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Flashcards in Drugs used Deck (20)
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1

What drugs improve symptoms in heart failure

- diuretics
- digoxin
- spironolactone

2

What drugs improve survival in heart failure

- beta blockers - carvedilol only
- ACE-I
- Spironolactone

3

What is the only beta blocker that improves survival in heart failure

carvedilol

4

What diuretic do you use in heart failure as 1st line

- Loop diuretic - to relieve symptoms – eg furosemide 40mg/d PO ↑ as needed
- add potassium- sparing diuretic if certain criteria is met

5

What criteria has to be met in order to add a potassium sparing diuretic e.g. spironolactone to treatment of heart failure

- potassium < 3.2mmol/L
- predisposition to arrhythmias
- concurrent digoxin therapy
- pre-exisiting potassium - losing conditions

6

What are the side effects of loop diuretics

- hypokalamiea
- hyponatraemia
- hypocalcaemia
- renal impairment
- dehydration
- ototoxicity

7

What does ACE-I do in heart failure

Improves symptoms and prolongs life in left ventricular systolic dysfunction (LVDSD)

8

when should you avoid ACE-I

avoid in dehydration

9

What are ACEI contraindicated in

- hyperkalaemia
- AKI
- bilateral renal artery stenosis
- aortic valve stenosis

10

What are the side effects of ACE-I

- cough
- hyperkalaemia
- urticaria
- angioedema
- renal failure

11

what do you need to monitor in ACE-I

- monitor U&E when starting or raising dose
- increase in creatinine >20% is alarming

12

what do beta blockers do (Carvedilol)

↓mortality in HF (and post-discharge mortality in decompensated HF)

13

How should you start Carvedilol (beta blocker)

- initiate after diuretic and ACE-I
- slow increase in dose with low start; wait > 2 weeks between each dose increment

14

What are the side effects of carvedilol

- bronchospasm
- cold peripheries
- lethargy
- impotence

15

What are beta blockers contraindicated in

- asthma

16

describe when spironolactone is used

- 25mg/d PO
- decreased mortality by 30% when in conventional therapy
- used in patients still symptomatic despite above treatment and post-MI patients with LVSD

17

what does digoxin do

Improves symptoms even in those in sinus rhythm, should be considered in patients with LVSD with signs/symptoms of HF while receiving standard therapy or in patients with AF

18

What should you monitor in digoxin

Monitor U&E, maintain K+ at 4-5mmol/L as hypokalaemia risks digoxin toxicity and vice versa

19

what side effects do you get in digoxin

arrhythmia, nausea, anorexia, yellow vision, confusion, gynaecomastia

20

How is digoxin contraindicated

Hypertrophic cardiomyopathy