Pharmacology of Heart Failure Drugs

Question 1

What are examples of loop diuretics?

Answer 1

Furosemide
Bumetanide
Torsemide

Question 2

When are loop diuretics used?

Answer 2

Pulmonary oedema = acute LV failure
Chronic heart failure

Question 3

How are loop diuretics normally administered?

Answer 3

IV

Question 4

What do loop diuretics do?

Answer 4

Reduce electrolyte reabsorption in thick ascending limb of loop of Henle

Question 5

What do loop diuretics target in loop of Henle?

Answer 5

Target Na+K+Cl- co-transporter
Traps Na+K+ = attracts H2O
= passes into urine

Question 6

What is 1st line treatment for HF?

Answer 6

ACEi with beta-blocker

Question 7

What are examples of ACEi?

Answer 7

Ramipril
Catopril
Enalapril
Lisinopril

Question 8

What can be used as an alternative of ACEi?

Answer 8

ARBs
BUT not as effective

Question 9

What are examples of ARBs?

Answer 9

Candesartan
Losartan

Question 10

What are the preferred beta-blockers for HF?

Answer 10

Bisoprolol
Carvedilol
Nebivolol

Question 11

What is the mechanism of action for beta-blockers?

Answer 11

Inhibits beta1 receptors
Blocks effects of adrenaline + noradrenaline
Inhibits release of renin

Question 12

What do beta-blockers do overall?

Answer 12

Slows HR + reduces contractility
= reduces workload of heart
= reduces strain

Question 13

What is Ivabradine used to treat?

Answer 13

Angina
Mild to severe chronic heart failure

Question 14

What is Ivabradine used as an alternative for?

Answer 14

Beta-blockers
BUT can be used alongside

Question 15

What is Sacubitril Valsartan?

Answer 15

ARB combined with a prodrug

Question 16

What does Sacubitril (prodrug part) do?

Answer 16

Inhibits breakdown of naturally occurring diuretic peptides

Question 17

When is Sacubitril Valsartan used?

Answer 17

In patients not currently taking an ACEi or ARB

Question 18

When is Hydralazine with nitrate used?

Answer 18

Patients intolerant to ACEi + ARBs with moderate to sever HF

Question 19

What is Hydralazine?

Answer 19

Arteriolar dilator

Question 20

What does arterial vasodilators do?

Answer 20

Reduce afterload
Increase SV + CO

Question 21

What are nitrates?

Answer 21

Venodilators

Question 22

What does venodilators do?

Answer 22

Reduce preload
Reduce risk of pulmonary congestion

Question 23

What are the side effects of Hydralazine with nitrate?

Answer 23

Headaches
Tachycardia
Irregular heartbeat

Question 24

What is digoxin?

Answer 24

Antiarrhythmic drug
Positive inotrope

Question 25

What does an antiarrhythmic drug do?

Answer 25

Increase vagal tone to heart = vagus nerve decreases HR

Question 26

What does a positive inotrope do?

Answer 26

Increase Ca2+ = increases force of contraction

Question 27

How does Digoxin work as a positive inotrope?

Answer 27

Blocks Na+K+-ATPase = less Na+ pumped out = accumulates into cell =Na+/K+ exchanger switched off = more Na+ inside = more Ca2+ left behind = more available for more forceful contraction

Question 28

What is the main problem/cautions with Digoxin?

Answer 28

Toxicity

Question 29

When is spironolactone used?

Answer 29

When patient does not respond to 1st line treatment = it's added on

Question 30

What is spironolactone?

Answer 30

K- sparing diuretic

Question 31

What does spironolactone do?

Answer 31

Blocks aldosterone-induced production of Na+ transport proteins in DCT = reduces ability to absorb Na+ = causes Na+ + H2O loss