Therapeutics - Approach to Treatment

Question 1

key steps

Answer 1

1) Correct identification of the underlying disease process
2) Staging of the severity of disease
3) Applying “evidence based medicine”
4) In the absence of “best-evidence” making an informed and rational decision on the basis of the type of signs being shown and the type of therapy that would be most effective.

Question 2

“wet” patient - define

Answer 2

showing congestive signs

Question 3

“cold” patient - define

Answer 3

poor output signs

Question 4

wet to dry - drugs

Answer 4

diuretics

preload reduction

Question 5

cold to warm - drugs

Answer 5

improve output
inotropes
afterload reduction
anti-arrythmics

Question 6

Heart failure characteristics

Answer 6

Increased preload
Increased afterload
Impaired inotropy
Impaired lusitropy (ability of the heart to relax)
Abnormalities of rate and rhythm

Question 7

classes of diuretic

Answer 7

loop diuretic
thiazides
potassium sparing diuretics

Question 8

Site of action of diuretics - carbonic anhydrase (CA) inhibitors

Answer 8

posterior convoluted tubule

Question 9

Site of action of diuretics - furosemide

Answer 9

loop of henle

Question 10

Site of action of diuretics - thiazides

Answer 10

distal convoluted tubule

Question 11

Site of action of diuretics - potassium sparing

Answer 11

Collecting ducts

Question 12

risks of diuretics

Answer 12

Hypovolaemia
Hypotension
Electrolyte disturbances
Stimulation of RAAS

Question 13

preload reduction

Answer 13

signs of congestion
diuretics
venodilation - decr pressure

Question 14

afterload reduction

Answer 14

patient can become hypotensive
arteriodilators
pateint appears cold

Question 15

improve systolic function - when + what to use

Answer 15

dilated cardiomyopathy + mitral valve disease

inotropic agents improve output signs

Question 16

improve diastolic function - drug types

Answer 16

ca channel blockers - hasten relaxation
beta blockers - decr heart rate
ACEI - decr fibrosis

Question 17

optimise cardiac rate + rhythm

Answer 17

arrhythmias

change SV, HR + CO

Question 18

benefits of afterload reduction

Answer 18

Increased stroke volume
Increased cardiac output
Decreased mitral regurgitation
decr systolic wall tension decrs cardiac work
Decreased myocardial oxygen demand
Improved oxygenation of myocardium

Question 19

risks of afterload reduction

Answer 19

hypotension

Decr blood pressure may compromise perfusion of essential vascular beds

Question 20

afterload reduction - drugs

Answer 20

Balanced vasodilators
ACE inhibitors
Pimobendan
Calcium channel blockers

Question 21

problems with inotropes

Answer 21

Increased myocardial work
May be associated with incr rate of myocardial deterioration
Incr myocardial oxygen demand
Exacerbate ischaemia/hypoxia
May lead to rhythm disturbances
Digoxin exception due to other effects	
Reduced heart rate
Decreased sympathetic tone