Heart Failure Drugs Flashcards
1
Q
List the following for: Loop diuretic
- Use
- Example drugs
- Drug class
- Mechanism of action
- Adverse effects
- Warnings / contraindications
- Important drug reactions
A
Heart failure (pulmonary oedema and fluid overload)
Furosemide
Bumetanide
Loop diuretic
- Inhibit Na2ClK transporter in ascending limb of LOH
- Reduced Na, Cl and K reabsorption (also reduced Mg and Ca reabsorption)
- Direct dilation of capacitance veins
All of the above reduce preload, reduce stretch of the heart so reduces its workload - Dehydration
- Hypotension
- Hypokalaemia
- Hyponatraemia
- Hyperuricemia (gout)
- Arrythmias
- Tinnitus / ototoxicity
- Increased cholesterol and triglycerides
- Hypokalaemia
- Hyponatraemia
- Gout
- Hepatic encephalopathy
- Aminoglycosides
- Digoxin
- Lithium
2
Q
List the following for: K sparing diuretic
- Use
- Example drugs
- Drug class
- Mechanism of action
- Adverse effects
- Warnings / contraindications
- Important drug reactions
A
Heart failure
Amiloride
K+ sparing diuretic
- Blocks ENaC channels in DCT/CD
- Reduces Na reabsorption (also reduces K excretion via ROMK)
- Often mixed use with other diuretics e.g., thiazides or loop diuretics to limit hypokalaemia
Overall effect = reduce preload, reduce stretch of the heart so reduces its workload - Hyperkalaemia
- Potential arrythmias
- Addison’s disease
- K supplements
- Other K sparing drugs
- ACEi
- ARB
3
Q
Explain the treatment pathway for heart failure
A
- Loop diuretic (Furosemide) to deal with congestive symptoms
If HFpEF:
- Manage co-morbidities
- Cardiac rehab
If HFrEF:
- ACEi (Lisinopril / Ramipril)
- PLUS beta-blocker (Bisoprolol)
- Maybe MRA (Spironolactone)
- Consider ARB if ACEi can’t be tolerated
