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Pharmacology > hEART fAILURE > Flashcards

hEART fAILURE Flashcards

1
Q

What is the difference in definition between systolic (HFrEF) and diastolic (HFpEF) heart failure?

A

HFrEF is systolic heart failure or heart failure with reduced systolic function. Left ventricle ejection fraction is less than 40%. Ventricle cannot pump. Lots of treatment available.

HFpEF is diastolic heart failure or heart failure with preserved systolic function. Ventricle cannot relax. Not a lot of treatment

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2
Q

What are two characteristics of systolic heart failure?

A

impaired pumping ability of the ventricle leading to a reduced cardiac output
Left ventricle ejection fraction is less than 40%

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3
Q

What are two characteristics of diastolic heart failure?

A

left ventricle does not fill properly (relax) during diastole leading to reduced CO
ejection fraction is normal but CO is reduced
limited evidence for treatment

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4
Q

What is systolic heart failure also known as?

A

HFrEF

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5
Q

What tries to maintain cardiac output in heart failure? (3 points)

A

RAAS, SNS, endothelin, vasopressin, ANP and BNP

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6
Q

Why is it bad to rely on other systems to restore cardiovascular function?

A

it is associated with disease progression

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6
Q

What happens when you rely on long term SNS activation? (2 points)

A

myocardial stress and increased oxygen use, cardiac hypertrophy and fibrosis, cardiac muscle cell necrosis and death, arrhythmias

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7
Q

What are five non-pharmacological measures for heart failure?

A

pt education and counselling
weight loss if obese
regualr exercise
fludi restriction (1-2L per day)
sodium restriction (2-3 grams a day)
no added salt or low salt diets
daily weigths
avoid smoking
alcohol restriction
flu, pneumococcal and covid vax

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8
Q

What are five treatments for HFrEF?

A

ACEIs
ANG2 receptor antagonists (sartans)\
Neprilysin inhibitors
Diuretics
BBs
Sprionolactone
Ivabradine
Digoxin
SGLT2Is

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9
Q

What are three functions which the RAAS helps regulate?

A

BP, fluid voluem and electrolyte levels

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10
Q

What is aldosterone?

A

a hormone released from the adrenal cortex which increases water and sodium absorption and potassium excretion. It acts in the distant convoluted tubule and collecting duct

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11
Q

What does ANG2 do?

A

Causes vasoconstriction and increased peripheral vascular resistance and causes release of aldosterone which causes increased blood pressure and increased preload/afterload

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12
Q

What is the initial therapy for systolic heart failure?

A

ACEIs

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13
Q

What are three features of ACEIs? (3 marks)

A

Reduces preload and afterload, slows progression of heart failure and improves morbidity and mortality

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14
Q

What are three counselling points for people on ACEIs?

A

start with a low dose, monitor renal function, titrate dose to levels known to improve survival, add a diuretic is symptoms are not adequately controlled.

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15
Q

What can you use if ANG2 receptor antagonists are not effective?

A

ACEIs

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16
Q

What would you expect to see in renal function and potassium levels if using ANG2RAs in heart failure?

A

lower renal function and increased potassium

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17
Q

How is renal perfusion controlled in elderly patients with heart failure in regard to renal self-regulation?

A

prostaglandins vasodilate on afferent renal vessels and ANG2 causes vasoconstriction on efferent renal vessels

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18
Q

what is the effect of aldosterone on sodium and water and potassium levels?

A

increases sodium and water reabsorption and excretion of potassium

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19
Q

what is the effect of ACEIs and ANG2RAs on sodium and water and potassium levels?

A

increased sodium and water excretion and reduced potassium excretion

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20
Q

What is ANP, BNP and CNP?

A

Naturetic peptides which are release on heart distension

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21
Q

List 4 functions of naturetic peptides

A

vasoialtion, diuresis and natriuresis, inhibition of renin and aldosterone release, reduction of sympathetic activity, reduction on preload and afterload, antihypertrophic and anti-fibrotic effects that reduce cardiovascular modelling

22
Q

How are naturetic peptides broken down?

A

by neprilyis, an enzyme

23
Q

What inhibits the breakdown of natural peptides?

A

sacubitril

24
Q

What are 3 effects of sacubitril to treat systolic HF?

