Treatment of cardiac failure Flashcards
Treatment plan
- Furosemide +/- Thiazide
- ACEI
- ARB/ ARNI
- Aldesterone receptor inhibitor
- beta blocker +/- Ivabridine
- Digoxin -positive inotrope
- Warfarin
Loop Diuretics: how do they work
- Reduce Nacl/H20 retention by blocking the Na-K- Cl system in the loop of Henle
- They work at a Low Glomerular filtration rate
- Used with thiazide in resistant patients
ADRs in Loop Diuretics
- dehydration
- hypotension
- Gout
- Hyperkalemia
- Diabetes
Drug-drug interactions
NSAIDs: liver toxicity Vancomycin: liver toxicity Aminoglucosides: renal toxicity +Aural toxicity Antihypertensives: Hypotension Lithium: renal toxicity
ACEI inhibitors: main one
RAMIPRIL
ARB
target AT1 receptors on angiotensin specifically
Aldesterone receptor inhibitors: main one
Spironolactone
ARNI
Prevents breakdown of ANPs/BNPs
Used with ARBs and Neprysil
Beta blocker guidelines?
-never use until patient has stabilised
Ivabridine
- used to decrease wave of depolarisation through SA node
- decreases heart rate
- does not decrease myocardial contractility
Nitrovasodilators
-reduce preload and after load so decrease myocardial contractility of the heart
Positive Inotrope: main one
Digoxin
Positive Inotropes- how do they work?
increase the calcium content of the heart so more myocardial contractility
main loop diuretic
Furosemide
Which drugs inhibit the RAAS
- loop diuretics
- ACEI
- ARBs
- aldesterone receptor inhibitor
- ARNIs
which drugs interrupt sympathetic activity?
- Beta blockers
- Ivabridine
which drugs improve cardiac function
- positive inotropes
- antiplatelets
what does AT1/AT2 receptors on angiotensin control?
AT1:-vasoconstriction -vascular,myocyte proliferation -increases sympathetic tone AT2: -vasodilation -apoptosis -antiproliferation
