Lecture 5

Question 1

what are the 3 types of heart failure?

Answer 1

• Heart failure due to left ventricular systolic dysfunction - LVSD
• Heart failure with preserved ejection fraction (diastolic failure – relaxation) – HFPEF
• Acute heart failure / Chronic heart failure

Question 2

what are the 4 classes of diuretics?

Answer 2

Thiazides and related drugs
Loop diuretics
Potassium-sparing diuretics
Aldosterone antagonists

Question 3

what are the features of Thiazides and related drugs?

Answer 3

 Act on distal tubule
 Medium level potency
 Act over a long time

Question 4

what are the features of loop diuretics?

Answer 4

 Act on loop of Henle
 Most potent
 Work over relatively short time – v affective

Question 5

what are the features of potassium sparing diuretics?

Answer 5

 Act on collecting tubules – most distal part
 Very weak
 Retain K

Question 6

what are the features of aldosterone antagonists?

Answer 6

 Weak

 Additional property – blocking enhanced renin-aldosterone system

Question 7

what are the adverse effects of diuretics ?

Answer 7

• Hypovolaemia (mainly loop diuretics) - Reduce blood volume too much
• Hypotension (mainly loop diuretics) - Low blood pressure
• Low serum potassium (hypokalaemia)
• Low serum sodium (hyponatraemia)
o Na loss in urine – followed by water
• Low serum magnesium (hypomagnesaemia)
• Low serum calcium (hypocalcaemia)
• Erectile dysfunction (mainly thiazides)
• Raised uric acid (hyperuricaemia – gout)
• Impaired glucose tolerance (mainly thiazides)

Question 8

what was the effect of vasodilator therapy on mortality?

Answer 8

Significant risk reduction in mortality in the hydralazine and isosorbide dinitrate treatment group 36% - 3 year mortality reduction
Improved LVEF in the same group.