Chronic HF Flashcards by Kaitlyn Coronel

Etiologies

-Arrhythmia
-Myocarditis
-HTN
-Drug-induced
-IHD
-Diabetes/obesity/thyroid
-Autoimmune

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Sx of HF

Back up of blood
-Dyspnea, cough, orthopnea
-Swelling, weight gain

Lack of blood delivery
-Fatigue, confusion
-Low urine output
-Cold skin
-Irregular heartbeat, exercise intolerance

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NYHA Classifications

Asymptomatic
Sx with physical activity (exercise, stairs)
Sx with ordinary activity (dishes, folding clothes)
Sx at rest

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BNP and NTproBNP levels in HF

> 100-400

> 900

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EF Ranges

< 40: reduced, systolic dysfunction

41-49: midrange, either or both types

> 50: preserved, diastolic dysfunction

Prev < 40 but now > 40: HF imp EF

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Non-Pharm Interventions

-Exercise
-Fluids < 2 L/d
-Weigh daily (> 2 lb in one day or > 5 lb in 1 week)
-Daily BP/HR
-Salt 2 g/d
-Immunizations
-Avoid NSAIDS, tobaccos, nonDHP CCBs, alcohol

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Captopril Dosing

6.25 TID - 50 TID

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Enalapril Dosing

2.5 BID - 10-20 BID

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Lisinopril Dosing

2.5-5 - 20-40 QD

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Ramipril Dosing

1.25-5 - 10 QD

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ACEI: Monitoring

AE:
-Cough
-Hyperkalemia
-Angioedema
-AKI
-Hypotension

CI:
-Pregnancy
-Hx of angioedema

Check Cr + K in 2 wk after starting/increasing dose

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Losartan Dosing

25-150 mg QD

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Valsartan Dosing

20 QD - 160 BID

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Candesartan Dosing

4-32 QD

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ARB: Monitoring

AE:
-Hyperkalemia
-Angioedema
-AKI
-Hypotension

CI:
-Pregnancy
-Hx of angioedema with ARB only

Check Cr + K in 2 wk after starting/increasing dose

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Sacubitril/valsartan (Entresto) Dosing

24/26 BID to 97/103 BID

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Transitioning from LOW-dose ACEi or ARB to ARNI

Low dose ACEI: wait 36 hours then switch (wash out)

Low dose ARB: switch (no wash out)

ACEI: < 10 LE or < 5 rami

ARB: < 160 Val, < 50 Losartan, < 16 Candesartan

STARTING DOSE OF ARNI WILL BE 24/26 BID

Transitioning from HIGH-dose ACEi or ARB to ARNI

High dose ACEI: wait 36 hours then switch (wash out)

High dose ARB: switch (no wash out)

ACEI: > 10 LE or > 5 rami

ARB: > 160 Val, > 50 Losartan, > 16 Candesartan

STARTING DOSE OF ARNI WILL BE 49/51 BID

ARNI: the 36-hr wait when transitioning from ACEi reduces the…

Risk for angioedema

ARNI: Monitoring

AE:
-Hyperkalemia
-Angioedema
-AKI
-Hypotension

CI:
-Pregnancy
-Hx of angioedema with ARB or ACEI

Check Cr + K in 2 wk after starting/increasing dose

Choosing between ACEI/ARB/ARNI

ONLY ONE

-ARNI preferred for clinical benefit
-ACEI or ARB may be preferred due to cost or lower impact on BP
-Can’t use ARNI if history of angioedema to ACEI or ARB

Eplerenone Dosing

25 - 50 mg QD

Spironolactone Dosing

25 if eGFR > 50

12.5 if eGFR < 50

25-50 QD max

MRA: Monitoring

AE: DDKNG
-Hyperkalemia
-Hyponatremia
-Gynecomastia (more S)
-Dysmenorrhea (more S)
-Dehydration

Spironolactone: CI

-Pregnancy
-GFR < 30
-Scr > 2.5 (men), > 2 (women)
-K > 5

Eplerenone: CI

-CLCR < 30
-K > 5.5

DDI:
-CYP3A4s

Carvedilol Dosing

3.125 BID - 50 BID

CR: 10-80

Metoprolol Succinate Dosing

12.5-25 to 200 QD

ONLY succinate NO tartrate or other BBs not listed

Bisoprolol Dosing

2.5-10 QD

BB: Monitoring

AE:
-Bradycardia
-Fatigue/drowsy
-Worsen congestive sx if not euvolemic
-Hypotension
-Withdrawal

CI:
-Acute DHP
-Active airway disease

AA BB C D

Dapagliflozin Dosing

10 mg

Empagliflozin Dosing

10 mg

Sotagliflozin Dosing

200 mg

to 400 mg in 2 week

SGLT2i: Monitoring

AE: U KID
-GU tract infections
-Euglycemic ketoacidosis
-Dehydration

CI:
-Recurrent UTIs (1-2 ok)

Dapa:
-Do not start if GFR < 25
-Ok to cont if on tx THEN drops < 25

Backbone of TX

BB (only carvedilol, metoprolol succ, bisoprolol)
ARNI, ACEI, ARB
MRA
SGLT2I (only dapa, empa, sota)

Additional: Loops

F 20-40
T 10-20
B 0.5-1
EA 25-50

for weight loss, clear congestive sx, urine output

If not at goal urine output or losing weight = double dose until met then can increase frequency

AE: AODEA
-Low elec
-AKI
-Dehydration
-Metabolic alkalosis
-Ototoxicity

Sulfa all: use EA

Loop diuretics: Stepwise approach to overcome resistance

Switch diuretic if taking Furosemide
then
Add thiazide diuretic
then
IV administration

PO conversion: 40 F = 20 T = 1 B = 50 EA

IV conversion: 20 F = 20 T = 1 B = 50 EA

Additional: Thiazides

Before loop by 30 min

Meto 2.5-10

Chloro 250-1000

AE:
-Low elec esp K
-Dehydration
-AKI

Additional: Hydralazine/Isosorbide

In patients who are intolerant to ACEi/ARB/ARNI or Black

25/20 TID to 100/40 TID

AE:
-Drug induced lupus >300mg
-HA, hypotension, tachy

DDI: iso = PDE5s

BLIP

Additional: Ivabradine

-Symptomatic EF ≤35%, max BB, HR > 70, norm sinus rhythm

Start 5 mg BID

AE:
-AV block, brady
-Atrial fib
-Phosphene (see light without light entering eye)

CI:
-Pregnancy
-Acute DHF
-Sick sinus syndrome
-2-3 degree AV block

PAAAPS

Additional: Vericiguat

2.5-10 QD

CI: preg

AE: hypotension, anemia

DDI: PDE5i

PPPA

Additional: Digoxin

0.5-0.9 ng/ml goal

AE:
-NV
-Color changes
-Brady
-Hyperkalemia
-AMS

CI:
-Ventricular fib
-Sick sinus syndrome
-2-3 degree AV block
-Avoid in worsening renal

CKRAB

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Chronic HF Flashcards

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