18. Clinical Treatment of Heart Failure

Question 1

How do diuretics treat HF?

Answer 1

reverse the Na and fluid retention

Question 2

What diuretics are preferred and why?

Answer 2

loop diuretics bc of high potency

Question 3

What do ACE inhibitors end in?

Answer 3

• pril

Question 4

How do ACE inhibitors work?

Answer 4

Block conversion of ATI to ATII

Question 5

What are the effects of ACE inhibitors?

Answer 5

 Direct vasodilation
 Decreased aldosterone activation
 Other effects

Question 6

What are the SE of ACE inhibitors?

Answer 6

Hypotension
 Worsening renal function (afferent vasocontraction)
 Hyperkalemia
 Cough (kinin potentiation)
 Angioedema

Question 7

Angiotensin receptor blockers (ARBs) end in?

Answer 7

-sartan

Question 8

What is the effect of Angiotensin receptor blockers (ARBs) ?

Answer 8

they block the receptor of angiotensin II

Question 9

What are Angiotensin receptor blockers (ARBs) used for?

Answer 9

to replace ACE inhibitors (ie when cough develops)

Question 10

What are the SE of Angiotensin receptor blockers (ARBs) ?

Answer 10

no kinin potentiation (no cough), otherwise same as ACE inhibitors:
Hypotension
Worsening renal function (afferent vasocontraction)Hyperkalemia
Angioedema

Question 11

Name 2 aldosterone receptor blockers.

Answer 11

1. Spironolactone

2. eplerenone

Question 12

What are the effects of aldosterone receptor blockers?

Answer 12

block effect of aldosterone on the kidney

antifibrotic

Question 13

What are the SE of aldosterone receptor blockers?

Answer 13

hyperkalemia

Question 14

What do the Beta-blockers end in?

Answer 14

-olol

Question 15

What are the effects of Beta-blockers?

Answer 15

Antagonize effect of sypathetic system (epinephrine/norepinephrine)
• β1 blockade:
– Negative chronotrope (slow heart rate, less arrhythmia)
– Negative inotrope (decreased metabolic demand)
• [α1 blockade: vasodilation]

Question 16

What are the SE of the Beta-blockers?

Answer 16

Negative inotrope: short-term loss for long-term gain
• Fluid retention
• Hypotension
• Decreased cardiac output, even cardiogenic shock
Bronchoconstriction

Question 17

Name 2 electrical therapies for HFrEF?

Answer 17

1. implanted cardioverter defibrillators

2. cardiac resynchronization therapy/ biventricular pacemakers (CRT or BiV)