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Pre Reg Pharmacy > Chapter 2 - Heart Failure > Flashcards

Chapter 2 - Heart Failure Flashcards

1
Q

What is heart failure?

A

A progressive condition that is caused by structural or functional abnormalities of the heart, resulting in a reduced cardiac output

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2
Q

What are the symptoms and signs of heart failure?

A 
Symptoms:
SOB
Persistent cough
Ankle swelling 
Wheezing
Fatigue
Reduced exercise tolerance

Signs:
Raised jugular venous pressure
Pulmonary oedema
Pulmonary crackles

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3
Q

What are the two types of heart failure?

A

HFrEF - the left ventricle loses its ability to contract

HFpEF - the left ventricle loses its ability to relax

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4
Q

What is the NYHA classification tool for heart failure?

A

New York Heart Association

This classifies heart failure based on a patients symptoms and how much they are limited by exercise

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5
Q

What is the lifestyle advice for patients with heart failure?

A

Smoking cessation
Reduce alcohol constantly
Increase exercise
Weight management (patients should weigh themselves daily and contact GP if they gain more than 1.5-2kg in 2 days as this indicates worsening heart failure
Dietary changes (restrict salt and fluids)

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6
Q

Are CCBs used in heart failure?

A

No, they because they can reduce cardiac contractility

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7
Q

When can CCBs be used in heart failure?

A

Amlodipine can be safely used in patients with heart failure and angina

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8
Q

When are diuretics used in heart failure?

A

For breathlessness and odema

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9
Q

Which diuretics are used in heart failure?

A

Loop e.g. furosemide

Thiazides can be used if eGFR >30ml/min

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10
Q

What are some risks associated with the use of diuretics in heart failure?

A

Dehydration
Renal impairment
Hypotension

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11
Q

Which beta-blockers are licensed in heart failure?

A

Bisoprolol
Carvedilol
Nebivolol

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12
Q

Which ARBs are licensed in heard failure?

A

Losartan
Candesartan
Valsartan

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13
Q

Should you used the combination of an ACE Inhibitor and a potassium sparing diuretic for heart failure?

A

Usually this combination is not recommended - due to an increased risk of hyperkalaemia

But in heart failure, a low dose spironolactone may be beneficial - monitor potassium

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14
Q

Should you used the combination of an ACE Inhibitor and a loop diuretic for heart failure?

A

This may cause first dose hypotension if the dose of loop diuretic is >80mg furosemide or equivalent - monitor the patient

This risk can be reduced by temporarily reducing the diuretic dose, but this may cause severe rebound pulmonary odema

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15
Q

When are aldosterone antagonists used in heart failure and give some examples

A

When symptoms persist or worsen despite optimal first line treatment

Examples include spironolactone, eplerenone

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16
Q

When are aldosterone antagonists cautioned/contraindicated?

A

Hyperkalaemia

Renal impairment

17
Q

When is digoxin used in heart failure?

A

When symptoms persist despite optimal treatment

For patients in sinus rhythm

18
Q

What treatments are available for heart failure and when are they used?

A

First line: ACEi/ARB and beta-blocker

If breathlessness and odema occur: diuretic (loop)

If symptoms persist despite optimal first line treatment: aldosterone antagonist, digoxin (if in sinus rhythm)

19
Q

What are the indications of spironolactone and eplerenone?

A

Spironolactone - HF, odema, resistant hypertension

Eplerenone - only HF

20
Q

What are the main side effects of aldosterone antagonists?

A

AKI
Hyperkalaemia
Many more

21
Q

What monitoring is associated with aldosterone antagonists?

A

Renal function and electrolytes

22
Q

When do you use ivabradine in heart failure?

A

Severe chronic heart failure that after BB, ACEI and aldosterone antagonists have failed

In patients in sinus rhythm

HR >75bpm

23
Q

What diuretic is used in acute heart failure?

A

IV furosemide

24
Q

What diuretics are used in chronic heart failure?

How do you convert between these?

A

Furosemide
Bumetanide

Furosemide 40mg = bumetanide 1mg

25
Q

What is entresto and where should it be initiated?

A

A combination of valsartan and sacubitril

It should be initiated in hospital under specialist supervision

26
Q

When should loop diuretics be taken?

A

In the morning

If BD, take the second dose by 4pm

27
Q

Which drugs can worsen heart failure?

A

NSAIDs
Beta-blockers
CCBs

28
Q

What CCBs are contraindicated in heart failure?

A

Verapamil

Diltiazem

29
Q

Is valsartan/sacubitril a black triangle drug?

A

Yes

30
Q

In Afro and Caribbean patients, is an ACEi or ARB preferred?

A

ARB

31
Q

What is the risk of starting a patient on an ACEI and a diuretic?

A

Potassium sparing diuretic - hyperkalaemia

Thiazide diuretic - rapid fall in BP

32
Q

List 3 drugs that can cause/exacerbate heart failure

A

BB
CCB
NSAID

33
Q

If a patient taking furosemide 40mg has resistant oedema, what can be done?

A

Switch to bumetanide 1mg

Pre Reg Pharmacy (36 decks)

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