Diuretics and treatment of Heart Failure

Question 1

Drug class of Bumetanide and Furosimide?

Answer 1

Loop diuretics

Question 2

MOA of this drug class is to inhibit the Na+/K+/2Cl- co-transporters in the ascending limb of the loop of Henle, preventing the absorption of these ions into the tubular epithelium

Answer 2

Loop diuretics (Bumetanide, Furosimide)

Question 3

Adverse effects of loop diuretics?

Answer 3

Dehydration
Hypotension
Low electrolyte states: hyponatraemia, hypokalaemia, hypochloaemia, hypocalcemia, hypomagnesaemia
Metabolic alkalosis

Can cause tinnitus and hearing loss in high doses d/t disruption of Na/K/Cl transporter in inner ear, endolymph composition

Question 4

Indications for loop diuretics?

Answer 4

For relief of breathlessness in acute pulmonary oedema
For symptomatic treatment of fluid overload in chronic heart failure

Question 5

Initial management of acute pulmonary oedema?

Answer 5

Initial recommendation is 40mg Furosimide IV
(subsequent doses might be either IV boluses or switched to oral)

Question 6

Contraindications for loop diuretics?

Answer 6

Severe hypovolaemia and dehydration. Use with caution in hypokalemia and hyponatraemia

Question 7

Name of the “Thiazide-like” diuretic?

Answer 7

Indapamide

Question 8

Similar to thiazide diuretics, this drug also acts to inhibit the Na/Cl co-transporter in the DCT of the nephron, preventing reabsorption of sodium (and therefore water)

Answer 8

Indapamide

Question 9

Adverse effects of this drug class include
hyponatraemia
hypokalemia
cardiac arrhythmias
increased glucose concentrations
can cause impotence in men

Answer 9

Thiazide and thiazide-like diuretics

Question 10

This drug class reduces uric acid excretion, so they should be avoided in cases of gout

Answer 10

Thiazide and thiazide-like diuretics

Question 11

Which common, OTC drug can reduce the effectiveness of diuretics?

Answer 11

NSAIDs such as Ibuprofen

Question 12

What drug is the “potassium-sparing” diuretic?

Answer 12

Spironolactone

Question 13

MOA of Spironolactone?

Answer 13

Aldosterone antagonist- by inhibiting Aldosterone, this acts to increase Na and water excretion and potassium retention in the epithelium of the collecting duct.

Question 14

Which diuretic acts to inhibit the effect of aldosterone by competitive inhibition at mineralcorticoid receptors?

Answer 14

Spironolactone

Question 15

Indicated for long-term use in cases of chronic heart failure, along with a beta blocker and Ace-inhibitor/ARB

Answer 15

Spironolactone

Question 16

Important adverse effects of spironolactone?

Answer 16

HYPERKALAEMIA
Gynaecomastia
Liver impairment and jaundice

Question 17

The combination of ______________ with other potassium-elevating drugs such as Ace-inhibitors and ARB’s increase the risk of hyperkalaemia

Answer 17

Spironolactone

Question 18

This drug is contraindicated in patients with severe renal impairment, hyperkalemia, and adrenal insufficiency

Answer 18

Spironolactone

Question 19

Do diuretics help to reduce mortality in the treatment of heart failure?

Answer 19

No, they are mainly used to improve symptoms.

Question 20

Which drug class shows the greatest benefit in reducing mortality in HF?

Answer 20

Beta blockers have the greatest benefit in reducing mortality in HF, followed by Ace-inhibitors, aldosterone antagonists, and finally ARB’s

Question 21

Which of the heart failure drugs is a mineralocorticoid receptor antagonist?

Answer 21

Spironolactone

Question 22

Which class of diuretics acts to inhibit the Na/K/Cl symporter?

Answer 22

Loop diuretics

Question 23

Which class of diuretics acts to inhibit the Na/Cl symporter in the DCT?

Answer 23

Thiazide diuretics

Question 24

Diuretics help to provide symptom control in HF, and reduce cardiac ____________

Answer 24

pre-load

Question 25

This class of drugs helps to increase life expectancy in heart failure, particularly in patients with severe LV dysfunction. They also help to reduce risk of hospitalisation

Answer 25

Ace-inhibitors

Question 26

This drug class (used when patients cannot tolerate Ace-inhibitors) helps to reduce mortality in heart failure

Answer 26

ARB’s
Losartan, Candesartan

Question 27

Randomised controlled trials have shown that this drug class increases life expectancy and reduces hospitalisation in heart failure patients

Answer 27

Beta blockers

Question 28

This diuretic has been shown to increase life expectancy and reduce hospital admission in patients with severe heart failure

Answer 28

Spironolactone

Question 29

______ inhibition is the key to heart failure treatment!

Answer 29

RAAS

Question 30

What are the four drug classes used in the treatment of chronic heart failure?

Answer 30

Diuretics
Ace-inhibitors or ARB’s
Beta blockers
Spironolactone

Question 31

Which of the diabetic drugs has a diuretic effect, and also has been shown to significantly increase life expectancy within a few weeks of starting treatment?

Answer 31

SGLT2 inhibitors (eg Dapagliflozin)

Remember that ~90% of renal glucose reabsorption occurs in the proximal tubule

Question 32

________________ is recommended as an option for treating symptomatic chronic heart failure with reduced EF in adults, only if it is used as an add-on with an ACE-inhibitor/ARB, beta blocker, and mineralcorticoid receptor antagnonist

Answer 32

Dapagliflozin (SGLT2 inhibitor)

Question 33

Sit patient upright
Administer high dose O2 (consider the early use of NIV/CPAP)
IV loop diuretics
IV opiates (reduces anxiety & preload)
IV, buccal, or sublingual nitrates

Answer 33

Treatment of acute heart failure

Question 34

Class I - No sx and no limitation in ordinary physical activity, e.g. SOB when walking, climbing stairs etc.

Class II - Mild sx (mild SOB and/or angina) and slight limitation during ordinary activity.

Class III - Marked limitation in activity due to sx, even during less-than-ordinary activity, e.g. walking short distances. Comfortable only at rest.

Class IV - Severe limitations. Experiences sx even while at rest. Mostly bedbound patients.

Answer 34

New York heart association classification of heart failure severity/symptoms