HF Therapy Flashcards
What drugs improve symptoms
Diuretics
Digoxin due to inotropic
What drugs improve survival
BB
- Not a class effect only certain BB
Ivabradeine
Vasodilator
What drugs improve symptoms and survival
ACEI / ARB
Spirnolactone
Where do loop diuretics work
Loop of Henle - ascending
Inhibit Na-K-Cl
Furosemide - rapid IV
Bumetanide - slower use in older people
What do you do if resistant to loop
Use with thiazide (inhibit reabsorption of Na at DCT)
Don’t leave on for too long
Indapamide / Bendrofluzemdide
What are adverse effects of loop diuretic
Dehydration Dizzy Hypotension Hypokalaemia Hypocalcium - useful in renal (thiazide cause hyper so gout) Hyponatraemia - due to fluid retention usually or high dose Hypochloraemic alkalosis Gout Impaired glucose tolerance Renal failure due to dehydration Uraemia Ototoxicty
What do BB do
Block sympathetic hormonal changes in HF
Can precipitate deterioration
Only use by specalist when other therapy has been tried
When are BB CI
Asthma Hypotension AV block Acute HF Verapamil - rate-liming CCB
When is morphine indicated
Anxious
Use if restless and distressed
Vasodilator as reduced sympathetic drive
Can cause respiratory depression
What does Ivabradine do and when do you use
Inhibitor of SA Node
Does not modify contractility
Must be on standard therapy, including BB and HR >70
What does digoxin do
Positive inotrope
Enhance cardiac function by increasing availability of cardiac
Use if still symptomatic on therapy / or if AF
Wha are affects of digoxin and how do you monitor
Arrythmia
Confusion
U+E - particularly K (if low = more toxic)
What are vasodilators
Hydralazine
Nitrate - isosorbide denitrate
What do vasodilators do
Reduce preload and after load
Use if intolerant to ACEI
What does ACEI do
Prevents conversion of angiotensin I to II
Reduce preload and after load
