Week 238 - Heart Failure Mx Flashcards Preview

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Flashcards in Week 238 - Heart Failure Mx Deck (36)
1

List the 2 main symptom relieving drugs used in heart failure

> Diuretics
> Digoxin

2

How does Digoxin work?

Increases contractility force (by increasing calcium movement into myocardium)
Slows electrical conduction through the AV node to slow HR

3

Give common indications and one contraindication for digoxin

Rapid atrial rhythms e.g. AF, atrial flutter, Atrial tachycardia
Contraindicated in heart block

4

How do ACEIs work?

Reduce the conversion of angiotensin I to II by blocking ACE produced by the lungs.
Inhibit breakdown of Bradykinin (an inflammatory mediator) we in causes vascular dilatation to increase blood flow
Increases preload and afterload!

5

What is special about Captopril besides being the very first ACEI?

The only ACEI used in paediatrics now

6

Give at least 3 contraindications for ACEIs

- cough
- hypotension
- aortic or mitral stenosis
- bilateral renal artery stenosis
- creatinine >220
- pregnancy. - hereditary/idiopathic angioedema

7

What stimulates renin release from the kidneys?

Reduced blood flow through renal arteries

8

Where in the kidneys is renin released from?

Juxtaglomerular apparatus

9

List 2 indications for ACEIs besides HF

1st line anti-hypertensive >55
Reduced proteinuria

10

Define the term preload

Tension on the myocardium (heart walls) when filled with blood I.e. End diastole

11

Define the term afterload

Tension/stress on the heart walls during contraction

12

What must you monitor 7-10 days after starting ACEIs?

Renal function (U&Es) as if creatinine raises too high (>~300) must stop

13

Which two Angiotensin II Antagonists (ARBs) have most evidence for benefit in HF?

Candesartan
Valsartan

14

What 4 other meds is an ARB usually added to in HF and what does it add therapeutically to the mix?

ACEIs, diuretics, digoxin and beta-blockers
It is cardioprotective

15

What is the most commonly used mineralcorticoid receptor blocker /aldosterone antagonist in HF?

Spironalactone

16

What adverse effect can Spironalactone (and digoxin) have in men and how can it be reduced?

Gynaecomastia and breast pain due to the steroid nucleus (pharmacologically)
Eplerenone has less effect in this respect

17

How do beta blockers act?

By reducing vasoconstriction (they effect beta-adrenoceptors have in peripheral vessels)

18

Which beta blockers have most evidence of benefit?

Bisoprolol
Carvedilol
Metoprolol
Nebivilol

19

In what circumstance is labetalol particularly indicated?

Reducing HTN in pregnancy (acts as both alpha and beta adrenoceptor blocker)

20

List at least 3 contraindications for beta-blockers

Asthma (and severe COPD)
Cardiac conduction defects (e.g. Heart block as with digoxin)
Severe HF
Severe peripheral vascular disease
Raynaud's Disease

21

How does Ivabradine work?

Slows heart rate in sinus rhythm (NOT AF) by inhibiting If "funny" channel in sinus node
By slowing the HR is reduces the oxygen demand on the myocardium (used in angina Tx also)

22

What class of drug is the only one that can be prescribed in diastolic heart failure with any confidence?

Diuretics

23

How does Spironalactone act?

It's a potassium sparing diuretic

24

List the main disease-modifying pharmacological treatments used in the management of (systolic) heart failure

ACEIs
Angiotensin II Receptor Blockers/antagonists (ARBs)
Beta-Blockers
Mineralcorticoid Receptor Antagonists
Ivabradine

25

Name 2 novel anticoagulants used in the prevention of thrombosis in AF instead of warfarin. What is the the major advantage over warfarin?

Rivaroxaban
Dabigatran

Advantage: monitoring of INR is unecessary

26

What are the two most important medications to put someone on newly diagnosed with LVF i.e. Have prognostic benefit?

ACEIs and Beta-Blockers
(Only need to add diuretics / digoxin when relevant Sx present e.g. Swelling and rapid or rapid and irregular atrial rhythms)

27

What two important pieces of advice / information must you discuss with patients newly started on HF medications?

To come back if any adverse side effects appear e.g. Hypotension, cough
Inform them that they will unlikely notice any/much benefit once the medications are started but that they are intended to benefit them long term

28

Which 2 loop diuretics are used in LVHF?

Furosemide and Bumetanide

29

If symptoms persist after introduction of ACEIs or ARBs and beta-blockers (ignoring loop diuretics) what other medications might a specialist add to the prescription?

Spironalactone
Isosorbide mono- or dinitrate and hydralazine
Ivabradine or Digoxin (depending on whether or not in sinus rhythm)

30

Besides reducing oedema how does furosemide act?

As a vasodilator

31

Which type of diuretic are used mainly in HF in the UK?

Loop (furosemide and Bumetanide)

Thiazide diuretics used more in controlling HTN

32

Where do Loop and Thiazides diuretic act respectively?

Loop - loop of Henle
Thiazides distal convoluted tubule

(Both act to reduced sodium resorption)

33

Give 4 side effects of thiazide diuretics?

Electrolyte disturbance (low sodium and potassium Na/K transporter)
Gout (high urate)
Hyperglycaemia
Deranged lipids
(Loop low K too but not as severely)

34

If thiazides (or thiazide related meds) are used in HF which do NICE recommend?

Chlortalidone (non-thiazide) -longer duration of action
Indapamide - less metabolic disturbance

Bendroflumethiazide only if pt already on

35

How do opiates such as diamorphine and morphine help in the management of Acute LVF?

Acute LVF can be very frightening and is an medical emergency
Diamorphine / Morphine can be used to reduce anxiety and alleviate respiratory distress

36

What are the key elements in the management of Acute LVF?

Oxygen - beware, too much O2 can vasoconstrict & complicate
Monitor: Sats, BP, Heart rhythm, urine output
Meds: diamorphine, antiemetics (metoclopramide), furosemide, nitrates (GTN or isosorbide dinitrate) ALL iv