Heart Failure - Medications

Question 1

ACEi

• a ? dose used a titrated ?
• don’t use with ? - risk of renal damage
• potential renal side effects -> monitor ?, creatinine and ? before/during trt
• avoid in pts with SBP -> may cause severe ?
• risk of first dose ? - withdraw ? until settled
• 10% get ? ? -> use ATRA

Answer 1

low
up
nsaids
urea
K
100
hypotension
hypotension
diuretics
dry cough

Question 2

BB

• block ? activity that causes maladaptation
• also have ? effects and thus reduce sudden ?
• reduce sympathetic drive so Sx get ? initially - start with ? dose and titrate ?
• CId in ?
• caution in ? - not CId

Answer 2

SNS
anti-arrhythmic 
death
worse
low
up
asthma
copd

Question 3

Diuretics

• mainly for Sx relief of ? but also ?
• ? are used in mild failure or in ? pts where massive ? may be intolerable
• ? diuretics used esp in pulm oedema
• both have propensity to cause ? - can be useful if pt also taking ACEis

Answer 3

oedema 
venodilate
thiazides
elderly
diuresis
loop
hypokal

Question 4

Spironolactone

• ? ? diuretic - used at ? dose (25mg) to reverse ? adaptation
• shown to reduce mortality by ?% -> ? usually leads to fibrosis of the heart muscle

Answer 4

K sparing
low
neurohormonal
35
aldosterone

Question 5

Digoxin 1

• used when HF is ?
• positive ? and negative chronotrope -> ? the force of contraction but decreasing ? ?
• impairs ? conduction and increases ? activity - although now the major use is in ??
• CId in concurrent ? ? /brady as it ? a degree of heart block

Answer 5

refractory
inotrope
increasing
heart rate
AVN
vagal
AF
heart block
induces

Question 6

Digoxin 2

• dosage titrated so that ? rate does not fall below ? - this indicates ?
• has a ? ? ?
• toxicity is a major problem - indicated by ?, nausea, ? disturbance, and ?
• dosage is according to ? as it is 2/3rds ? cleared

Answer 6

ventricular
60
toxicity
narrow therapeutic window
anorexia
visual
diarrhoea
eGFR
renally

Question 7

Always montor ? fx in pts trtd for HF

• ? is renally cleared
• ? are ineffective in renal failure
• ? are used in caution in renal failure
• ACEi + diuretics can lead to ?

Answer 7

renal
digoxin
thiazides
ACEis
hyperkalaemia