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
What do you do if K >6
Stop ACEI immediate
Why don’t give ACEI and ARB
Renal failure
Valve disease
What is an ARNI
ARB
ACEI
Neprhrylysin
What does nephylysin do
Prevent metabolism of ANP and BNP
Increases diuresis and causes myocardial relaxation
What anti-coagulant and when
DOAC or warfarin
If in AF
What is spironolactone
Aldosterone antagonist
Blocks effects of aldosterone in DCT
K sparing diuretic
Useful in resistant oedema
What do you do if spironolactone not tolerated
Eplerenone if not tolerated or if had MI
What are SE
Gynaecomastia
Hyperkalaemia
HYponatraemia
Renal failure
When are BB CI
Acute HF as -ve inotrope
Used in chronic
What does morphine do in pulmonary oedema
Reduce preload
What do nitrates do
Reduce preload and after load
What do diuretics interact with
NSAID Anti-hypertensives = hypo Vancomycin Lithium Aminoglycosides
What should always be monitored in hF
U+E as all drugs affect
What drug CI in HF
Thiazoldidione as cause oedema (DM drug)
What combination drug used in HF
K sparing diuretic + ARB
Caution if renal impaired and hyperkalaemia
