ELM 8.2 Flashcards
loop diuretics
Examples
Furosemide (aka frusemide), bumetanide
Mechanism
Inhibit Na+, K+ Cl- transport in ascending limb of the Loop of Henle
Main uses
Heart failure, oedema. Also licenced for hypertension that does not respond to other drugs (resistant hypertension). Can be used in hypertension when patient also has kidney problems or heart failure
Side effects
Hypokalaemia, high volume of urine production (most powerful class of diuretics), fatigue, headache, muscle spasms
Thiazide and thiazide-related diuretics
Examples
Bendroflumethiazide, chlortalidone, indapamide (for information only)
Mechanism
Inhibit Na+ Cl- transport in the distal convoluted tubule
Main uses
Low doses: used in hypertension (mainly chlortalidone, indapamide)
Higher doses: used in oedema and sometimes in heart failure
Side effects
Hypokalaemia, hypochloraemia (at higher doses), moderately high volume of urine production (not as powerful as the loop diuretics), fatigue, headache, GI tract disturbance, postural hypotension
Potassium sparing diuretics
Examples
Spironolactone (also known as aldactone), eplerenone (a similar drug: for information only)
Amiloride, triamterene (a similar drug: for information only)
Mechanism
Spironolactone is an aldosterone antagonist
Amiloride blocks the epithelial sodium channel (ENaC)
Main uses
Amiloride: added to loop and thiazide diuretics to prevent potassium loss
Spironolactone: to treat oedema in heart failure; used as an adjunct treatment in moderate to severe heart failure; adjunct in resistant hypertension; oedema due to liver dysfunction. Also used in aldosteronism
Side effects
Hyperkalaemia, GI tract disturbance, more frequent urination (milder diuretics than thiazide or loop drugs)
Spironolactone can also act as an antiandrogen at high doses which can cause feminization in men. It can disrupt the menstrual cycle in women.
A clinical trial that demonstrated that angiotensin II receptor antagonists share the useful properties of ACE inhibitors in treating heart failure was:
a. CHARM
b. COMET
c. RALES
d. SOLVD
a
Which of the following types of heart failure currently does not have good treatment options?
a. Backward heart failure b. Heart failure with preserved ejection fraction c. Heart failure with reduced ejection fraction d. Left sided heart failure
b
Which of the following conditions is most likely to result in diastolic dysfunction?
a. dilated cardiomyopathy
b. hypertrophic cardiomyopathy
c. pulmonary oedema
d. unstable angina
b
Select an aldosterone antagonist that is used as a treatment for heart failure:
a. atenolol
b. diltiazem
c. losartan
d. spironolactone
d
The A-HeFT clinical trial showed that isosorbide dinitrate is useful in the treatment of heart failure in black patients when combined with:
a. atropine
b. bisoprolol
c. hydralazine
d. losartan
c
Statement X: Loop diuretics reduce the body’s salt and water load
Statement Y: Loop diuretics are useful treatments for cardiac failure
a. Statement X is false; statement Y is false b. Statement X is false; statement Y is true c. Statement X is true; statement Y is false d. Statement X is true; statement Y is true AND X is NOT the reason for Y e. Statement X is true; statement Y is true AND X IS the reason for Y
e
Statement X: Left sided heart failure reduces the amount of blood reaching the lungs
Statement Y: Patients with left sided heart failure can suffer from breathlessness
a. Statement X is false; statement Y is false b. Statement X is false; statement Y is true c. Statement X is true; statement Y is false d. Statement X is true; statement Y is true AND X is NOT the reason for Y e. Statement X is true; statement Y is true AND X IS the reason for Y
b
Statement X: Bisoprolol rapidly increases cardiac output
Statement Y: High dose bisoprolol is a useful emergency treatment for heart failure
a. Statement X is false; statement Y is false b. Statement X is false; statement Y is true c. Statement X is true; statement Y is false d. Statement X is true; statement Y is true AND X is NOT the reason for Y e. Statement X is true; statement Y is true AND X IS the reason for Y
a
Statement X: Ivabradine is a beta 1 adrenoceptor antagonist
Statement Y: Ivabradine decreases the heart rate
a. Statement X is false; statement Y is false b. Statement X is false; statement Y is true c. Statement X is true; statement Y is false d. Statement X is true; statement Y is true AND X is NOT the reason for Y e. Statement X is true; statement Y is true AND X IS the reason for Y
b
