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Cardio (actually) > Chronic HF > Flashcards

Chronic HF Flashcards

1
Q

Etiologies

A

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

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2
Q

Sx of HF

A

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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3
Q

NYHA Classifications

A
  1. Asymptomatic
  2. Sx with physical activity (exercise, stairs)
  3. Sx with ordinary activity (dishes, folding clothes)
  4. Sx at rest
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4
Q

BNP and NTproBNP levels in HF

A

> 100-400

> 900

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5
Q

EF Ranges

A

< 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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6
Q

Non-Pharm Interventions

A

-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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7
Q

Captopril Dosing

A

6.25 TID - 50 TID

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8
Q

Enalapril Dosing

A

2.5 BID - 10-20 BID

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9
Q

Lisinopril Dosing

A

2.5-5 - 20-40 QD

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10
Q

Ramipril Dosing

A

1.25-5 - 10 QD

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11
Q

ACEI: Monitoring

A

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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12
Q

Losartan Dosing

A

25-150 mg QD

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13
Q

Valsartan Dosing

A

20 QD - 160 BID

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14
Q

Candesartan Dosing

A

4-32 QD

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15
Q

ARB: Monitoring

A

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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16
Q

Sacubitril/valsartan (Entresto) Dosing

A

24/26 BID to 97/103 BID

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17
Q

Transitioning from LOW-dose ACEi or ARB to ARNI

A

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

18
Q

Transitioning from HIGH-dose ACEi or ARB to ARNI

A

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

19
Q

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

A

Risk for angioedema

20
Q

ARNI: Monitoring

A

AE:
-Hyperkalemia
-Angioedema
-AKI
-Hypotension

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

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

21
Q

Choosing between ACEI/ARB/ARNI

A

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

22
Q

Eplerenone Dosing

A

25 - 50 mg QD

23
Q

Spironolactone Dosing

A

25 if eGFR > 50

12.5 if eGFR < 50

25-50 QD max

24
Q

MRA: Monitoring

A

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

25
Q

Spironolactone: CI

A

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

26
Q

Eplerenone: CI

A

-CLCR < 30
-K > 5.5

DDI:
-CYP3A4s

27
Q

Carvedilol Dosing

A

3.125 BID - 50 BID

CR: 10-80

28
Q

Metoprolol Succinate Dosing

A

12.5-25 to 200 QD

ONLY succinate NO tartrate or other BBs not listed

29
Q

Bisoprolol Dosing

A

2.5-10 QD

30
Q

BB: Monitoring

A

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

CI:
-Acute DHP
-Active airway disease

AA BB C D

31
Q

Dapagliflozin Dosing

A

10 mg

32
Q

Empagliflozin Dosing

A

10 mg

33
Q

Sotagliflozin Dosing

A

200 mg

to 400 mg in 2 week

34
Q

SGLT2i: Monitoring

A

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

35
Q

Backbone of TX

A
  1. BB (only carvedilol, metoprolol succ, bisoprolol)
  2. ARNI, ACEI, ARB
  3. MRA
  4. SGLT2I (only dapa, empa, sota)
36
Q

Additional: Loops

A

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

37
Q

Loop diuretics: Stepwise approach to overcome resistance

A

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

38
Q

Additional: Thiazides

A

Before loop by 30 min

Meto 2.5-10

Chloro 250-1000

AE:
-Low elec esp K
-Dehydration
-AKI

39
Q

Additional: Hydralazine/Isosorbide

A

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

40
Q

Additional: Ivabradine

A

-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

41
Q

Additional: Vericiguat

A

2.5-10 QD

CI: preg

AE: hypotension, anemia

DDI: PDE5i

PPPA

42
Q

Additional: Digoxin

A

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

Cardio (actually) (22 decks)

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