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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
What are the drug interactions assoicated with beta-blockers?
risk of bradycardia/AV block with digoxin, amiodarone, veraoamil, diltiazem
26
Common side effects of beta-blockers
* Bradycardia/heart block * fatigue * SOB * Dizziness * Cold peripheries * Impotence/reduced libido (sex drive) * insomnia
27
What is Step 2 treatment of CHF?
Aldosterone antagonists; spironolactone/eplerenone)
28
In what instances do you use step 2?
NYHA class II-IV
29
What type of doses are used in aldosterone antagonists?
low doses
30
When are aldosterone antagonists used?
effective in severe HF (when combined with DAB)
31
What is the effect of aldosterone antagonists?
Reduces symptoms and mortality
32
What is the new name for aldosterone antagonists?
Mineralocorticoid receptor antagonists (MRA)
33
Common side effects of aldosterone receptor antagonists
* Hyperkalaemia * Hyponatreamia (low Na) * Nausea * Hypotension * Gynaecomastia * Renal impairment
34
What is step 3/4 of treatment of CHF?
Sacubitril-Valsartan Combination Ivabradine
35
What is sacubitril?
neprilysin inhibitor
36
What is valsartan?
ARB
37
What is ivabradine?
for specialist use only. It acts on the sinus node if heart rate \>75bpm
38
What drug should be considered if there is persistent water/sodium retention?
additional diruetics (thiazides)
39
What drug should be considered if there is atrial fibrillation?
Digoxin
40
What drugs should be considered if there is co-exisiting angina?
Oral nitrates; amlodipine
41
What is the mechanism of digoxin in atrial fibrillation?
Increased vagal efferent activity to the heart decreasing SAN firing (decreasing HR) and decreased condution velocity in the AV node
42
What is the Mechanism of digoxin in heart failure?
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
Side effects of digoxin
* GI upset * Dizziness * Conduction abnomalities * Blurred or yellow vision
44
What does ABBA stand for
(Diruetic) **A**CE Inhibitor or **A**RB **B**eta **B**locker **A**ldosterone antagonist
45
What is acute (decompensated) heat failure?
Sudden worsening of signs and symptoms of heart failure as a result of severe congestion of multiple organs
46
What are the causes of AHF?
* MI * Infection * Anaemia * Thyroid dusfunction * Arrhythmia * Uncontrolled hypertension * Poor concordance
47
What can occur as a result of ACF?
increase dyspnoea and oedema
48
Aims when a patient is suffering from acute heart failure?
* Normalised ventricular filling pressures * Restore adequate tissue perfusion
49
First Line treatments of AcuteHF
* **L**oop diruetics * **M**orphine * **N**itrates * **O**xygen * **P**ositioning
50
What is the function of IV loop diruetics?
* Cause venodilation and diuresis * Reduced preload
51
What is the function of IV opiates in AcuteHF?
* Reduce anxiety * Vasodilates, reducing preload * Reduces sympathetic drive * Not routinely offered
52
What is the function of nitrates in AcuteHF?
* Reduce preload and afterload * Vasodilates
53
What is the function of oxygen in AcuteHF?
maintain O2 stats
54
What is the suggested positioning in AcuteHF?
Keep pateint upright
55
What is the intention of second line treatment of AcuteHF?
* inotropic agents * Increase contractility * Decrease HR and TPR as baroreceptors detect a change in MABP
56
What are inotropes?
beta-agonists (increase myocardial contractility)
57
When are second line treatments for acute heart failure used?
Intesive care units only
58
Dobutamine actions
used in pateints with cardiogenic shock to maintain blood pressure
59
Dopamine actions
Increase renal perfusion at low doses and can increase BP at high doses
60
When is isoprenaline used?
in bradycardia/heart block emergencies
61
Noradrenaline actions
cause vasocontriction, raise BP and used in severe septic shock

MD3001 - Cardiology Pharmacology (8 decks)

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