Treatment of Chronic Heart Failure: NICE

Questions and Answers

What is the primary action of loop diuretics in the treatment of chronic heart failure?

Increase blood pressure

Decrease heart rate

Promote urinary excretion of Na+, Cl-, K+ and H2O (correct)

Enhance calcium reabsorption in renal tubules

Which of the following statements accurately describes loop diuretics compared to thiazide diuretics?

Loop diuretics have a longer half-life than thiazide diuretics.

Loop diuretics have a higher ceiling effect for diuresis. (correct)

Thiazide diuretics are more potent in excreting electrolytes.

Thiazide diuretics are used primarily for acute left ventricular failure.

Which of these is NOT a recommended use for loop diuretics?

Prevention of thrombosis (correct)

Management of pulmonary oedema

Adjunct treatment for resistant hypertension

Treatment of fluid retention in chronic heart failure

What side effect is commonly associated with the use of loop diuretics?

Fatigue Signup and view all the answers

In what circumstance should loop diuretics be avoided?

Anuria Signup and view all the answers

Which loop diuretic undergoes liver cytochrome P450 metabolism?

Torasemide Signup and view all the answers

What is a significant caution for using loop diuretics in elderly patients?

Risk of urinary retention with enlarged prostate Signup and view all the answers

What is the peak effect duration of oral loop diuretics after administration?

30 minutes Signup and view all the answers

Study Notes

Treatment of Chronic Heart Failure

Congestive symptoms and fluid retention managed with loop diuretics.
Anticoagulation is recommended if there is a risk of thrombosis.
Verapamil should be avoided as it blocks cardiac calcium channels.

Loop Diuretics

Common loop diuretics include furosemide, bumetanide, and torasemide.
Effective for pulmonary edema due to acute left ventricular failure and chronic heart failure.
Can be used as an adjunct to antihypertensive treatments for resistant hypertension.
Enhance vasodilator effects and provide rapid relief of breathlessness and preload reduction.
Intravenous loop diuretics allow for immediate effects, usually within 10 minutes.

Mechanism of Action

Loop diuretics reduce electrolyte reabsorption in the thick ascending limb of the loop of Henle.
Promote urinary excretion of sodium (Na+), chloride (Cl-), potassium (K+), and water (H2O).
Classified as highly potent "high ceiling" diuretics, excreting 20-25% of filtered Na+.

Pharmacokinetics

Oral administration shows 50% bioavailability with a peak effect at 30 minutes.
Half-life (T½) is approximately 2 hours, with effects lasting 4-6 hours.
Rapid onset with intravenous use at around 10 minutes.
These drugs undergo liver cytochrome P450 metabolism.

Contraindications and Cautions

Contraindicated in patients with anuria, drug-induced renal failure, severe hypokalaemia, and severe hyponatraemia.
Caution required for patients with risk factors like urinary retention, hypotension, and elderly patients.
Combining with potassium-sparing diuretics can reduce the risk of hypokalaemia.

Side Effects

Common side effects include dizziness, electrolyte imbalances, fatigue, headaches, metabolic alkalosis, muscle spasms, and nausea.

Description

This quiz focuses on the NICE guidelines for the treatment of chronic heart failure. It covers critical aspects like the use of loop diuretics, anticoagulation considerations, and the avoidance of certain medications. Test your knowledge about managing congestive symptoms and fluid retention effectively.