Chronic heart failure: drug management Flashcards
What is the first line management of chronic heart failure?
ACE-inhibitor and a beta-blocker
What are the main beta blockers used to treat chronic heart failure in the UK?
Bisoprolol
Carvedilol,
Nebivolol.
What do beta blockers and ACEi have no effect on?
HF with preserved ejection fraction
What is the second line management of chronic heart failure?
Aldosterone antagonist
What are examples of aldosterone antagonists?
Spironolactone
Eplerenone
What drugs can also be used for chronic heart failure for a reduced ejection fraction?
SGLT-2 inhibitors
What are examples of SGLT-2 inhibitors?
Canagliflozin
Dapagliflozin
Empagliflozin
Who should initate third line treatment for chronic heart failure?
Third-line treatment should be initiated by a specialist
What are the options for third line treatment of chronic heart failure?
Ivabradine
Sacubitril-valsartan
Hydralazine in combination with nitrate
Digoxin
Cardiac resynchronisation therapy
What is the criteria for administering ivabradine?
Sinus rhythm > 75/min
Left ventricular fraction < 35%
What vaccinations should people with chronic heart failure be offered?
Annual influenza vaccine
One-off pneumococcal vaccine
Which patients might require a pneumococcal vaccine booster every 5 years?
Asplenia
Splenic dysfunction
Chronic kidney disease
What is the indication for sacubitril-valsarta?
Left ventricular fraction < 35%
Heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs
should be initiated following ACEi or ARB wash-out period
When might you consider using hydralazine in combination with nitrate in the management of chronic heart failure?
Indicated in Afro-Caribbean patients
When migh you consider using digoxin in someone with chronic heart failure?
coexistent atrial fibrillation
