Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 845 > 11 HF 2 > Flashcards

11 HF 2 Flashcards

1
Q

HF drugs by indication

mortality or mortality and hospitalization
- chronic HFrEF (18)

A

metoprolol succinate, carvedilol, captopril, enalapril, ramipril, trandolapril, quinapril, fosinopril, lisinopril, candesartan, valsartan, sacubitril/valsartan, spironolactone, eplerenone, isosorbide/hydralazine
bisoprolol (not US), empagliflozin, dapagliflozin

BB, ACEi, ARBs, ARNi, MRA, SGLT2, ISDN/hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HF drugs by indication

hospitalization
- chronic HFrEF (2)

A

digoxin, ivabradine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HF drugs by indication

hemodynamic or physical function
- chronic HFrEF (2)
- AHF (4)

A
  • digoxin, isosorbide/hydralazine
  • inotropes, milrinone, sodium nitroprusside, nesiritide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HF drugs by indication

QOL or symptoms
- chronic HFrEF (2)
- AHF: (2)

A
  • digoxin, diuretics
  • nesiritide, diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neurohormonal Blockers

RAS Inhibitors
- angiotensin receptor ___ inhibitors (ARNi)
- ACEi
- ARB

BB
SGLT2
MRA
___ / ___

A

neprilysin
hydralazine/ISDN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ACEi

T or F: benefit occurs regardless of etiology or severity of disease, must be used in all without contraindications

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACEi MOA and benefit in HF

MOA: inhibition of ___ formation, enhancement of ___
- improved endothelial function
- ___ NE
- inhibition of cardiac ___
- improved cardiac ___
- ___ aldosterone
- decreased endothelin-1
- decreased arginine ___
- ___ vasoconstriction
- reduced ___ and ___ retention

A

angiotensin II, bradykinin
- decreased
- hypertrophy
- hemodynamics
- reduced
- vasopressin
- reduced
- Na, Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical use of ACEi - dosing

enalapril ( ___ )
initial: ___ - ___ mg ___
target: ___ mg ___

A

Vasotec
2.5-5, BID
10 BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical use of ACEi - dosing

captopril ( ___ )
initial: ___ - ___ mg ___
target: ___ mg ___

A

Capoten
6.25-12.5, TID
50, TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical use of ACEi - dosing

lisinopril ( ___ , ___ )
initial: ___ - ___ mg ___
target: ___ - ___mg ___

A

Prinivil, Zestril
2.5-5, QD
20-40, QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical use of ACEi - dosing

quinapril ( ___ )
initial: ___ - ___ mg ___
target: ___ - ___ mg ___

A

Accupril
5-10, BID
20-40, BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical use of ACEi - dosing

ramipril ( ___ )
initial: ___ - ___ mg ___
target: ___ mg ___ - ___ mg ___

A

Altace
1.25-2.5, QD
5, BID, 10, QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical use of ACEi - dosing

fosinopril ( ___ )
initial: ___ - ___ mg ___
target: ___ mg ___

A

Monopril
5-10, QD
40, QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

enalapril___ mg = capropril ___ mg = lisinopril ___ mg

total daily amounts

A

20
150
20

total daily amounts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dosing ACEi

titrate slowly to target dose used in clinical trials
- start low and double dose every ___ - ___ weeks

Caution if: ___ depleted, SBP < ___ , K > ___ , SCr > ___
- lower doses and more monitoring are required with SCr > ___ and/or CrCl < ___ mL/min
- can do ___ of the inital/survival

A

1-4
volume, 80, 5, 3
3, 30
half

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

absolute ACEi CI

  • pregnancy
  • history of ___ or hypersensitivty
  • ___ renal artery ___
  • history of well documented intolerance due to symptomatic ___ , decline in ___ function, ___ kalemia, or cough
A
  • angioedema
  • bilateral, stenosis
  • hypotension, renal, hyperkalemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Monitoring

volume status (normalize prior to initiation)

regular maintenance of ___ function and ___
- prior to therapy, ___ - ___ weeks after each increase in dose and ___ - ___ month intervals
- SCr may rise after initiation ( < ___ % acceptable)

BP
- avoid symptomatic ___

A

renal, K
- 1-2, 3-6
- 30%
- hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ACEi AE

