heart failure pharmacology

Question 1

neurohormonal disturbances in heart failure

Answer 1

there is decreased cardiac output because of inability of the heart to contract after it has dilated , this will lead to activation of RAAS and sympathetic system which in turn leads to an increase in salt retention leading to further oedema.

Question 2

drugs that inhibit fluid retention

Answer 2

loop diuretics

Question 3

action of loop diuretics

Answer 3

they induce profound diuresis by inhibiting Na-K-Cl transporter in the loop of henle

Question 4

example of loop diuretics

Answer 4

furesemide
bumetanide
ethacrynic acid

Question 5

diuretic resistant patients can use loop in combination with thiazide diuretics what are the side effects of this?

Answer 5

dehydration
hypotension
hypokalaemia
hyponatraemia
gout
impaired glucose tolerance

Question 6

drug to drug interactions of frusemide

Answer 6

aminoglycosides aural and renal toxicity
lithium renal toxicity
NSAIDs renal toxicity
antihypertensives profound hypotension
vancomycin renal toxicity

Question 7

neurohormonal antagonists

Answer 7

ACE inhibitors
beta receptor blockers
mineralocorticoid receptor blockers
combined angiotensin blockade plus anp /bnp

Question 8

action of ace inhibitors

Answer 8

inhibit the conversion of angiotensin 1 to 2 by blocking the ace enzyme
this will in turn reduce the preload and the afterload

Question 9

examples of ace inhibitors

Answer 9

ramipril
enalapril
lisinopril

Question 10

what are side effects of ace inhibitors

Answer 10

hyperkalaemia
bradycardia
dry cough
not suitable for pregnant women
angioedema
renal failure

Question 11

drug to drug interactions with ace

Answer 11

nsaid which may lead to acute renal failure
potassium supplements -hyperkalaemia
potassium sparing diuretics -hyperkalaemia

Question 12

angiotensin receptor blockers

Answer 12

block the angiotensin from binding with the receptor

Question 13

ace inhibitor reduces ?

Answer 13

morbidity
mortality

Question 14

what do angiotensin receptor blockers reduce ?

Answer 14

morbidity

Question 15

effect of combination of angiotensin and neprilysin inhibition

Answer 15

there is increased decrease in mortality

Question 16

action of mineralocorticoid receptor antagonists

Answer 16

block receptors for steroids and aldosterone

Question 17

examples of mineralocorticoid receptor antagonists

Answer 17

spironolactone
eplerenone

Question 18

beta blockers action

Answer 18

blocks the actions of the sympathetic system
has been demonstrated to reduce morbidity and mortality

Question 19

examples of beta blockers

Answer 19

carvedilol
bisoprolol

Question 20

ivabradine

Answer 20

slows the heart rate through inhibition of the channel in the sinus node which should only be used with patients with a sinus rhythm

Question 21

positive inotropes

Answer 21

digoxin

Question 22

side effects of digoxin

Answer 22

Increases availability of calcium in the myocyte
Shown to reduce number of hospitalisations
No effect on mortality
Narrow therapeutic index
Arrhythmias
Nausea
Confusion

Question 23

therapeutic regime of heart failure drugs

Answer 23

Furosemide ± thiazide Appropriate dose
Furosemide + pulsed metolazone
ACE Inhibitor Appropriate dose
Angiotensin receptor blocker
ARNI
Beta-blocker ± Ivabradine
MRA-spironolactone 25mg
Digoxin TDM
Warfarin TDM

Question 24

what are the pharmacokinetics of using loop diuretics

Answer 24

may cause intense loop diuretic resistance and this will lead to increase in the dosage

Question 25

drug to drug interactions of loop diuretics

Answer 25

should not be used with aminoglycosides for example amikacin, gentamicin, neomycin sulfate , streptomycin, and tobramycin