Pharmacology of heart failure and hypertension

Question 1

How does pulmonary oedema occur in heart failure?

Answer 1

Left ventricular dysfunction - fluid backs up into pulmonary capillaries - hydrostatic pressure increases - fluid enters lungs

Question 2

Acute treatment for pulmonary oedema:

Answer 2

Diamorphine
O2
Diuretic
Nitrates
Ventilatory support
Inotrophic support

Question 3

What diuretic is used in pulmonary oedema?

Answer 3

IV furosamide

Question 4

What is diamorphine used to do in PO?

Answer 4

Relief of anxiety

vasodilation

Question 5

Nitrates act to

Answer 5

Vasodilate

Question 6

Types of ventilatory support:

Answer 6

CPAP

IPPV

Question 7

CPAP

Answer 7

Continuous postive airway pressure

Question 8

IPPV

Answer 8

Invasive positive pressure ventilation

Question 9

What can be used as ionotrophic support?

Answer 9

Dobutamine

Question 10

Dobutamine =

Answer 10

Synthetic catecholamine

Question 11

Following recover from PO, patient has what?

Answer 11

Chronic heart failure

Question 12

What should a patient be started on after acute PO?

Answer 12

Diuretic
Beta blocker
ACEi

Question 13

What is the aim of treatment for anasarca?

Answer 13

Need to induce diuresis

Question 14

Ways to induce diuresis:

Answer 14

Best rest 
Fluid restriction
Diuretic
Inotrophic support
Mechanical help: dialysis

Question 15

What should you give to a patient on bed rest?

Answer 15

LMWH

Question 16

Diuretics of choice in HF:

Answer 16

Loop

Loop + thiazide

Question 17

Problems caused by loop diuretics:

Answer 17

Hypokalaemia
Hyponatreaemia
Hypercaemia

Question 18

MoA amiloride:

Answer 18

Blocks K+/Na+ exchanger

Question 19

MoA spironolactone

Answer 19

Aldosterone antagonist

Question 20

1st line treatment for HF:

Answer 20

Diuretics
ACEi (or ARB)
Betablocker
MRAs

Question 21

ARB =

Answer 21

Angiotensin II receptor blocker

Question 22

MRAs =

Answer 22

Mineralcorticoid receptor antagonist

Question 23

Suffix of ARB

Answer 23

-sartan

Question 24

What is ACE escape?

Answer 24

Angiotensin II can be made by other enzymes

Question 25

What does ARBs get around?

Answer 25

ACE escape

Question 26

Why are ACEis better than ARBs

Answer 26

ACE breaks down kinins (vasodilators). Kinins increase

Question 27

What do ACEi and ARB cause?

Answer 27

Fall in BP Rise in K+ Rise in creatinine Fall in Hb

Question 28

Why does ACEi cause a rise in creatinine?

Answer 28

Renal artery stenosis

Question 29

Side effects of ACEi

Answer 29

Cough Rash Angio-oedema

Question 30

Why may we need MRAs?

Answer 30

Aldosterone not totally suppressed by ACEi

Question 31

Name 2 MRAs

Answer 31

Spironolactone | Epleronone

Question 32

Side effects of spironolactone:

Answer 32

Hyperkalaemia | Gynaecomastia

Question 33

Name a SARA

Answer 33

Eplerenone

Question 34

SARA =

Answer 34

Selective aldosterone receptor antagonist

Question 35

a1 receptors cause

Answer 35

Vasoconstriction

Question 36

What acts on a1 receptors

Answer 36

Noradrenaline

Question 37

b1 is found on

Answer 37

Cardiac muscle | Kidneys

Question 38

b2 is found on

Answer 38

Peripheral vessels Ciliary body Bronchodilation Decrease GI contractility

Question 39

Is sympathetic activation good or bad in HF?

Answer 39

Bad

Question 40

Effect of blocking b1 =

Answer 40

Decrease in HR Decrease contractility Decrease renin release

Question 41

Effect of blocking b2 =

Answer 41

``` Vasoconstriction of vessels Bronchoconstriction Speeds up GI motility Reduce IOP Less glucose released, more glucagon ```

Question 42

How to betablockers help in HF?

Answer 42

``` Improve myocardial function Protect myocytes Slow HR Anti-ischaemia Anti-arrythmic Ejection fraction improves ```

Question 43

Examples of non-selective beta blockers

Answer 43

Propanolol Timolol Nadolol

Question 44

Examples of selective beta blockers

Answer 44

Atenolol | Metoprolol

Question 45

What conditions are selective beta blockers prefered for?

Answer 45

COPD Asthma Diabetes

Question 46

Ivabradine =

Answer 46

Inhibits pacemaker current, slows HR

Question 47

Aliskiren =

Answer 47

Direct renin inhibitors

Question 48

What enzymes system blocks ANPs?

Answer 48

NEP

Question 49

Sacubritil =

Answer 49

NEP inhibitor

Question 50

Valsartan =

Answer 50

ARBs

Question 51

Digoxin is indicated in

Answer 51

Atrial fibrilation Atrial flutter HF

Question 52

MoA of digoxin

Answer 52

Blocks Na+/K+ on cardiac myocytes | Ca2+ moves in

Question 53

4 drugs to avoid in HF

Answer 53

- Calcium antagonists - Positive inotrophs - Aspirin - Statins

Question 54

ABCD of hypertension:

Answer 54

ACEi Beta blockers Ca2+ blockers Diuretics

Question 55

MoA of calcium antagonists:

Answer 55

Reduce BP | Negative inotrophy

Question 56

Name 2 dihydropyridines =

Answer 56

Amlodipine | Nifedipine

Question 57

Name 2 non-dihydropyridines =

Answer 57

Verapamil | Diltiazem

Question 58

Doxazosin =

Answer 58

Alpha blocker