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3.23 > Lecture 20: Pharmaceutical Care in Cardiovascular disease > Flashcards

Lecture 20: Pharmaceutical Care in Cardiovascular disease Flashcards

1
Q

What are the causes of heart failure?

A
  • Myocardial Infarction
  • Hypertension
  • Atrial Fibrillation
  • Alcohol / drugs
  • Valve diseases
  • Viral / thyroid
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2
Q

What are the clinical symptoms of heart failure? (5)

A
  • breathlessness
  • nocturnal symptoms
  • fatigue
  • ankle oedema
  • poor exercise tolerance
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3
Q

What investigations should be done for heart failure?

A
  • Chest x-ray
  • Echocardiogram
  • Ejection Fraction
  • Electrocardiogram
  • BNP
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4
Q

What blood tests are done for heart failure?

A
  • Full blood count
  • Urea and electrolytes
  • TFTs
  • Iron studies
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5
Q

What is New York Heart Classification?

A

I - Asymptomatic, even on exercise
II - Heart failure symptoms, but only on exercise
III - Heart failure symptoms on very mild exercise
IV - Heart failure symptoms at rest

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6
Q

What is Non-pharmacological management for heart failure?

A
  • Education for patients and carers
    May include self-management advice (e.g. diuretic adjustment within pre-defined and individualised limits)
  • Self-monitoring of weight
    Gain of >2kg in 2-3 days seek advice or self-adjust diuretic dose
  • Dietary measures
    Reduce salt intake (care with salt substitutes)
    Fluid restrict in advanced heart failure (1.5-2.0L/day)
    Moderate alcohol intake
    Weight reduction if obese
  • Other lifestyle issues
    Smoking cessation
    Exercise; best rest in acute heart failure, exercise training programs encouraged for stable patients
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7
Q

What is heart failure?

A

Left ventricular systolic Dysfunction

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8
Q

What is left ventricular systolic dysfunction?

A

Damage to the left ventricle

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9
Q

What are the signs for heart failure?

A
  • Elevated jugular venous pressure
  • Pulmonary crackles
  • Peripheral Oedema
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10
Q

How is heart failure examined?

A
  • Auscultation
  • Heart rate may be very fast
  • Jugular venous pressure (JVP) may be elevated
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11
Q

What are the investigations for heart failure?

A
  • Chest xray
  • Echocardiogram
  • Ejection fraction
  • BNP
  • Electrocardiogram
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12
Q

What blood tests are done for heart failure?

A
  • Full blood count
  • Urea and electrolyte
  • Thyroid function tests
  • Iron studies
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13
Q

What is NYH I?

A

Asymptomatic, even on exercise

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14
Q

What is NYH II?

A

Heart failure symptoms but only on exercise

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15
Q

What is NYH III?

A

Heart failure symptoms on very mild exercise

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16
Q

What is NYH IV?

A

Heart failure symptoms at rest

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17
Q

What is the non pharmacological management for heart failure?

A
  • Education for patients and carers
  • Self monitoring of weight
  • Dietary measures
  • Smoking cessation
  • Exercise
18
Q

What is self monitoring of weight in heart failure patients?

A

Gain of more than 2kg in 2-3, seek advice or self adjust diuretic dose

19
Q

What are the dietary measures for heart failure?

A
  • Reduce salt intake
  • Fluid restrict in advanced heart failure (1.5-2L a day)
  • Moderate alcohol intake
  • Weight reduction if obese
20
Q

What are the therapeutic options for heart failure?

A
  • Diuretics
  • ACE inhibitors
  • Angiotensin receptor blockers
  • Beta blockers
  • Aldosterone antagonists
  • Digoxin
  • Vasodilators
  • Sacubitril/ Valsartan
  • Dapagliflozin
21
Q

What monitoring is required with diuretics?

A
  • Renal function and electrolytes
  • Monitor weight and adjust dose
22
Q

What are the counseling points for diuretics?

A
  • Counsel patients on flexible dosing time
  • Inconvenience as you need to pee a lot
  • Diuretics can cause gout
23
Q

What are diuretics place in therapy?

A

Used to control symptoms

24
Q

How are diuretics usually given?

A
  • Loop diuretic is usually given
  • Combination of loop diuretic and thiazide may be required
  • May be given orally/ intravenously
25
Q

What is furosemide 40mg equivalent to?

A

Bumetamide 1mg

26
Q

What are ACE inhibitor place in therapy?

A
  • Improve survival and symptoms and reduce hospitalization
  • Indicated for all grades of heart failure unless contraindicated
27
Q

What monitoring is required with ACE inhibitors?

A

Renal function and electrolytes before and after each dose change and initial dose

28
Q

When can you combine an ARB with an ACE inhibitor?

A

In patients who remain symptomatic for additional benefits

29
Q

What is the choice for ARB?

A
  • Candesartan
  • Valsartan
30
Q

What are beta blockers place in therapy?

A
  • Reduce hospitalization, morbidity and mortality
  • Indicated for stable patients in addition to an ACE inhibitor or angiotensin receptor blocker
31
Q

What is the choice of beta blocker?

A
  • Carvedilol
  • Bisoprolol
  • Nebivilol
  • Metopralol
32
Q

What are the practical points for beta blockers?

A
  • Patients heart failure should be stable at initiation
  • Heart failure symptoms may be exacerbated during titration
  • Avoid abrupt withdrawal
33
Q

What beta blocker is better for a hypertensive patient with heart failure?

A

Bisoprolol - a cardio selective beta blocker

34
Q

What is ivabradines place in therapy?

A
  • Reduces mortality and hospitalization
  • NYHA II- IV
  • Used in patients intolerant to beta blockers or in addition to beta blocker if HR>75
35
Q

What are the practical points of ivabradine?

A
  • Avoid grapefruit
  • Bradycardia
  • Sinus Rythm
36
Q

What are aldosterone antagonists place in therapy?

A
  • Spironolactone reduces morbidity and mortality when added to usual treatment in advanced heart failure patients ( Class III-IV)
  • Eplerenone reduces morbidity and mortality when added to usual treatment in MI complicated by heart failure or in spironolactone intolerant heart failure patients
37
Q

What needs to be checked before initiation of aldosterone antagonists?

A

Serum creatinine and potassium levels

38
Q

What is the initial dose of spironolactone?

A

12.5-25mg OD

39
Q

What is the initial dose of eplerenone?

A

25mg OD

40
Q

When do serum and potassium levels need to be re checked when first given a aldosterone antagonist?

A

After 4-6 days

41
Q

What are vasodilators place in therapy?

A
  • Hydralazine combined with isosorbide dinitrate improve survival
  • Only indicated if patient remains symptomatic or if all other options have been considered
42
Q

What are heart failure exacerbating drugs?

A
  • NSAIDS/ COX inhibitors
  • Rate limiting calcium channel blockers
  • Chemotherapy
  • Anti psychotic drugs
  • Glitazones
  • Corticosteroids
  • Medicines with a high sodium content

3.23 (26 decks)

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