Diuretics and treatment of Heart Failure Flashcards
Drug class of Bumetanide and Furosimide?
Loop diuretics
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
Loop diuretics (Bumetanide, Furosimide)
Adverse effects of loop diuretics?
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
Indications for loop diuretics?
For relief of breathlessness in acute pulmonary oedema
For symptomatic treatment of fluid overload in chronic heart failure
Initial management of acute pulmonary oedema?
Initial recommendation is 40mg Furosimide IV
(subsequent doses might be either IV boluses or switched to oral)
Contraindications for loop diuretics?
Severe hypovolaemia and dehydration. Use with caution in hypokalemia and hyponatraemia
Name of the “Thiazide-like” diuretic?
Indapamide
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)
Indapamide
Adverse effects of this drug class include
hyponatraemia
hypokalemia
cardiac arrhythmias
increased glucose concentrations
can cause impotence in men
Thiazide and thiazide-like diuretics
This drug class reduces uric acid excretion, so they should be avoided in cases of gout
Thiazide and thiazide-like diuretics
Which common, OTC drug can reduce the effectiveness of diuretics?
NSAIDs such as Ibuprofen
What drug is the “potassium-sparing” diuretic?
Spironolactone
MOA of Spironolactone?
Aldosterone antagonist- by inhibiting Aldosterone, this acts to increase Na and water excretion and potassium retention in the epithelium of the collecting duct.
Which diuretic acts to inhibit the effect of aldosterone by competitive inhibition at mineralcorticoid receptors?
Spironolactone
Indicated for long-term use in cases of chronic heart failure, along with a beta blocker and Ace-inhibitor/ARB
Spironolactone
Important adverse effects of spironolactone?
HYPERKALAEMIA
Gynaecomastia
Liver impairment and jaundice
The combination of ______________ with other potassium-elevating drugs such as Ace-inhibitors and ARB’s increase the risk of hyperkalaemia
Spironolactone
This drug is contraindicated in patients with severe renal impairment, hyperkalemia, and adrenal insufficiency
Spironolactone
Do diuretics help to reduce mortality in the treatment of heart failure?
No, they are mainly used to improve symptoms.
Which drug class shows the greatest benefit in reducing mortality in HF?
Beta blockers have the greatest benefit in reducing mortality in HF, followed by Ace-inhibitors, aldosterone antagonists, and finally ARB’s
Which of the heart failure drugs is a mineralocorticoid receptor antagonist?
Spironolactone
Which class of diuretics acts to inhibit the Na/K/Cl symporter?
Loop diuretics
Which class of diuretics acts to inhibit the Na/Cl symporter in the DCT?
Thiazide diuretics
Diuretics help to provide symptom control in HF, and reduce cardiac ____________
pre-load
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
Ace-inhibitors
This drug class (used when patients cannot tolerate Ace-inhibitors) helps to reduce mortality in heart failure
ARB’s
Losartan, Candesartan
Randomised controlled trials have shown that this drug class increases life expectancy and reduces hospitalisation in heart failure patients
Beta blockers
This diuretic has been shown to increase life expectancy and reduce hospital admission in patients with severe heart failure
Spironolactone
______ inhibition is the key to heart failure treatment!
RAAS
What are the four drug classes used in the treatment of chronic heart failure?
Diuretics
Ace-inhibitors or ARB’s
Beta blockers
Spironolactone
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?
SGLT2 inhibitors (eg Dapagliflozin)
Remember that ~90% of renal glucose reabsorption occurs in the proximal tubule
________________ 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
Dapagliflozin (SGLT2 inhibitor)
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
Treatment of acute heart failure
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.
New York heart association classification of heart failure severity/symptoms
