What are the four pillors of medications for HErEF ?
- ACE-I or ARNI or ARB
- Bata blocker
- MRA
- SGLT 2 inhibators
What are the side effects of spironolactone ?
- Hyperkalaemia
- Metabolic acidosis
- Gynecomastia
Triamtrene is….
Triametrene is a potassium sparing diuretics.
It does not work on aldosterone receptor.
It blocks the Na channel on the collecting tubule, from being stumulated, thus decrease Na reabsorption and decrease K excretion.
The side effects include hyperkaelemia, metabolic acidosis, kidney stone.
It used together with indomethacin, would lead to acute kidney failure.
Explain the MOA of furosemide:
Furosemide is a loop diuretic.
It inhibits the luminal Na/K/2Cl Transporters in the thick ascending limb on Loop of Henle, which increasing the Na and Water into the urine, leading to diuretic effects.
Meanwhile, it causes an increased excretion of K, Mg and Ca, leading to hypokalaemia, hypomagnessium and hypocalcemia.
What can furosemide be used for ?
- Acute pulmonary oedema or other oedema
- Acute hyperkaelemia
- Acute renal failure
- Anion overdose
List the side effects of furosemide ?
- Hypotension
- Hypokaelemia
- Ototoxicity
- Hyperuricemia
- Hypomagnesiam
What would happen when use furosemide and amigoglycoside antibiotic?
Ototoxicity
How does Hydrochlorothiazide work?
Hydrochlorothiazide is thiazide diuretic.
It inhibits NaCl reabsoprtion by blocking the Na/Cl transporter, increasing the Na, and water in urine, leading to diurectic effect
It also enhances Ca reabsorption in the distal convoluted tubule.
What are hydrochlorothiazide used for ?
- Hypertension
- CCF
- nephrolithiasis due to idiopathic hypercalciuria
- Nephrogenic diabetes insipidus
List the side effects of thiazide :
- Hypokaelemia
- Metabolic alkalosis
- Hyperuricemia
- Hyperglycemia
- Hyperlipidimia
- Hyponatremia
Two examples of cardiac glycosides :
Digoxin
Digitoxin
How does digitalis work ?
Digitalis inhibits Na-K exchange, increases Na , resulting in less Ca efflux by reducing CICR, decrease the membrane potential, reducing SA node and AV node conduction and myocardium contractility
What is digitalis used for ?
- End-stage heart failure ( to increase the cardiac contractility)
- Fast AF ( by increasing parasympathetic activity, decreasing thr AV conduction, increasd PR interval and decrease ventricular rate)
How to manage degoxin toxicity ?
- Discontinue treatment
- Correction of hyperkaelemia using loop diuretic
- Anti-arrhythmia drugs when increased automacity is predominant: lidocaine or propranolol
- Digoxin antibody: to bind digoxin and clear the digoxin. E.g. FAB fragments or digibind
