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Flashcards in Treatment of Heart Failure Deck (26)
1

What happens to CO in a heart failure patient if preload is increased?

Decreases

2

What 4 physiological parameters of heart failure need to be targeted in treatment and how do they need to be altered?

Increase CONTRACTILITY
Decrease PRELOAD and/or AFTERLOAD --> decrease CARDIAC WORKLOAD
- by relaxing vascular smooth muscle
- by reducing blood volume
Inhibit Renin Angiotensin Aldosterone System (RAAS)
Prevent inappropriate increase in HR

3

What is the recommended treatment plan (drugs in order) for heart failure?

DAB!
D: Diuretic
A: ACE inhibitor or ARB
B: Beta blocker

4

List as many signs and symptoms of heart failure as possible.

o Shortness of breath
o Swelling of feet and legs
o Chronic lack of energy
o Difficulty sleeping due to breathing problems
o Swollen or tender abdomen with loss of appetite
o Cough with frothy sputum
o Increased urination at night
o Confusion and/or impaired memory

5

What are some conditions that often predispose to heart failure?

CHD (via atherosclerosis of coronary arteries)
Hypertension
Cardiomyopathy
AF
Anaemia
Overactive thyroid gland (since thyroxin's MOA is similar to adrenaline's MOA)

6

Why are ACE inhibitors, beta blockers, aldosterone antagonists and ARBs appropriate for the treatment of chronic heart failure?

Promote production of angiotensin II and release of ADH

7

Is heart failure cured by these drugs?

No, these pharmaceutical agents can alleviate symptoms and prolong life, but don't treat the underlying cause

8

What is the MOA of diuretics in heart failure treatment?

Mobilise oedematous fluid

9

What are the 5 main classes of drug used in treatment of heart failure?

Loop diuretics
ACE inhibitors
ARBs
Aldosterone receptor antagonists
Beta blockers

10

What class of drug does candesartan belong to?

ARBs

11

What does ARB stand for?

Angiotensin II Receptor Blocker

12

Give two examples of beta blockers used in heart failure treatment.

Carvedilol
Bisoprolol

13

What is the primary example of an aldosterone receptor antagonist?

Spironolactone

14

What class of drug does ramipril belong to?

ACE inhibitors

15

Give two examples of ACE inhibitors.

Ramipril
Lisinopril

16

What class of drug does furosemide belong to?

Loop diuretics

17

What is an advantage of candesartan?

Doesn't increase risk of mortality

18

Why is carvedilol a special type of beta blocker?

Because it blocks both beta receptors and alpha receptors

19

Where in the nephron do loop diuretics act?

Thick ascending limb of Loop of Henley

20

How do loop diuretics increase urine output?

Loop diuretics inhibit the passage of K+, Cl- and Na+ from the collecting tubule back into the renal circulation, meaning water can't pass back into the capillaries either (water follows solute (ions))

21

Where in the nephron does spironolactone act?

Collecting duct

22

How can beta blockers have a negative effect on CO and what is this effect?

Decrease HR, decreasing CO

23

What positive effects do beta blockers have on the CVS?

Allow increased, more complete ventricular filling during diastole
Some may cause vasodilation --> decreased afterload

24

What are some common side effects of RAAS inhibitors?

ACE inhibitors:
- persistent dry cough
- headaches
- dizziness
- tiredness
ARBs:
- dizziness
- headaches
- back/leg pain

25

What are some common side effects of aldosterone receptor antagonists?

Hyperkalaemia
Hyponatraemia
Nausea
Hypotension

26

What are some common side effects of loop diuretics?

Acute gout (common with high doses)

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