac Failure 2

Question 1

How do ACE inhibitors help treat heart failure?

Answer 1

. Reduce vasoconstriction to reduce pre-load and after-load
. Reduce salt and water retention to lower BP
. Inhibit RAAS

Question 2

Describe four common side effects of ACE inhibitors.

Answer 2

. First dose hypotension
. Renal dysfunction
. Dry cough
. Hypokalaemia

Question 3

What is an alternative for ACE inhibitors that avoids the dry cough?

Answer 3

. Angiotensin I receptor antagonists (AT1 receptor antagonists/ ATRAs)
. These inhibit the action of AT1 to decrease BP and decrease pre-load and after-load

Question 4

ACE inhibitors and beta-blockers are first line treatment for heart failure. What kind of beta-blockers are used?

Answer 4

B1-selective inhibitors (to lower heart rate and not affect other beta-receptors)

Question 5

What is one precaution of beta-blockers for heart failure that a doctor should tell their patients?

Answer 5

Symptoms may get worse at first before they get better

Question 6

Name two loop diuretics.

Answer 6

Furosemide and thiazides

Question 7

What is one risk of using loop diuretics?

Answer 7

Hypokalaemia

Question 8

What is spironolactone? What does it do?

Answer 8

. Aldosterone receptor antagonist

. Reverses LVF

Question 9

How does Digoxin work in treating heart failure? (works differently with AF)

Answer 9

. Inhibits sodium-potassium ATPase
. Na+ accumulates in myocytes, exchanged with Ca2+
. Positive inotrope (increased force of contraction)

Question 10

How does Digoxin work in treating AF? (works differently with HF)

Answer 10

. Impairs AV conduction and vagal activity via CNS

. Slows heart rate to improve cardiac filling

Question 11

How do you titrate the dose of Digoxin?

Answer 11

Titrate dose to ventricular rate of over 60 bpm

Question 12

Digoxin isn’t commonly used as it is seen as outdated. In what circumstances is it sometimes used?

Answer 12

. Patients with heart failure and AF

. If ACEI and diuretic fails

Question 13

What do nitrates, prazosin, and hydralazine have in common?

Answer 13

They are all vasodilators

Question 14

What is one danger of using digoxin?

Answer 14

. Digoxin has a narrow therapeutic window and outside of this window Digoxin is toxic!
. Can cause anorexia, nausea, visual disturbances
. Must monitor pulse when using for AF

Question 15

Describe the drug pathway for treating LV dysfunction.

Answer 15

. ACEI or beta-blocker
. If cough, ATRA
. Persistent symptoms, ATRA, aldosterone antagonist, or hydralazine plus nitrate (vasodilators)
. Persistent symptoms, digoxin

. At any point if there’s oedema, can use diuretic