Heart Failure Pharmacology Flashcards

1
Q

Goal of CHF Pharmacology

A

Treating the maladaptations of the heart (inappropriate response of the heart)

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2
Q

Most relevant drugs in CHF management

A

ACE Inhibitor and Beta blockers

Patients with oedema should receive a diuretic

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3
Q

Example of an ACE Inhibitor

A

Ramipril (Remember the suffix ‘pril’)

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4
Q

Role of ACE Inhibitors (ACEIs)

A

Reducing afterload and preload

Reducing salt/water rention to a degree as it interacts with the aldosterone side of things

Most importantly inhibits RAAS which prevents cardiac remodelling

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5
Q

How to use ACEIs

A

Low dose then titrate up

Monitor eGFR and K+ before and during treatment

(ACEIs increase plasma K+)

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6
Q

Effect of Aldosterone on Sodium and Potassium

A

Aldosterone is a sodium retaining and potassium losing hormone

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7
Q

Risk of ACEIs in terms of BP (and treatment of side effect)

A

ACEIs may cause severe hypotension. If this is a risk, withdraw diuretic therapy for a few days before and give ACEIs at night to prevent falling

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8
Q

What does a small drop in eGFR indicate when ACEI therapy begins

A

It indicates that they are doing their job

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9
Q

Respiratory side effect of ACEIs and why (vaguely)

A

Occasionally a dry cough at the start of therapy that tends to be quite managable

Because ACE also breaks down bradykinin

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10
Q

Important contraindication of ACEIs and why

A

Renovascular disease

Let’s say we have atherosclerosis in renal artery; Kidney releases a lot of renin to compensate and so the body’s BP becomes reliant on RAAS

ACEIs affect this system and can cause significant hypotension

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11
Q

AT1 Receptor antagonists

A

aka ATRAs or ARBs

Block actions of Angiotensin II at AT1 Receptors; alternative to ACEIs in CHF but far less likely to give cough

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12
Q

Example of AT1 Receptor Antagonist

A

Losartan (Suffix -sartan)

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13
Q

Beta blockers on CHF

A

It can precipitate heart failure

Although, if used in very low doses to start with, they are first line along with ACEIs

They are anti-arrythmics

Key is that they take out the toxicity of the sympathetic nervous system that causes myocyte dysfunction

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14
Q

Are B blockers contraindicated in COPD

A

No; COPD is no reason to avoid beta blockers

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15
Q

Dosage of beta blockers on CHF patients at beginning

A

Begin with tiny dose of bisoprolol due to negative ionotropic and chronotropic effects of beta blockers (symptoms may initially get worse after initiating treatment and that’s ok)

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16
Q

Loop diuretic

A

e.g. Furosemide

Destroys ability of loop of henle to excrete concentrated urine

Reduces circulating volume, preload on heart and relieves pulmonary/peripheral oedema

17
Q

Eplenerode

A

Aldosterone Receptor Antagonist

Opposes cardiac fibrosis

18
Q

Example of a Mineralocorticosteroid

A

Aldosterone since it regulates sodium balance in blood

19
Q

Mechanism of digoxin

A

Positive inotrope;

Inhibits Na+/K+ ATPase so that Na+ accumulates in myocytes to be exchanged with Ca2+ which leads to increased contractility

20
Q

Digoxin and AF

A

Digoxin’s main use is for AF

Digoxin impairs AV conduction (partially directly via AV node) and increases vagal output
Slows the heart rate

21
Q

Ivabradine

A

Inhibits pacemaker current

Used in heart failure; slows heart rate down - in addition to ACEi/B Blockers

22
Q

Dapagliflozin

A

Sodium-Glucose co-transporter 2 (SGLT2) inhibitor

Improves the outcome of CHF; mechanism kinda unknown tho lol

there are a few theories but data don’t lie

23
Q

Monitoring of Cardiovascular drugs

A
Renal Function
ACEIs (avoid in renovascular disease!!)
K+
 - Hypokaelaemia (Aldosterone)
Side effects of loop diuretics
Digoxin just in general (narrow TW - side effects high)

MAKE SURE DIGOXIN AF PATIENTS HAVE > 60bpm!!