10 HF 1 Flashcards
Drug Therapy
- reduce intravascular volume ( ___ and ___ )
- increase myocardial contractility ( ____ ionotropes)
- decrease ventricular afterload ( ___ , ___ , and ___ )
- neurohormonal blockade (6)
- diuretics, SGLT2i
- positive
- ACEi, vasodilators, SGLT2i
- ARNis, BB, ACEi, ARBs, MRAs, SGLT2i
GDMT for Stages A and B
stage A: drug therapes for routine use if atheroscleotic vascular disease is present
- ___ / ___
stage B: drug therapies for routine use if previous MI or asymptomatic rEF
- ___ / ___
- ___
ACEi/ARB
ACEi/ARB
beta blocker
GDMT for HFrEF Stage C
1) ARNI/ACEi/ARB ( ___ preferred)
2) BB
3) ___ antagonist
4) SGLT2i
5) ___ diuretic
ISDN/hydralazine for ___ patients persistently symptomatic on GDMT or if ACEi/ARB intolerant
- ___ and ___ also used
- ARNi
- aldosterone
- loop
- black
- ivabradine
- digoxin
Diuretics
cornerstone of HF treatment from a symptoms standpoint
All HF patients with s/s of ____ (SYMPTOMATIC) should be on a diuretic
- reduce ___ but not mortality
- want ___ dose that maintains euvolemia
- patients who do not have symptoms of volume ___
should not receive diuretics
fluid retention
hospitalization
lowest
overload
Diuretics
short term benefits
- reduced fluid ___ via decreased edema, ___ congestion, and JVD by reducing ___ and cardiac ___ pressure
longer term benefits
- reduced daily ___ and improve ability to exercise
MOA: increase Na and water excreion by reducing Na ___ at a variety of sites in the nephron
- must get to their site of action to elicit response
- retention, pulmonary, preload, filling
- symptoms
- retention
Loop Diuretics
potent diuretics block ___ and ___ reabsorption in the ___ limb
- 20-25% of filtered ___ is reabsorbed
additional benefits
- enhance renal release of ___ (increases renal blood low and enhancing venous capacitance)
- blocked by ___
patients with impaired renal function may require ___ doses
Na, Cl, ascending
Na
prostaglandins
NSAIDs
higher
T or F: torsemide has erratic bioavailability (10-90%). For this reason, furosemide may have an advantage in some pateints
False, other way around
Loop Diuretic use in HF
IV equialent doses
furosemide ___ mg = bumetanide ___ mg = torsemide ___ mg = ethacrynic acid ___ mg
40
1
20
50
Furosemide dosing
initial oral dose: ___ - ___ mg QD or BID
usual dose range: ___ - ___ mg QD or BID
CrCl < 20 mL/min: ___ daily total
bioavailability: 50 ( ___ - ___ )
t1/2: ___ - ___ hrs
duration of action: ___ - ___ hrs
20-40
20-160
400
10-70
0.3-3.4
6-8
Bumetanide
initial oral dose: ___ - ___ mg QD or BID
usual dose range: ___ - ___ mg QD or BID
CrCl < 20 mL/min: ___ - ___ daily total
bioavailability: ___ - ___
t1/2: ___ - ___ hrs
duration of action: ___ - ___ hrs
0.5-1
1-2
8-10
80-100
0.3-1.5
4-6
Torsemide
initial oral dose: ___ - ___ mg QD
*
usual dose range: ___ - ___ mg QD
*
CrCl < 20 mL/min: ___ daily total
*
bioavailability: ___ - ___
*
t1/2: ___ - ___ hrs
*
duration of action: ___ - ___ hrs
10-20
10-80
200
80-100
3-4
12-16
Ethacrynic acid
initial oral dose: ___ - ___ mg QD or BID
bioavailability: ___
25-50
100
Thiazide and thiazide-like diuretics
- relatively weak agents, block Na and Cl reabsorption in the ___
- THZ may be used in patients with mild HF and small amouts of fluid retention
- THZ (like all diuretics) lose effectiveness as ___ function decreases
- ___ doses are generally necessary when GFR < ___ mL/min
- ___ is erratically absorbed and has a long t 1/2
- ___ and ___ are frequently used in combination with loop diuretics in patients who become ___ to a single drug therapy
- DCT
- renal
- higher, 30
- MTZ
- HCTZ, MTZ, resistant
Thiazide and thiazide-like diuretics dosing
HCTZ (Esidrix, Hydrodiuril)
initial: ___ mg/day
max: ___ mg/day
25
100
