WEEK 9 Flashcards
The algorithm for medicinal treatment of heart failure groups patients into what two categories?
Euvolemic and congested
A patient with heart failure who is expressing symptoms of congestion will be started on what classes of medication?
A diuretic would be used and at the same time an ARNI/ ACE inhibitor and an SGL2 inhibitor started.
A patient with heart failure who is euvolaemic will be started on what classes of medication?
An ARNI/ ACE inhibitor and beta-blocker would be started.
T or F
Raised JVP is a sign of congested heart failure
T
You tend to see … diuretics used in heart failure for initial therapy. … diuretics are reserved where fluid retention is sustained despite optimum therapy.
loop
Thiazide
T or F
When you start a loop diuretic you want to give a higher dose and decrease slowly over time as the oedema lessens.
F
Start with a low dose and increase the dose if it’s needed for your patient.
List some signs that a patient with heart failure should have their loop diuretic dose decreased.
hypotension, experiences orthostatic hypotension or their kidney function starts to decline
When a patient with congested heart failure is not tolerating the doses of their medications, which class of medication do you decrease first?
1) ACE inhibitor
2) Loop diuretic
3) ARNI
4) Beta blocker
2
20 mg of intravenous furosemide is equivalent to … mg orally
40
If a patient requires twice daily dosing of furosemide the second dose is usually taken no later than …pm
2pm
T or F
Furosemide has a quick onset of action
T
How is the effectiveness of furosemide monitored?
Monitor the patient’s weight and if their weight changes by 0.5 to 1Kg per day that is approximately a diuresis effect of 500mL to 1000mL/ day.
Side effects of furosemide include:
- dehydration
- hypotension
- orthostatic hypotension
- electrolyte disturbances
Common changes in electrolytes due to furosemide are:
- hyponatraemia ( ↓ sodium)
- hypokalaemia ( ↓ potassium)
- hypomagnesaemia ( ↓ magnesium)
What drug class is first-line treatment for heart failure?
Angiotensin receptor neprilysin inhibitors
ACE-inhibitors are started at a low dose for heart failure with the dose then increased every … to … weeks depending upon the patients’ blood pressure and kidney function.
2 to 4
T or F
For a patient with heart failure who is taking an ACE-inhibitor the plan is to try and get the patient on the highest dose they can tolerate.
T
T or F
Bradycardia and ankle oedema are side effects of ACE inhibitors
F
T or F
A cough due to an ACE-inhibitor will only develop soon after starting the medication
F
The side effect may first appear months after starting
T or F
Ceasing ACE inhibitors will not always reverse the coughing side effect
F
the cough will resolve on stopping the ACE-inhibitor.
T or F
A patient who experiences angioedema due to an ACE-inhibitor should not receive an ACE-inhibitor again for their heart failure
T
If a patient develops an angioedema from an ACE-inhibitor which other medication class should be avoided when treating this patients heart failure?
ARNI
If an ACE-inhibitor and ARNIs are not appropriate for a patient what other medication class could be used to treat heart failure?
angiotensin receptor blocker
T or F
ACE inhibitors can be used safely with NSAIDs
F
They can lower renal function
Why does an ACE-inhibitor need to be stopped 36 hours before commencing an ARNI?
because the combination of an ACE-inhibitor and ANRI increases the risk of angioedema.
What are some common side effects of sacubitril and valsartan?
- Dizziness
- Hypotension,
- Cough
- Diarrhoea
- Impaired kidney function
- Hyperkalaemia
T or F
It is difficult to optimise the dose of ANRIs when a patient is also taking a CCB
T
T or F
There is no evidence that felodipine improves outcome in heart failure
T
T or F
In patients without diabetes, dapagliflozin and empagliflozin have been shown to have benefits when added into other therapy in patients with heart failure.
F
Patients with or without diabetes
What 3 medication classes with patients typically be put on if they have heart failure WITH congestion?
SGLT2 inhibitor
Anti diuretic
ARNI
What 3 medication classes with patients typically be put on if they have heart failure WITHOUT congestion?
SGLT2 inhibitor
ARNI
Beta-blocker
Name the two Mineralocorticoid Receptor Antagonists available in Australia
spironolactone and eplerenone
T or F
It is not safe to add mineralocorticoid receptor antagonists to heart failure therapy
F
MRAs have been shown to reduce hospitalisations and mortality when added into other heart failure therapy
Name three common side effects of spironolactone
- Hyperkalaemia
- Hyponatraemia
- Mastalgia (breast tenderness)
Name three common side effects of eplerenone
- Hyperkalaemia
- Hypotension
- Dizziness
T or F
Eplerenone can cause mastalgia
F
Spironolactone can
T or F
MRAs cause hyperkalaemia
T
From the first dose of an MRA, how often should a patients renal function and serum potassium be tested?
1 week after treatment, then monthly for the first 3 months, then every 3 months for 1 year, then every 4–6 months or when clinically indicated.
Which beta blockers have been PROVEN to be beneficial in heart failure
bisoprolol, metoprolol controlled release, carvedilol and nebivolol.
T or F
Beta-blockers are only used in patients with congested heart failure
F
They are only used in patients with euvolemic heart failure
T or F
In heart failure, beta-blockers are used to the maximum tolerated or recommended dose
T
List some common side affects of beta-blockers
Bradycardia
Hypotension*
Orthostatic hypotension*
Fatigue
Dizziness*
*Transient worsening heart failure
List some infrequent or rare side effects of beta-blockers
- Hallucinations
- Insomnia
- Nightmares (related to lipid solubility)
- Depression
The infrequent-rare side effect of nightmares is more prevalent in which beta-blockers?
Carvedilol and nebivolol
Which beta-blocker only has evidence for treating heart failure in patients over the age of 75?
Nebivolol
What does it mean is a drug is a “negative inotrope”
The drug weakens the heart’s contractions and slow the heart rate.
T or F
Antiarrhythmic medications are not used in heart failure due to their negative ionotropic effects
F
While most antiarrhythmics aren’t used in heart failure amiodarone and digoxin can be used as they do not have negative ionotropic effects
What are some complementary medicines that cannot be used in heart failure due to their negative ionotropic effects?
Licorice and devils claw as they cause sodium and water retention. As well as stimulants such as ginseng root and guarana.
What symptoms of worsening heart failure should patients with heart failure be told to watch out for?
- Sudden weight gain
- Ankle swelling
- Difficulty breathing whilst sleeping
What lifestyle changes should patients with heart failure immplement?
- Reducing fluid intake (limit to 2L/ day or 1.L/day when signs of fluid retention)
- Weigh themselves (↑>2.0kg in 48 hours or weight decrease then contact their healthcare professional)
- Reducing sodium intake (consume <2g/day)
- Healthy diet
- Exercise
- Stopping smoking
- Reducing alcohol intake (max 1-2 standard drinks per day)
