Heart failure drugs

Question 1

ACE inhibitors

Answer 1

ACE inhibitors inhibit ACE chymase which prevents the conversion of Angiotensin I—– Angiotensin II
- improve LV dysfunction, but have not been shown to protect against sudden death.

Question 2

What are the side effects of ACE inhibitors

Answer 2

-The first dose can cause hypotension
- Dry cough
- Most serious effect: Angioedema (swelling of the tongue and lips)

contraindicated for pregnancy

Question 3

ARB’s

Answer 3

Angiotensin receptor blockers
Prevent angiotensin II being converted into aldosterone and causing

vasoconstriction

Question 4

Beta Blockers

Answer 4

• Reduce sympatho-adrenergic activity
• reduce afterload
  -They reduce Renin release and therefore - Prevent the conversion of Angiotensin to Angiotensin I

** Negative inotropic effect: weaken the force of the contraction of the caridiac muscle — therefore they can cause heart failure

• drug shown to improve mortality rates from CHD but their is conflicting research on which class causes this effect.

Question 5

What are the side effects of Beta blockers & contraindications?

Answer 5

Negative Inotropic effect: they weaken the force of contraction by weakening the heart muscle.

• Bradycardia
  -Hypotension

its recommended to start slow and then increase

contraindications:
-Asthma
-Uncontrolled heart failure
- Severe heart failure

Question 6

Spironolactone

Answer 6

block the number of aldosterone receptors on the distal convoluted tubule

• Drug has shown to reduce mortality and hospitalisations

Question 7

Side effect of Spironolactone

Answer 7

• Gyaenocomastia
• Testicular atrophy
• Hyperkalemia (renal impairment)

Question 8

Digoxin mode of action

Answer 8

Digoxin inhibits the Na/k ATPase pump. This increases the levels of intracellular Na.

The Na feeds into into the NCX, which in turn increases intracellular calcium levels (a reversal of its effects)

more calcium is available for an increased force of contraction

Question 9

What are the uses of Digoxin and what are the side effects

Answer 9

Slows down the ventricular rate in atrial fibrillation

side effects: nausea, vomitting, arryythmias

Question 10

What are the uses of direutics

Answer 10

• Relieve symptoms

-relieve circulatory congestion, pulmonary and peripheral oedema

-reduce atrial and ventricular diastolic pressure

• do not improve LV dysfunction

Question 11

What are the side effects of diruetics

Answer 11

Metabollic effects:
-Hypokalemia
-Hyperglycemia
-Hyperuricemia

social distruption
- frequency
- urgency

Question 12

What are the NON-drug therapies for heart failure

Answer 12

1. Cardiac resynchronisation therapy - electrodes are placed into the ventricles - adjust the firing to the activity in the atrium. This can improve cardiac output. (for patients with intra-ventricular conduction delays)
2. Ventricular assist device- connect the left ventricle with the aorta
3. Cardiac Transpant - patient with a pig heart to help his heart fialure.