Alternative Pharmacotherapy of Heart Failure with HF-Reduced Flashcards
How does Aldosterone antagonist aid in the treatment of Heart Failure
Decreased preload and cardiac remodeling
T/F: Aldosterone antagonist are use to replace ACEs and ARBs in HF-Reduced
False: Aldosterone antagonist are used in ADDITION to standard therapy (ACE-I or ARB Plus BB)
What patients potentially take an Aldosterone antagonist for HF-Reduced
Patients classified as Stage C/D, post MI, EF less than 40, Has Diabetes, Stage B with resistant HTN
What Aldosterone antagonists used in HF-Reduced, what is the initial dose and the Target high dose
Spironolactone: 12.5-25 mg every day, 25 mg every day
Eplerenone: 25 mg every day, 50 mg every day
When should Aldosterone antagonists be avoided
Potassium is greater than or equal to 5, Serum Creatinine is greater than 2.5, CrCl is less than 30
How should a patient on Aldosterone antagonist be monitored
Within 3 days and again at 1 week after initiation, monthly for 1st 3 months, every 3-4 months thereafter (especially if also on ACEs or ARBs)
T/F:New bradycardia can be caused by using Aldosterone and ACE/ARB leading to severe hyperkalemia
True
How does Hydralazine and Isosorbide Dinitrate aid in the treatment of HF-Reduced
Isosorbide dinitrate causes venous dilation decreasing preload and donating Nitrous Oxide, Hydralazine causes arterial dilation and inhibits destruction of Nitrous Oxide
T/F: Hydralazine/Isosorbide is used in addition to optimal therapy in RAAS-I plus BB in Class 3 and 4 black patients or alternative to patients unable to tolerate an ACE/ARB
True
What is the initial dosing for hydralzaine/isosorbide dinitrate and Target high dose
Initial: hydralazine 25-50 and ISDN 20-30 mg TID or QID
Target: Hydralazine 300 and ISDN 120 in divided doses
What is the MOA of sacubitril
Inhibts neprilysin leading to an increase in BNP
When would Sacubitril/Valsartan be used
Replaces ACE/ARB in patients with symptomatic Heart Failure
What is key CONTRADICTION for using sacubitril/valsartan
Any history of angioedema with ACEs/ARBs
T/F: If a patient is on a high dose ARB or ACE the low dose of sacubitril/valsartan should be given and then titrated every 2 weeks to target as tolerated
True
How long should the discontinue period be between ACE/ARB and sacubutril/valsartan
36 hours
What is the mechanism of Ivarbradine
Reduces the influx of Na causing less action potentials and slowing the heart rate down
What is the heart rate reduction in Ivarbidine, what should be expeceted
Dependent on dose and baseline heart rate, at recommended doses of 10 bpm during rest and exercise
T/F: Ivarbidine bioavalability is consistent
False: Ivabridine has a 60-80% increase in bioavailability with food
When would Ivarbidine be used
ADD to standard therapy in patients with symptomatic Heart failure and a resting HR greater than 70 bpm and the patient MUST be in sinus rhythm (Cannot use if arrhythimic)
T/F: Ivarbidine should be used if their Beta blocker is at less than 50% of the target dose
True
What is the MOA of digoxin
Inhibit Na/K ATPase
What is a possible drug interaction between digoxin
Pgp inducers or inhibitors
How is digoxin distributed
4-6 after the dose is given BUT never distributes to the adipose tissue
T/F: Digoxin should be ADDED to standard care of HF-Reduced and it lowers preload
False: Digoxin should be ADDED to standard care of Hf=Reduced and has NO effect on mortality but treats SYMPTOMS
