heart failure pharmacology Flashcards
neurohormonal disturbances in heart failure
there is decreased cardiac output because of inability of the heart to contract after it has dilated , this will lead to activation of RAAS and sympathetic system which in turn leads to an increase in salt retention leading to further oedema.
drugs that inhibit fluid retention
loop diuretics
action of loop diuretics
they induce profound diuresis by inhibiting Na-K-Cl transporter in the loop of henle
example of loop diuretics
furesemide
bumetanide
ethacrynic acid
diuretic resistant patients can use loop in combination with thiazide diuretics what are the side effects of this?
dehydration
hypotension
hypokalaemia
hyponatraemia
gout
impaired glucose tolerance
drug to drug interactions of frusemide
aminoglycosides aural and renal toxicity
lithium renal toxicity
NSAIDs renal toxicity
antihypertensives profound hypotension
vancomycin renal toxicity
neurohormonal antagonists
ACE inhibitors
beta receptor blockers
mineralocorticoid receptor blockers
combined angiotensin blockade plus anp /bnp
action of ace inhibitors
inhibit the conversion of angiotensin 1 to 2 by blocking the ace enzyme
this will in turn reduce the preload and the afterload
examples of ace inhibitors
ramipril
enalapril
lisinopril
what are side effects of ace inhibitors
hyperkalaemia
bradycardia
dry cough
not suitable for pregnant women
angioedema
renal failure
drug to drug interactions with ace
nsaid acute renal failure
potassium supplements -hyperkalaemia
potassium sparing diuretics -hyperkalaemia
angiotensin receptor blockers
block the angiotensin from binding with the receptor
ace inhibitor reduces ?
morbidity
mortality
what do angiotensin receptor blockers reduce ?
morbidity
effect of combination of angiotensin and neprilysin inhibition
there is increased decrease in mortality
action of mineralocorticoid receptor antagonists
block receptors for steroids and aldosterone
examples of mineralocorticoid receptor antagonists
spironolactone
eplerenone
beta blockers action
blocks the actions of the sympathetic system
has been demonstrated to reduce morbidity and mortality
examples of beta blockers
carvedilol
bisoprolol
ivabradine
slows the heart rate through inhibition of the channel in the sinus node which should only be used with patients with a sinus rhythm
positive inotropes
digoxin
side effects of digoxin
Increases availability of calcium in the myocyte
Shown to reduce number of hospitalisations
No effect on mortality
Narrow therapeutic index
Arrhythmias
Nausea
Confusion
therapeutic regime of heart failure drugs
Furosemide ± thiazide Appropriate dose
Furosemide + pulsed metolazone
ACE Inhibitor Appropriate dose
Angiotensin receptor blocker
ARNI
Beta-blocker ± Ivabradine
MRA-spironolactone 25mg
Digoxin TDM
Warfarin TDM
