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Pharmacology 3001 > Pharmacological treatment of cardiac failure > Flashcards

Pharmacological treatment of cardiac failure Flashcards

1
Q

Name some non pharmacological treatments for HF?

A
  • Lifestyle factors - as per all CVD conditions remember mental health factors
  • Device therapy
    Pacing
    Cardiac resynchronisation therapy
    Implantable cardiac defibrilators
    Coronary revascularisation
    Heart transplant
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2
Q

What are the main drugs used in CHF?

A
  • Loop diuretics
  • ACE inhibitors
  • ARBs
  • Beta blockers
  • Aldosterone receptor antagonists
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3
Q

Name an aldosterone receptor antagonist

A

Spironalactone

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4
Q

What is the pharmacological treatment of HF?

A

ABBA

  • ACEI or ARB
  • Beta Blocker
  • Aldosterone antagonist
  • Waterloo diuretics can be added sometimes
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5
Q

What is the step 1 treatment of CHF?

A

DABB

  • Diuretic if fluid retention
  • ACE inhibitor or ARB
  • Beta-Blocker
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6
Q

Name two loop diuretics

A

Furosemide, bumetanide

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7
Q

What does the patient have to look for when using loop diuretics?

A
  • Daily weight - if varies in either direction, alter dose
  • Symptom review - breathlessness, peripheral oedema
  • Thirst level, dizziness, “washed out”
  • GP checks blood chemistry within a week of any dose change
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8
Q

What are the common side-effects of loop diuretics?

A
  • Electrolyte distrurbances
  • Hypotension
  • Renal impairment
  • Hypovolaemia
  • Nocturia if taken too late in day (troublesome)
  • Acute gout common with high doses
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9
Q

Name some ARBs

A
  • Candesartan
  • Valsartan
  • Losartan
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10
Q

What are the effect of using the ACEi and ARBs in HF

A
  • Reduce salt and water retention
  • Reduce vasoconstriction
  • Reduce vascular resistance
  • Reduce afterload
  • Improve tissue perfusion
  • Reduces ventricular remodelling and hypertrophy
  • Less effective in African or Caribbean ethnicity (try hydralazine + nitrate)
  • Start low lose dose, monitoring BP and blood chemistry and symptoms and uptitrating to maximum tolerated or target doses
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11
Q

What are the contraindications to ACEi and ARBs?

A
  • Severe bilateral renal artery stenosis
  • Severe aortic stenosis
  • Known history of angioedema
  • Pregnancy/risk of pregnancy
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12
Q

What can some third generation Beta blockers do to reduce afterload?

A

E.g Carvedilol cause vasodilation through blockage of alpha-receptors

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13
Q

How do Beta-blockers work in HF?

A
  • Allow ventricle to fill more completely during diastole

- Reduce renin release by kidney

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14
Q

When would Beta blockers be used in HF?

A
  • Start if reduced ejection fraction but stable NYHA class II-IV
  • Start low, go slow
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15
Q

What drugs should beta-blockers not be used with?

A
  • Risk of bradycardia / AV block with:
  • Digoxin
  • Amiodarone
  • Verapamil
  • Dilitiazem
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16
Q

What are the side-effects of Beta-blockers?

A
  • Bradycardia/HB (contra-indicated)
  • Fatigue
  • Shortness of breath (contra-indicated in Asthma)
  • Dizziness, cold peripheries, imponenc/reduced libido, insomnia (more with older versions)
17
Q

What is another name for Aldosterone antagonists?

A

Mineralocorticoid receptor antagonists

18
Q

When is spironalactone used?

A

Added in when there are still symptoms after ACEI or ARB + BB + diuretic

  • In NYHA class II-IV failure
  • Low doses used (larger doses used in hepatic cirrhosis)
19
Q

What are Aldosterone Receptor Antagonists common side-effects?

A
  • Hyperkalaemia
  • Hyponatraemia
  • Nausea
  • Hypotension
  • Gynaecomastia with spironalactone
  • Renal impairment
20
Q

What is used in step 3 or 4 HF?

A
  • Sacubitril + Valsartan (Valsartan counteracts angiotensin 2 produced by sacubitril)
  • Ivabradine
21
Q

What is Sacubitril?

A

Nephrilysin inhibitor

22
Q

What is a Valsartan?

A

An ARB

23
Q

when would digoxin be used in HF?

A

Atrial fibrilation

24
Q

How does digoxin work to treat HF?

A
  • Increases force of myocardial contraction
  • Inhibits Na/K pump, thus affecting Na/Ca exchanger, elevating intracellular calcium levels in SR then when Ca released results in strenghtened contractility
25
Q

What are the possible digoxin side-effects?

A
  • GI upset
  • Dizziness
  • Conduction abnormalities
  • Blurred or yellow vision
26
Q

What are the first line drugs used to treate Acute HF?

A

LMNOP

  • IV loop diuretics
  • IV opiates
  • IV buccal or sublingual nitrtates
  • Oxygen
  • Positioning - keep upright
27
Q

Second line acute HF drugs

A 
Intensive care units 
- Inotropes - Beta-agonists 
Dobutamine 
Dopamine 
Isoprenaline 
Adrenaline 
- Vasopressors 
NA

Pharmacology 3001 (13 decks)

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