  • hypo ___
  • functional ___ insufficiency
  • hyper ___
  • skin rash and __
  • ___ (20%)
  • ___ (1%)
A
  • hypotension
  • renal
  • hyperkalemia
  • dysgeusia
  • cough
  • angioedema

dysgeusia = altered taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ARBs do not get the benefit of inhibiting that breakdown of ___

A

bradykinin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ARBs dosing

losartan ( ___ )
initial: ___ - ___ mg ___
target: ___ mg ___

A

Cozaar
25-50, daily
150, daily

21
Q

ARBs dosing

valsartan ( ___ )
initial: ___ - ___ mg ___
target: ___ mg ___

A

Diovan
20-40, BID
160, BID

22
Q

ARBs dosing

candesartan ( ___ )
initial: ___ mg ___
target: ___ mg ___

A

Atacand
4, daily
32, daily

23
Q

ARBs vs ACEis

not superior to ACEi
alternative if:
- unable to take ACEi due to ___ or ___

monitoring: pretty much everything that you would monitor for ACEi (except ___ )

A

cough, angioedema
cough

24
Q

sacubitril/valsartan inhibits ___ from degrading ___ and blocks ___ receptor

A

neprilysin, BNP, AT1

25
Q

sacubitril/valsartan

BNP causes ___
- ___ BP
- decreases ___ tone
- ___ aldosterone
- ___ fibrosis
- ___ hypertrophy
- natriuresis/diuresis

A

vasodilation
- decreases
- sympathetic
- decreases
- decreases
- decreases

26
Q

sacubitril/valsartan

angiotensin II binding to the AT1 receptor causes ___
- ___ BP
- increases ___ tone
- increases ___
- ___ fibrosis
- ___ hypertrophy

A

vasocontriction
- increases
- sympathetic
- aldosterone
- increases
- increases

27
Q

sacubitril/valsartan

indications: reduce the risk of CV ___ / ___ for HFrEF patients with NYHA class ___ - ___

sacubitril ( ___ , ___ , ___ mg)
valsartan ( ___ , ___ , ___ mg)
- valsartan equivalents: = ___ , ___ , and ___ respecitively

A

death/hospitalization
II-IV
24, 49, 97
26, 51, 103
- 40, 80, 160

28
Q

sacubitril/valsartan

T or F: the way that the drug is packaged makes valsartan more bioavailable

A

T
26 = 40, 51 = 80, 103 = 160

29
Q

sacubitril/valsartan AEs

same as ACEi/ARB
- ___ rare

PARADIGM-HF trials
- hypotension ___ enalapril
- elevation in SCr and K ___ enalapril

A
  • angioedema
  • >
  • <
30
Q

sacubutril/valsartan dosing

population:
- high dose ACEi ( > ___ mg total daily enalapril or equivalent)
- high dose ARB ( > ___ mg total daily valsartan or equivalent)

initial dose: ___ / ___ mg ___
max dose: ___ / ___ mg ___

A
  • 10
  • 160
  • 49/51, BID
  • 97/103, BID
31
Q

sacubutril/valsartan dosing

population:
- low-to medium dose ACEi or ARB
- ACEi/ARB ___
- eGFR < ___
- moderate ___ impairment
- age > ___ years

initial dose: ___ / ___ mg ___

double the dose every ___ - ___ weeks to target ___ / ___ mg ___ as tolerated

A
  • naive
  • 30
  • hepatic
  • 75

24/26, BID
2-4, 97/103, BID

32
Q

enalapril ___ mg/day = captopril ___ mg/day = lisinopril ___ - ___ mg/day

A

20, 150, 20-40

33
Q

sacubutril/valsartan CI

  • taking within ___ hours of ACEi use
  • angioedema/known hypersensitivity to ACEi/ARB
  • pregnancy/lactation
  • severe heaptic impairment
  • concomitant ___ use in patients with diabetes
A

