Term
| Rationale for diuretics in heart failure? |
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Definition
| relieve symptoms of fluid retention. |
|
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Term
| what are the symptoms of fluid retention in heart failure? |
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Definition
shortness of breath
oedema (pooling of fluid in lungs and body) |
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Term
| What are the diuretics of choice in heart failure? |
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Definition
| Loop diuretics: frusemide (lasix), bumetanide (burinex), ethacrynic acid (edecrin). |
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Term
| When should loop diuretics be taken in heart failure? |
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Definition
| 1 dose in the morning, if taking 2 doses, take 2nd dose before 6pm (so sleep is not disturbed) |
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Term
| What are the practice points patients taking a loop diuretic may be counselled on ? |
|
Definition
- weight themselves regularly (after urinating but before eating); keep weight diary; contact doctor if they have persistent weight gain
- may feel dizzy on standing; sit/stand up gradually. Sit/lay down if dizzy.
- consider non-drug measures; exercise; reduce salt, fluid, alcohol intake; stop smoking |
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Term
| What is the mode of action of loop diuretics? |
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Definition
| Inhibit reabsorption of Na and Cl in the ascending limb of the loop of Henle. |
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Term
|
Definition
| bumetanide (loop diuretic). |
|
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Term
| What is the brand name for bumetanide? |
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Definition
|
|
Term
| What is the initial dose frusemide? What is the maintenance dose? |
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Definition
| 20mg-40mg d or bd; 20-400mg d |
|
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Term
| What are the side effects of frusemide (6)? |
|
Definition
| hyponatraemia, hypokalaemia, hypomagnesaemia, dehydration, hyperuricemia, gout, dizziness, orthostatic hypotension. |
|
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Term
| When is burinex (bumetanide) indicated? |
|
Definition
Allergy to frusemide (eg rash); cross reactivity cannot be excluded.
When patients are unresponsive to frusemide. |
|
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Term
| What is the dosage of burinex? |
|
Definition
| 0.5-4mg d or bd. (1mg is equivalent to 40mg of frusemide) |
|
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Term
| When is ethacrynic acid considered? |
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Definition
| when patients are both allergic to bumetanide and frusemide. |
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|
Term
| What is a precaution of particular to edecrin? |
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Definition
| use with caution in renal impairment -> increased risk of ototoxicity. |
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Term
| Patient on diuretic and ACEI with decreasing renal function. What action should be taken? |
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Definition
| monitor weight, renal function, electrolytes; titrate diuretic dose. |
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Term
| What is the rationale for ACEI use in HF? (2) |
|
Definition
improvement in symptoms
improvement in survival |
|
|
Term
| How is ACEI therapy started? |
|
Definition
Stop K supplements and K-sparring diuretics.
Omit/Reduce diuretic dose 24h before first dose
Start low dose; Review 1-2 weeks; increase unless there is decreased renal function or hyperkalaemia.
Titrate to maximal tolerable dose (decreasing loop diuretic dose if necessary) |
|
|
Term
| What are the counselling points for ACEI? |
|
Definition
you may feel dizzy when you start taking this medicine, get up gradually from sitting or lying to minimise this effect, sit or lie down if you become dizzy
Do not take K supplements while you are taking this medicine. |
|
|
Term
| When are Angiotensin II receptor blockers used? |
|
Definition
| When patients cannot tolerate ACEIs. |
|
|
Term
| What type of heart failure may be ACEIs and ARBs be combined? |
|
Definition
| low left ventricular ejection fraction BUT increase in risk of adverse effects |
|
|
Term
| When is spironalactone used? |
|
Definition
| Severe heart failure - patient not controlled by ACEI + diuretic |
|
|
Term
| How is spironolactone monitored? |
|
Definition
| Monitor potassium each week for 1/12 then each month for 2/12 then every 3/12. |
|
|
Term
| Brands of spironolactone? |
|
Definition
|
|
Term
| What category of drugs does spironolactone belong to? |
|
Definition
| Potassium sparring diuretic. |
|
|
Term
| What is the rationale for using Beta-blockers in heart failure? |
|
Definition
|
|
Term
| Which beta-blockers in particular are used in heart failure. |
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Definition
| controlled release metoprolol (Toprol-XR), metoprolol bd, bisoprolol (Bicor) d, carvedilol (dilatrend) bd. |
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|
Term
| How are betablockers added to HR treatment |
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Definition
| Initially very low dose, increase slowly over weeks to maintenance dose. "start low, go slow" |
|
|
Term
| Patients with HF are very sensitive to BBs. How can complications when adding a BB to their therapy be minimised? |
|
Definition
start low - go slow
monitor weight daily
adjust dose of ACEI and diuretics
use caution if on CCB
avoid simultaneously adding other vasodilators. |
|
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Term
| What may be added to HF patient on ACEI, diuretic, and spironlactone with worsening symptoms? |
|
Definition
|
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Term
| What is the rationale of digoxin in treating heart failure? |
|
Definition
| improvement in symptoms, does not improve survival. |
|
|
Term
| What is the therapeutic range of digoxin in patients with heart failure? |
|
Definition
| 0.5-0.8mcg/L for patients with HF and who are in sinus rhythm. |
|
|
Term
| What should be checked before starting a patient on digoxin? |
|
Definition
| renal function and electrolyte concentrations. |
|
|
Term
| What are the side effects of digoxin (toxicity) |
|
Definition
| anorexia, N+V, diarrhoea, blurred vision, visual disturbances, confusion, drowsiness, dizziness, nightmares, agitation, depression |
|
|
Term
| What is the dosage of digoxin? |
|
Definition
Loading: 250-500mcg every 4-6 h (M1.5mg/d)
Maintenance: 125-250mcg d (rarely 500mcg) |
|
|
Term
| Why are anti-thrombotics used in HF patients. |
|
Definition
| Increased risk of thromboembolism. Aspirin or warfarin. |
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