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MD3001 - Cardiology Pharmacology > Pharmacological treatment of cardiac failure > Flashcards

Pharmacological treatment of cardiac failure Flashcards

1
Q

Strategies for treatment in Heart Failure

A
  • Increase cardiac contractility
  • Decrease preload/afterload
    • Relax vascular smooth muscle
    • Reduce blood volume
  • Inhibit RAAS
  • Prevent inappropriate decrease of HR
  • Mobilise oedematous fluids
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2
Q

What occurs in the left ventricular systolic dysfunction?

A

heart failure with reduced ejection fraction

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3
Q

Aims of the treatment for LVSD

A
  • Relieve sumptoms
  • Improved exercise tolerance
  • Redcued incidence of acute exacerbations
  • Reduce morality
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4
Q

What 2 methods aside from drugs are there to treat heart failure?

A
  • Adjust lifestyle factors
  • Device therapy
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5
Q

What is included in device therapy for cardiac failure?

A
  • Pacing
  • Cardiac resynchronisation therapy
  • Implantable cardiac defibrillators
  • Coronary revascularisation
  • heart transplant
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6
Q

What are the main drugs used in Chronic Heart Failure?

A
  • Loop Diruetics
  • ACE inhibitors
  • Angiotensin II receptor blockers
  • Beta-blockers
  • Aldosternone receptor antagonists
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7
Q

What is the major fault of heart failure drugs?

A

prolon life and counteract symptoms but dont correct the underlying fault

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8
Q

What is Step 1 of treatment for CHF?

A

A + B

ACE I or ARB and a Beta-Blocker

Use a diuretic if there is fluid retention present

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9
Q

Common side effects of Loop Diruetic

A
  • Electrolyte distrubances
  • Hypotension
  • Renal impairment
  • Hypovolaemia
  • Nocturia if taken too late in the day
  • Acute gout (common with high doses)
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10
Q

Where do loop diruetics work?

A

Work in the ascending limb of the nephron and inhbit the Na+ - Cl- transporter therefore reducing the amount of fluid retained in the body

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11
Q

What are the actions of angiotensin II

A
  • Vascular growth
    • Hyperplasia
    • Hypertrophy
  • Vasoconstriction
    • Direct
    • via increased NA release from SNS
  • Salt retention
    • aldosterone secretion
    • Tubular Na+ resorption
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12
Q

When are Renin Angiotensins System inhibitors used?

A

In heart failure with reduced ejection fraction in all NYHA classes (I-IV)

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13
Q

What is the effect of renin angiotensin system inhibitors?

A

reduces morbidity/mortality

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14
Q

Examples of ACE inhibitors

A

ramipril, lisinopril

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15
Q

Examples of anhiotensin AT1 receptor antagonists

A

candesartan, valsartan, losartan

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16
Q

What are the effects of using ACE inhibitors or ARBs in heart failure?

A
  • Reduce salt and water retention
  • Reduce vasocontriction
  • Reduce vascular resistance
  • Reduce afterload
  • Increase tissue perfusion
  • Reduce ventricular remodelling and hypertrophy
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17
Q

Who are ACEIs and ARBs less effective in and why?

A

African and Caribbean ethnicity due to lower renin secretion rates

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18
Q

What are the main contraindications of ACEI and ARBs?

A
  • Severe bilateral renal artery stenosis
  • Severe aortic stenosis
  • history of angioedema
  • pregnancy
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19
Q

Side effects of Renin-Angiotensins System inhibitors

A
  • Dizziness
  • Headache
  • risk of hyperkalaemia
  • renal impairment
  • teratigenic (disrupt development)
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20
Q

Side effects unqiue to ACE inhibitors

A
  • Persistent dry cough
  • tiredness
  • angioedema
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21
Q

Side effects unique to ARBs

A

Back/leg pain

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22
Q

Why use beta-blockers in heart failure?

A
  • May slow HR, decreasing CO (bad)
  • Allows ventricle to fill more completely during diastole (good)
    • Some beta-blockers cause vaso-dilation therefore decreasing afterload
    • reduce renin release by the kidney
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23
Q

In what conditions should beta-blockers be used?

A

Reduced ejection fraction but stable NYHA class II-IV

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24
Q

What are the benefits of beta blockers?

A

Reduces mortality

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25
Q

What are the drug interactions assoicated with beta-blockers?

