Chapter 2 - Heart Failure Flashcards Preview

Pharmacy Pre-Reg 2020/2021 > Chapter 2 - Heart Failure > Flashcards

Flashcards in Chapter 2 - Heart Failure Deck (33)
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1

What is heart failure?

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

2

What are the symptoms and signs of heart failure?

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

Signs:
Raised jugular venous pressure
Pulmonary oedema
Pulmonary crackles

3

What are the two types of heart failure?

HFrEF - the left ventricle loses its ability to contract

HFpEF - the left ventricle loses its ability to relax

4

What is the NYHA classification tool for heart failure?

New York Heart Association

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

5

What is the lifestyle advice for patients with heart failure?

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)

6

Are CCBs used in heart failure?

No, they because they can reduce cardiac contractility

7

When can CCBs be used in heart failure?

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

8

When are diuretics used in heart failure?

For breathlessness and odema

9

Which diuretics are used in heart failure?

Loop e.g. furosemide
Thiazides can be used if eGFR >30ml/min

10

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

Dehydration
Renal impairment
Hypotension

11

Which beta-blockers are licensed in heart failure?

Bisoprolol
Carvedilol
Nebivolol

12

Which ARBs are licensed in heard failure?

Losartan
Candesartan
Valsartan

13

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

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

14

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

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

15

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

When symptoms persist or worsen despite optimal first line treatment

Examples include spironolactone, eplerenone

16

When are aldosterone antagonists cautioned/contraindicated?

Hyperkalaemia
Renal impairment

17

When is digoxin used in heart failure?

When symptoms persist despite optimal treatment

For patients in sinus rhythm

18

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

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

What are the indications of spironolactone and eplerenone?

Spironolactone - HF, odema, resistant hypertension

Eplerenone - only HF

20

What are the main side effects of aldosterone antagonists?

AKI
Hyperkalaemia
Many more

21

What monitoring is associated with aldosterone antagonists?

Renal function and electrolytes

22

When do you use ivabradine in heart failure?

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

In patients in sinus rhythm

HR >75bpm

23

What diuretic is used in acute heart failure?

IV furosemide

24

What diuretics are used in chronic heart failure?
How do you convert between these?

Furosemide
Bumetanide

Furosemide 40mg = bumetanide 1mg

25

What is entresto and where should it be initiated?

A combination of valsartan and sacubitril

It should be initiated in hospital under specialist supervision

26

When should loop diuretics be taken?

In the morning

If BD, take the second dose by 4pm

27

Which drugs can worsen heart failure?

NSAIDs
Beta-blockers
CCBs

28

What CCBs are contraindicated in heart failure?

Verapamil
Diltiazem

29

Is valsartan/sacubitril a black triangle drug?

Yes

30

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

ARB