Week 4 - Chronic Heart Failure Treatments Flashcards
What is the aim of treatment?
- improve status and functional capacity of patient,
- QoL,
- prevent hospital admission
- reduce mortality
What are the neuro-hormonal antagonists we use?
ACE inhibitors, ARB’s, ARNI
b blockers
MRA - mineralcorticoid receptor antagonist
What is a loop diuretic example and its role?
furosemide. inhibits ion transporters at loop of henle to reduce salt and water retention. works at low GFR’s
What are issues with loop diuretics?
- patient may become resistant by other transport mechanisms being activated
- oedema in gut may prevent drug absorption
- oedema may continue
How do you overcome loop diuretic resistance? Whats an issue?
furosemide with thiazides.
pee a lot. risk dehydration, hypotension, hyponatraemia, hypokalaemia
What ACE inhibitors are used?
ramipril, enalapril, lisinopril
What is the benefit and negatives of ACE inhibitors in HF patients?
- used first line. reduces mortality
- many ADR’s and drug-drug interractions
What is ARB’s and when is it used?
candesartan. angiotensin II receptor blockers. in ACE resistance or cough as a side effect.
What is an ARNI?
Valsartan-sacubitral
angiotensin II receptor blocker and neprilysin inhibitor combined. prevents breakdown of ANP and BNP.
When would ARNI be used?
- NYHA class II-IV symptoms
- In patients with EF 35% or less.
- those already taking ACE/ARB
What is the action of sacubitral?
inhibits neprilysin. that prevents the breakdown of ANP and BNP.
What 4 benefits do ANP and BNP provide in heart failure?
vasodilation, diuretics, natriuretics, and inhibit RAAS
What is a large benefit and a negative in ARNI?
significantly decrease hospitalisation and mortality rates more than ACE and ARB
in high doses may cause hypotension
What is a MRA?
mineralcorticosteroid receptor antagonist. diuretic.
block receptors that bind aldosterone, therefore causing Na+ loss and sparing K+, in distal tubule.
When is MRA used and what is its benefit?
in patients with symptoms despite other treatment - ACE/ARB/ARNI and B blockers
reduced hospitalisation and mortality significantly
What are 2 MRA’s?
spironolactone and Eplerenone
What beta blockers do we use and on who/not?
- carvedilol and bisoprolol.
- use only on stable patients. can cause deterioration in patients with fluid overload
Whats the positive of beta blockers?
decrease mortality by 30% in mild, moderate and severe HF.
What is the mechanism and use of ivabridine?
- not neurohormonal. blocks Na+ receptor in SA node to slow down HR.
- use in patients with sinus rhythm only
- dont use in patients with HR <70bpm or atrial fibrillarion
- significantly reduce hospitalisation and mortality
What is the use of positive inotropes?
- digoxin we use only. reduces hospitalisation but not mortality.
- toxicity isn’t uncommon. nausea and confusion (in elderly)
How many drugs may a patient expect to be on following chronic heart failure?
many. combination theraoy shows greatest reduction in mortality and hospitalisation
What is the therapeuric regime?
- ACE. if resistant, ARB. if resistant, ARNI.
- B Blockers and ivabradine
- MRA
- MAYBE digoxin and warfarin
How do we monitor the benefit of treatment?
- symptoms,
- clinical relief
- weight for oedema and water retention
Which drug shouldnt be given with ACE inhibitors?
- naproxen - NSAID. Reduces blood pressure lowering effect of ACE
- can cause acute kidney injury
What is a common side effect of ACE ? what do you give instead if they have this?
cough. give ARB instead - Candesartan
