Pharmaceutical Care of CV patients hospital- 2 heart failure

Question 1

what are the aims of the treatment for heart failure?

Answer 1

1) To reduce mortality
2) To delay disease progression
3) To control symptoms and improve quality of life

Question 2

outline the primary Drugs Used in Heart Failure and discuss the role of each one.

Answer 2

1) Diuretics: Remove fluid from lungs and periphery
2) ACE inhibitors:
- Lower blood pressure and vascular resistance
- Reduce mortality by 35%
3) Beta-blockers:
- Lower cardiac load by reducing heart rate and force of contraction
- Reduce mortality by a third
4) Aldosterone antagonists:
- Reduce mortality in severe heart failure by 35%

Question 3

outline the role of a hospital pharmacist with regards to heart failure

Answer 3

1) Control of symptoms
2) Monitoring for side effects/effect
3) Watch for drug-drug and drug-disease interactions
4) Health promotion
5) Counselling

Question 4

what can weight loss of more than 1kg a day cause in heart failure patients and why?

Answer 4

1) more than 1kg per day can cause exacerbation in heart failure due to acute reduction in blood volume, hypotension and diminished renal perfusion.
2) Also electrolyte disturbance and dehydration can worsen heart failure

Question 5

discuss how the symptoms of heart failure can be controlled

Answer 5

1) Weight loss– no more than 0.5-1kg/day
2) Monitor fluid balance
3) Exercise tolerance
4) Therapy should be started at a low dose to avoid first-dose hypotension
- is less common when using longer-acting options such as ramipril and lisinopri
5) Build up slowly – may take months
- Doses should be titrated slowly over a period of two to three months or longer until the patient’s heart rate is controlled between 50 and 60 beats/min.

Question 6

Diuretics are used to treat heart failure, state what would need to be monitored when using this medication.

Answer 6

1) Fluid balance
2) Weight
3) Electrolytes and renal function
4) Symptom improvement

Question 7

ACE inhibitors are used to treat heart failure, state what would need to be monitored when using this medication.

Answer 7

1) Blood pressure
2) Renal function
3) Potassium

Question 8

Beta blockers are used to treat heart failure, state what would need to be monitored when using this medication.

Answer 8

1) Pulse
2) Blood pressure
3) Lung function if asthmatic

Question 9

Aldosterone antagonists are used to treat heart failure, state what would need to be monitored when using this medication.

Answer 9

1) Potassium
2) Renal function
3) Pulse- can cause arrhythmias

Question 10

discuss the side effects of Loop diuretics and outline what would need to be monitored as a consequence

Answer 10

1) Hypokalaemia
- Monitor after starting therapy and then periodically
2) Fluid loss
- Watch for dehydration

Question 11

discuss the side effects of Aldosterone Antagonists

and outline what would need to be monitored as a consequence

Answer 11

1) Hyperkalaemia
- Reduce dose/stop if > 6 mmol/l
2) Renal function
- Stop if serum creatinine>200 micromoles/l
3) Gynaecomastia
- Can try eplerenone instead
4) Also nausea, vomiting, diarrhoea

Question 12

state the side effects of Digoxin

Answer 12

1) Anorexia
2) Nausea
3) Bradycardia

Question 13

state the side effects of Ivabradine

Answer 13

1) Bradycardia
2) Visual effects
3) Dizziness

Question 14

state the side effects of Nitrates

Answer 14

1) Headache
2) Tolerance
3) Postural hypo-tension
4) Tachycardia

Question 15

state the side effects of Hydralazine

Answer 15

1) Tachycardia
2) Dizziness
3) Systemic lupus erythema-tosus (SLE)

Question 16

discuss the Drug-drug interactions that might occur for the following drugs used in heart failure.

1) Diuretics
2) ACEi
3) Digoxin

Answer 16

1) Diuretics: NSAIDS, Carbamazepin, Lithium
2) ACEi: NSAIDS, Ciclosporin, Lithium, Diuretics
3) Digoxin: Anti-arrhythmics, Verapamil, Diuretics, Amphotericin

Question 17

discuss the Drug-drug interactions that might occur for the following drugs used in heart failure.

1) Nitrates
2) Aldosterone antagonists
3) Beta blockers

Answer 17

1) Nitrates: Sildenafil, Heparins
2) Aldosterone antagonists: Digoxin
3) Beta blockers: Amiodarone, Diltiazem, Verapamil

Question 18

what counselling advice would you provide for the following drugs used in heart failure.

1) Diuretics
2) ACEi and beta blockers

Answer 18

1) Diuretics:
- Adjust time of dose to suit lifestyle
- Flexible dosing – where indicated

2) ACEi and beta blockers:
- Avoid standing rapidly

Question 19

what counselling advice would you provide for the following drugs used in heart failure.

1) Digoxin
2) Nitrates

Answer 19

1) Digoxin
- Report nausea, anorexia
- May need blood tests

2) Nitrates
- Timing of dose
- Avoid standing rapidly

Question 20

Healthcare professionals should adapt their consultation style to the needs of individual patients so that all patients have the opportunity to be involved in decisions about their medicines at the level they wish. discuss how do you demonstrate good Patient-centred Care

Answer 20

1) Involve patients in decisions.
2) Discuss benefits.
3) Explain aims
4) Discuss the pros and cons
5) What does the patient hope the treatment will achieve?
6) Avoid making assumptions
7) Accept that patients may have different views

Question 21

Medicines optimisation: is the safe and effective use of medicines to enable the best possible outcomes. discuss how to effectively conduct a medicines optimisation

Answer 21

1) Ensure patients are on best regime - evidence based
2) Monitor effects and side effects
3) Help patients manage their medicines
- Adapt to daily routine
- Compliance aids
- Flexible dosing
4) Perform accurate drug histories
5) Communicate changes