Drugs used Flashcards
What drugs improve symptoms in heart failure
- diuretics
- digoxin
- spironolactone
What drugs improve survival in heart failure
- beta blockers - carvedilol only
- ACE-I
- Spironolactone
What is the only beta blocker that improves survival in heart failure
carvedilol
What diuretic do you use in heart failure as 1st line
- Loop diuretic - to relieve symptoms – eg furosemide 40mg/d PO ↑ as needed
- add potassium- sparing diuretic if certain criteria is met
What criteria has to be met in order to add a potassium sparing diuretic e.g. spironolactone to treatment of heart failure
- potassium < 3.2mmol/L
- predisposition to arrhythmias
- concurrent digoxin therapy
- pre-exisiting potassium - losing conditions
What are the side effects of loop diuretics
- hypokalamiea
- hyponatraemia
- hypocalcaemia
- renal impairment
- dehydration
- ototoxicity
What does ACE-I do in heart failure
Improves symptoms and prolongs life in left ventricular systolic dysfunction (LVDSD)
when should you avoid ACE-I
avoid in dehydration
What are ACEI contraindicated in
- hyperkalaemia
- AKI
- bilateral renal artery stenosis
- aortic valve stenosis
What are the side effects of ACE-I
- cough
- hyperkalaemia
- urticaria
- angioedema
- renal failure
what do you need to monitor in ACE-I
- monitor U&E when starting or raising dose
- increase in creatinine >20% is alarming
what do beta blockers do (Carvedilol)
↓mortality in HF (and post-discharge mortality in decompensated HF)
How should you start Carvedilol (beta blocker)
- initiate after diuretic and ACE-I
- slow increase in dose with low start; wait > 2 weeks between each dose increment
What are the side effects of carvedilol
- bronchospasm
- cold peripheries
- lethargy
- impotence
What are beta blockers contraindicated in
- asthma
