pharmacology (mainly chronic heart failure)

Question 1

main thing to block with drugs during heart failure

Answer 1

vasodilator therapy via neurohumoral blockade (RAAS - SNS) and not from LV stimulants

Question 2

what is meant by positive and negative chronotrophy and inotrophy

Answer 2

chronotrophy - heart rate regulation
- positive chronotrphy - increasing heart rate
- negative chronotrophy - decreasing heart rate

introphy - force of cardiac muscle contraction
- positive - increases force of contraction
- negative - decreases the force of contraction

Question 3

heart failure 2 targets to treatment

Answer 3

• symptomatic treatment of congestion (loop diuretic)
• disease influencing therapy (inhibition of SNS + RAAS)

Question 4

drugs administered during heart disease for disease influencing therapy.

Answer 4

• first line - ACE + BB - LOW DOSE AND SLOW UPTITRATION
• aldosterone antagonist
• consider aldosterone receptor antagonist and neprilysin inhibitor
• consider SGLT-2 inhibitor

if ACE intoletant - ARB
if ACE and ARB intolerant - hydralazine / nitrate combination

• consider digoxin or ivabradine

Question 5

Nitrates actions

Answer 5

Arterial and venous dilators
Reduction of preload and afterload
Lower BP

Question 6

Nitrates uses and drug examples

Answer 6

Ischaemic heart disease (angina)
Heart failure

ISOSORBIDE MONONITRATE
GTN spray
GTN infusion

Question 7

Chronic stable angina

Answer 7

antiplatelet therapy - aspirin or clopidogrel if cant have aspirin

lipid-lowering therapy - statins

short acting nitrate - GTN spray

first line - BB / CCB
combine if not working
then add long acting nitrate

Question 8

Acute coronary syndromes (NSTEMI and STEMI) drugs

Answer 8

pain relief:
- GTN spray
- opiates - dimorphine

dual antiplatelet therapy:
- aspirin + plus ticagrelor or prasugrel or clopidogrel

antithrombin therapy:
- fondaparinux

consider Glycoprotein IIb IIIa inhibitor (high risk cases):
- tirofiban, eptifibatide, abciximab

Background angina therapy:
- BB
- long acting nitrate
- CCB

lowering lipid:
- statins

Therapy for LVSD/heart failure as required:
- ACE, BB, aldosterone antagonist

most will then have angiography and revascularisation

Question 9

Antiarrhythmic drugs

Answer 9

Class I: Sodium channel blockers
Ia - disopyramide, quinidine, procainamide
Ib - lidocaine, mexilitene
Ic - flecainide, propafenone

Class II: Beta adrenceptor antagonists
- propranolol, nadolol, carvedilol (non-selective)
- bisoprolol, metoprolol (β1-selective)

Class III: Prolong the action potential
- amiodarone, sotalol

Class IV: Calcium channel blockers
- verapamil, diltiazem

Question 10

example of Antiarrhythmic drugs

Answer 10

Digoxin

Question 11

Digoxin class and how it works

Answer 11

Cardiac glycoside

Inhibit Na/K pump

Question 12

Digoxin effects on heart

Answer 12

Bradycardia (increased vagal tone)
Slowing of atrioventricular conduction (increased vagal tone)
Increased ectopic activity
Increased force of contraction (by increased intracellular Ca)

Question 12

digoxin side effects

Answer 12

Narrow therapeutic range
Nausea, vomiting, diarrhoea, confusion

Question 13

when is digoxin used

Answer 13

Used in atrial fibrillation (AF) to reduce ventricular rate response
Use in severe heart failure as positively inotropic

Question 14

Amiodarone adverse effects

Answer 14

QT prolongation
Polymorphic ventricular tachycardia

Interstitial pneumonitis
Abnormal liver function
Hyperthyroidism / Hypothyroidism
Sun sensitivity
Slate grey skin discolouration
Corneal microdeposits
Optic neuropathy

Multiple drug interactions
Very large volume of distribution