A

vasodialtion, diuresis and naturesis, inhibits renin and aldosterone release, reduces sympathetic activity and reduces preload and afterload

25
Q

What is one practice point to remember about sacubitril?

A

never administer with an ACEI as it could cause angioedema- 36 hour washout period

26
Q

What is a practice point for loop diuretics?

A

should not be used as monotherapy in HF, does not improve prognosis or mortality

27
Q

What is a competitive antagonist of aldosterone?

A

spironolactone

28
Q

What is the effect of spironolactone on sodium, water and potassium levels?

A

increases sodium and water excretion and decreases potassium excretion

29
Q

what are 2 side effect of spironolactone?

A

it has anti-adrenergic activity which could lead to gynaecomastia
hyperkalaemia due to reduces potassium excretion

30
Q

What should you not combine with spironolactone?

A

ACEIs and A2 antagonists- can cause sever hyperkalaemia and death

31
Q

List 4 beta blockers (including their selectivity) which are useful in systolic HF

A

Bisoprolol- B1 selective
Metoprolol- B1 selective
Nebivolol- B1 selective (vasodilating properties)
Carvedilol (alpha 1 receptor blocking activity)

32
Q

What are two possible MOAS of BBs in systolic HF?

A

reduces sympathetic activity
reduce cardiac ischemia and dysrhythmias
reduced renin release

33
Q

What are two practice points for BBs in heart failure?

A

start low and go slow
first four to eight weeks, symptoms may worsen, add to existing ACEIs can cause mortality and morbidity issues

34
Q

How can you predict adverse outcomes in someone with systolic heart failure?

A

measure HR

35
Q

What is the effect of Ivabradine on the heart?

A

It reduces it by inhibiting the SA node which is responsible for spontaneous depolarisation

36
Q

What is the drug class of digoxin?

A

cardiac glycoside

37
Q

What is the MOA of digoxin?

A

slows HR and increases contraction force, inhibits the sodium potassium pump causing an increase in intracellular calcium

38
Q

What are 3 points about Digoxin?

A

low therapeutic range
long half life
mostly excreted in the urine
hypokalaemia increases toxicity

39
Q

What are two adverse drug reactions for digoxin?

A

Nausea, vomiting, diarrhoea, green/yellow vision, bradycardia, ectopic beats and arrhythmias

40
Q

What is SGLT2?

A

the predominant transporter for the reabsorption of glucose from the glomerular filtrate back into the circulation

41
Q

What are two SGLT2 inhibitors?

A

dapagliflozin and empagliflozin

42
Q

What should you monitor when using SGLT2Is in HF?

A

fluid balance

43
Q

What is the only drug group that shows real benefit in diastolic HF?

A

SGLT2Is

44
Q

What is the rationale for drug use in heart failure? (5)

A

Halt disease progression, improve survival, improve remodelling, prevent complications and relieve symptoms

45
Q

What are three non-pharmacological treatments for heart failure?

A

patient education and counselling, fluid and sodium restriction, weight loss if obese, exercise. Flu, pneumococcal and COVID vax

46
Q

What are three pharmacological options for heart failure?

A

angiotensin receptor neprilysin inhibitor (ARNI) with a sartan, beta blocker, aldosterone antagonists, SGLT2 inhibitors, loop diuretics, ivabradine and digoxin

47
Q

What are two drugs used in first line treatment of heart failure?

A

ARNI (combo of Neprilysin inhibitor and sartan) and SGLT2I

48
Q

What are 2 adverse effects of an ARNI?

A

hypokalaemia, renal impairment, hypotension, increased serum creatinine, diarrhoea, cough

49
Q

What are two things to monitor when using an ARNI?

A

Monitor serum creatinine, potassium concentration and blood pressure

50
Q

What are two adverse effects of an SGLT2I?

A

genital infections, polyuria, dysuria, uti, dyslipidemia, hypoglycaemia

51
Q

What are 2 things you should monitor when using an SGLT2I?

A

renal function at least annually, serum creatinine and eGFR.

52
Q

What are 2 practice points for digoxin?

A

check renal function and electrolyte concentrations before starting digoxin
regularly assess patients for digoxin toxicity

Pharmacology (23 decks)

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