CVS

Question 1

What is the primary action of diuretics?

Answer 1

1. Diuretics act by reducing the reabsorption of electrolytes by the tubules.
2. This leads to an increase in the excretion of electrolytes with an increase in water excretion as well.
3. This helps decrease the amount of fluid flowing through the veins and arteries and thus reduce BP

Question 2

Which group of diuretics is most usually given for management of heart failure symptoms?

Answer 2

1. Loop diuretics are the most commonly used diuretics to manage heart failure symptoms as they are rapid onset in action and powerful.
2. H/E can cause serious electrolyte imbalances and dehydration and so must be monitored through renal functioning.

Question 3

What blood test should be used to monitor the use of diuretics and what results do you get with it? What may an imbalance of these results indicate?

Answer 3

1. U&E: gives urea and creatinine levels, Na and K levels.
2. Increase in urea and creatine levels indicates renal issues of dehydration or damage
3. Na and K imbalance can cause significant side effects so it is important to ensure they remain stable.

Question 4

If a patient on your first line diuretic develops hypokalaemia how might you manage this?

Answer 4

1. K-sparing diuretic (spironolactone) increases K retention.
2. These have a weak diuretic effect when used on their own but in conjunction with loop diuretics

Question 5

What is the mechanism of action of ramipril?

Answer 5

(1. ) Ramipril is an ACEi
(2. ) ACEi inhibit angiotensin converting enzyme (ACE), this prevents the conversion of Angiotensin I to Angiotensin II.
(3. ) Angiotensin II is a vasoconstrictor and stimulates aldosterone release.
(4. ) Reducing its levels will cause vasodilation and decrease in aldosterone levels, which will promote Na and water excretion.

Question 6

When should the renal function be monitored if using an ACE inhibitor?

Answer 6

(1. ) Renal function should be checked before starting ACEi as well as 2-4 weeks after any increase in dose.
(2. ) Renal function should be checked periodically during treatment especially if there is pre-existing renal impairment as hyperkalaemia can occur.

Question 7

What is ACE-inhibitor cough and how common is it?

Answer 7

(1. ) ACEi cough occurs in 10-30% of patients taking ACEi.
(2. ) This is a chronic cough thought to occur due to the accumulation of kinins in the lung.
(3. ) It is more common in women and can occur after many months of treatment.

Question 8

Why do Afro-Caribbean patients respond less well to ACE inhibitors?

Answer 8

(1.) ACEi are less commonly used in patients of afro-caribbean descent because they commonly have low renin essential HTN, where the renin-angiotensin system is contributing little to their HTN.