Treatment of Heart Failure Flashcards
What happens to CO in a heart failure patient if preload is increased?
Decreases
What 4 physiological parameters of heart failure need to be targeted in treatment and how do they need to be altered?
Increase CONTRACTILITY
Decrease PRELOAD and/or AFTERLOAD –> decrease CARDIAC WORKLOAD
- by relaxing vascular smooth muscle
- by reducing blood volume
Inhibit Renin Angiotensin Aldosterone System (RAAS)
Prevent inappropriate increase in HR
What is the recommended treatment plan (drugs in order) for heart failure?
DAB!
D: Diuretic
A: ACE inhibitor or ARB
B: Beta blocker
List as many signs and symptoms of heart failure as possible.
o Shortness of breath o Swelling of feet and legs o Chronic lack of energy o Difficulty sleeping due to breathing problems o Swollen or tender abdomen with loss of appetite o Cough with frothy sputum o Increased urination at night o Confusion and/or impaired memory
What are some conditions that often predispose to heart failure?
CHD (via atherosclerosis of coronary arteries)
Hypertension
Cardiomyopathy
AF
Anaemia
Overactive thyroid gland (since thyroxin’s MOA is similar to adrenaline’s MOA)
Why are ACE inhibitors, beta blockers, aldosterone antagonists and ARBs appropriate for the treatment of chronic heart failure?
Promote production of angiotensin II and release of ADH
Is heart failure cured by these drugs?
No, these pharmaceutical agents can alleviate symptoms and prolong life, but don’t treat the underlying cause
What is the MOA of diuretics in heart failure treatment?
Mobilise oedematous fluid
What are the 5 main classes of drug used in treatment of heart failure?
Loop diuretics ACE inhibitors ARBs Aldosterone receptor antagonists Beta blockers
What class of drug does candesartan belong to?
ARBs
What does ARB stand for?
Angiotensin II Receptor Blocker
Give two examples of beta blockers used in heart failure treatment.
Carvedilol
Bisoprolol
What is the primary example of an aldosterone receptor antagonist?
Spironolactone
What class of drug does ramipril belong to?
ACE inhibitors
Give two examples of ACE inhibitors.
Ramipril
Lisinopril
What class of drug does furosemide belong to?
Loop diuretics
What is an advantage of candesartan?
Doesn’t increase risk of mortality
Why is carvedilol a special type of beta blocker?
Because it blocks both beta receptors and alpha receptors
Where in the nephron do loop diuretics act?
Thick ascending limb of Loop of Henley
How do loop diuretics increase urine output?
Loop diuretics inhibit the passage of K+, Cl- and Na+ from the collecting tubule back into the renal circulation, meaning water can’t pass back into the capillaries either (water follows solute (ions))
Where in the nephron does spironolactone act?
Collecting duct
How can beta blockers have a negative effect on CO and what is this effect?
Decrease HR, decreasing CO
What positive effects do beta blockers have on the CVS?
Allow increased, more complete ventricular filling during diastole
Some may cause vasodilation –> decreased afterload
What are some common side effects of RAAS inhibitors?
ACE inhibitors: - persistent dry cough - headaches - dizziness - tiredness ARBs: - dizziness - headaches - back/leg pain
What are some common side effects of aldosterone receptor antagonists?
Hyperkalaemia
Hyponatraemia
Nausea
Hypotension
What are some common side effects of loop diuretics?
Acute gout (common with high doses)