36
aliskiren

34
Q

recommendations for ARNi/ACEi/ARB

Stage B
- ACE or ARBs if not tolerant

Stage C
- ARNi: patients with current or previous ___ (replacing ACEi/ARB with ARNi further reduces ___ )
- ACEi: patients with current or previous symptoms when use of an ___ is not feasible $$$
- ARBs: if intolerant to ___ and ___ isn’t feasible
- ARBs are reasonable alternatives as first line agents, especially if taking an ARB for another indication

class = evidence

A
  • symptoms, mortality
  • ARNi
  • ACEi, ARNi
35
Q

ACE/AHA Guidelines

  • ARNi should not be administered concomitantly with ACEi or within ___ hours for the last dose
  • ARNi should not be administered to patients with Hx of ___
  • inhibition of RAS with ARNi, ACEi, or ARB is recommended to reduce ____
  • ___ is preferred and can be used rather than with pre-treatmnt with ACEi/ARBs
A
  • 36
  • angioedema
  • mortality/morbidity
  • ARNi
36
Q

BB

reverse ___ is proposed as one mechanism of benefit
3 approved BBs: ___ , ___ , ___

A

remodeling
carvedilol, metoprolol XL, bisoprolol

37
Q

rationale B-AR pathway in HF

increased cardiac ___
1) B-AR pathway ___ leads to impaired ___ tolerance resulting in HF
2) ___ toxicity leads to myocardial ___ resulting in HF

A

NE
1) desensitization, exercise
2) myocytes, dysfunction

38
Q

rationale BB in HF

decrease
- ___ arrythmias
- cardiac ___ and cell death
- ___ and ___
- cardiac ___

A
  • ventricular
  • hypertrophy
  • VC, HR
  • remodeling
39
Q

BB Patinet Selection

  • Stable and ___ patients
  • symptomatic patients should receive ___ , especially with current or recent histroy of fluid retentiion
  • should be considered in patients with bronchospastic disease and asymptomatic bradycardia, but ___
  • dont abruptly D/C
  • dont start initially in hospital, but if patients are already on them while being admitted, dont ___

Sowinski wouldnt do if patient has hospitalized uncontrolled asthma

A
  • euvolemic
  • diuretics
  • cautiously
  • D/C
40
Q

BB Dosing

bisoprolol ( ___ )
initial dose: ___ mg ___
target: ___ mg ___

A

Zebeta
1.25, daily
10, daily

41
Q

BB Dosing

carvedilol ( ___ )
initial: ___ mg ___
target: ___ - ___ mg ___

A

Coreg
3.125, BID
25-50, BID

42
Q

BB Dosing

carvedilol CR ( ___ )
initial: ___ mg ___
target: ___ mg ___

A

Coreg CR
10, daily
80, daily

43
Q

BB Dosing

metoprolol XL ( ___ )
initial: ___ - ___ mg ___
target: ___ mg ___

A

Toprol XL
12.5-25, daily
200, daily

44
Q

BB

___ and ___ are FDA approved and ___ is a european thing

A

carvedilol, metoprol, bisoprolol

45
Q

BB Dose titration

Double the dose every ___ weeks and monitor vital signs and symptoms
- planned dose increases can be slowed if necessary

aim for target dose in ___ - ___ weeks or highest tolerated dose

A

2
8-12

46
Q

NAPLEX weight and carvedilol

< 85 kg = ___ mg ___
> 85 kg = ___ mg ___

A

25, BID
50, BID

47
Q

dose conversion between Coreg and Coreg CR

  • 3.125 mg BID = __ mg QD
  • ___ mg BID = 20 mg QD
  • 12.5 mg BID = ___ mg QD
  • ___ mg BID = 80 mg QD
A

10
6.25
40
25

48
Q

BB monitoring

BP, symptomatic hypotension, HR ___ - ___ weeks
- symp. hypotension, bradycardia, and dizziness are uncommon is slow ___ (reduce dose ~ ___ % if necessary)
- if hypotension only, reduce other drugs first
- Goal HR is not defined

edema, fluid retention, signs of congestion ( ___ - ___ weeks)

fatigue or weakness

A

1- 2
- titration, 50

1-2

49
Q

Consensus panel recommendations for BB

Stage B
- in all patients with a recent or remote history of ___ and ___ should receive at least one of the agents shown to reduce ___
- all other patients should also receive at least one of the agents shown to reduce ___

Stage C
- Use one of the agents shown to reduce ___ in all patients, with current or previous symptoms unless CI

A

ACS, rEF, mortality
mortality
mortality

PHRM 845 (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions