Reduced ejection Fraction HF 1 Flashcards
Uses of Captopril in HFrEF
ACE inhibitor:
all stages of heart failure both symptomatic & Asymptomatic
Enumerate types of Drugs used in HFrEF
- ACEIs (Captopril, Enalapril)
- ARBs/AT2 receptor blockers (Losartan,valsartan)
- Aldosterone receptor blocker/ Potassium sparring Diuretics (spironolactone,eplerenone)
- Beta blockers (Metoprolol,Bisoprolol)
- Diuretics
- Neprilysin Inhibitors (Sacubitiril)
- Ivabradin (HACNGCB)
- SGLT2 Inhibitors (Gliflozins)
- Cardiac Glycosides (digitalis)
Dosage of Captopril in HFrEF
Low doses or titrated
ACEI
Benefit of Valsartan over captopril
Valsartan doesn’t produce irritant cough, as it doesn’t affect level of bradykinin
Valsartan= ARBs
Captopril= ACEI
Uses of Spironolactone in HF
used in most severe cases of Heart failure, or HF with recent MI
Potassium sparring diuretic/ Aldosterone receptor blocker
Explain why Metoprolol/Bisoprolol are given to HF patients
Inhibit sympathetic activity, which stimulates Renin, Angiotensin & Aldosterone secretion:
* Cardio-toxic effect
* Cardiac remodelling effect
Beta Blocker
Mechanism of Action of Sacubitril
Neprilysin inhibitor:
* reduced degradation of Atrial & Brain Naturetic peptides by Neprilysin
Sacubitiril should always be given in combination with ____, because ____
- Valsartan (ARBs)
- Sacubitiril (neprilysin inhibitor) leads to accumulation of Angiotensin II
Sacubitril should not be given with ________ due to ___
- Captopril (ACEI)
- excess accumulation of Bradykinin —> Angioedema & Irritant cough
Adverse effects of Sacubitril
- Angioedema
- Irritant cough
- Hypotension
- renal failure
- Hyperkalemia
Neprilysin inhibitor
Example & uses of Hyperpolarization activated cyclic neculotide gated channel blockers
- Ivabradine
- HErEF with sinus rhythm
Mechanism of action of Gliflozins in HFrEF
SGLT2 inhibitors:
* reduce glucose reabsorption in proximal tubule
* Increased Chloride concentration –> resetting Tubulo-glomerular feedback
* Reduction in plasma volume without activation of sympathetic NS
