Pharmacology

Question 1

Medications that can be used for HFrEF

Answer 1

• Loop Diuretics (eg Furosemide)
• Beta Blockers (-lol)
• ACE-i (-pril)
• Angiotensin receptor blocker (eg Candesartan)
• Mineralcorticoid antagonist (eg spironolactone)
• Cardiac Glycoside (eg digoxin)
• Selective sinus node inhibitor (ivabradine)
• Angiotensin receptor/ neprolysin inhibiator
• sodium glucose transport inhibitor

Question 2

ACE Inhibitors (ACE-I)

Answer 2

Mechanism of Action
* Inhibits action of Angiotensin converting enzyme (ACE) preventing angiotensin I —> II, thus stopping it’s effect and the release of Aldosterone

Naming

• ends in -pril

side effects

• cough (as also inhibits breakdown of bradykinin)

Question 3

Neprolysin inhibitors (ARNI when combined with angiotensin II blocker)

Answer 3

mechanism
* inhibits of neprolysin (usually breaks down) resulting in increase BNP
* —> lower BP, lower sympathetic tone, lower fibrosis, lower hypertrophy, diuresis and ntriuersis

Side effects
* inhibits breakdown of bradykinin resulting in angioedema, leading to cough
* also leads to increased angiotensin II concentrations (hence the Angiotensin II blocker)

Question 4

Beta Blockers

Answer 4

Mechanisms of Action
* competitive antagonist of beta receptors in Heart (B1) and Lungs, skeletal muscle Metabolic, Kidney (B2)
* selective B1 blockers lead to reduced cardiac output, HR, and BP by blocking the innervation of B1 receptors that usually have a + chronotpic and iontropic effect
naming
-end in -olol