A

risk of bradycardia/AV block with digoxin, amiodarone, veraoamil, diltiazem

26
Q

Common side effects of beta-blockers

A
  • Bradycardia/heart block
  • fatigue
  • SOB
  • Dizziness
  • Cold peripheries
  • Impotence/reduced libido (sex drive)
  • insomnia
27
Q

What is Step 2 treatment of CHF?

A

Aldosterone antagonists; spironolactone/eplerenone)

28
Q

In what instances do you use step 2?

A

NYHA class II-IV

29
Q

What type of doses are used in aldosterone antagonists?

A

low doses

30
Q

When are aldosterone antagonists used?

A

effective in severe HF (when combined with DAB)

31
Q

What is the effect of aldosterone antagonists?

A

Reduces symptoms and mortality

32
Q

What is the new name for aldosterone antagonists?

A

Mineralocorticoid receptor antagonists (MRA)

33
Q

Common side effects of aldosterone receptor antagonists

A
  • Hyperkalaemia
  • Hyponatreamia (low Na)
  • Nausea
  • Hypotension
  • Gynaecomastia
  • Renal impairment
34
Q

What is step 3/4 of treatment of CHF?

A

Sacubitril-Valsartan Combination

Ivabradine

35
Q

What is sacubitril?

A

neprilysin inhibitor

36
Q

What is valsartan?

A

ARB

37
Q

What is ivabradine?

A

for specialist use only. It acts on the sinus node if heart rate >75bpm

38
Q

What drug should be considered if there is persistent water/sodium retention?

A

additional diruetics (thiazides)

39
Q

What drug should be considered if there is atrial fibrillation?

A

Digoxin

40
Q

What drugs should be considered if there is co-exisiting angina?

A

Oral nitrates; amlodipine

41
Q

What is the mechanism of digoxin in atrial fibrillation?

A

Increased vagal efferent activity to the heart decreasing SAN firing (decreasing HR) and decreased condution velocity in the AV node

42
Q

What is the Mechanism of digoxin in heart failure?

A

Inhibits the Na/K pump, affecting Na/Ca exchanger, elevating INT Ca levels in the SR then when calcium is released results in strengthened contractility

43
Q

Side effects of digoxin

A
  • GI upset
  • Dizziness
  • Conduction abnomalities
  • Blurred or yellow vision
44
Q

What does ABBA stand for

A

(Diruetic)

ACE Inhibitor or ARB

Beta Blocker

Aldosterone antagonist

45
Q

What is acute (decompensated) heat failure?

A

Sudden worsening of signs and symptoms of heart failure as a result of severe congestion of multiple organs

46
Q

What are the causes of AHF?

A
  • MI
  • Infection
  • Anaemia
  • Thyroid dusfunction
  • Arrhythmia
  • Uncontrolled hypertension
  • Poor concordance
47
Q

What can occur as a result of ACF?

A

increase dyspnoea and oedema

48
Q

Aims when a patient is suffering from acute heart failure?

A
  • Normalised ventricular filling pressures
  • Restore adequate tissue perfusion
49
Q

First Line treatments of AcuteHF

A
  • Loop diruetics
  • Morphine
  • Nitrates
  • Oxygen
  • Positioning
50
Q

What is the function of IV loop diruetics?

A
  • Cause venodilation and diuresis
  • Reduced preload
51
Q

What is the function of IV opiates in AcuteHF?

A
  • Reduce anxiety
  • Vasodilates, reducing preload
  • Reduces sympathetic drive
  • Not routinely offered
52
Q

What is the function of nitrates in AcuteHF?

A
  • Reduce preload and afterload
  • Vasodilates
53
Q

What is the function of oxygen in AcuteHF?

A

maintain O2 stats

54
Q

What is the suggested positioning in AcuteHF?

A

Keep pateint upright

55
Q

What is the intention of second line treatment of AcuteHF?

A
  • inotropic agents
  • Increase contractility
  • Decrease HR and TPR as baroreceptors detect a change in MABP
56
Q

What are inotropes?

A

beta-agonists (increase myocardial contractility)

57
Q

When are second line treatments for acute heart failure used?

A

Intesive care units only

58
Q

Dobutamine actions

A

used in pateints with cardiogenic shock to maintain blood pressure

59
Q

Dopamine actions

A

Increase renal perfusion at low doses and can increase BP at high doses

60
Q

When is isoprenaline used?

A

in bradycardia/heart block emergencies

61
Q

Noradrenaline actions

A

cause vasocontriction, raise BP and used in severe septic shock

MD3001 - Cardiology Pharmacology (8 decks)

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