Chronic HF Pharm 1

Question 1

Name 4 mortality reducing agents used in HF

Answer 1

ACE/ARS, BB, Aldosterone blocking agents, Vasodilators

Question 2

Morbidity reducing agent in HF

Answer 2

Digoxin, Diuretics

Question 3

Beta Blockers Dosing: can be used in..

Answer 3

Stage A or B, should be used in stage C; goal dosing are essential in maximizing mortality/morbidity benefit

Question 4

Dosing of Metoprolol succinate

Answer 4

6.25-12.5mg/day; goal 200mg/day

Question 5

dosing of Bisopolol

Answer 5

1.25mg/day;goal 10mg/day

Question 6

dosing of Carvedilol

Answer 6

3.125mg twice daily; goal 25 mg twice daily

Question 7

ADR BBs

Answer 7

Bradycardia
Worsening of HF if dose is started too high or up titrated too quickly
Respiratory issues

Question 8

Why don’t we use metoprolol tartrate in HF?

Answer 8

MERIT HF clinical trial showed metoprolol succinate is superior to metoprolol tartate

Question 9

MOA of Beta blockers

Answer 9

blockage of beta receptors leading to decreased HR, decreased BP, increased coronary artery blood flow

Question 10

ACEi/ARBs MOA

Answer 10

• Interference wuth RAAS ending with disruption of angiotensin II
• decreases BP, Na/H2O retention
• Afterload reducer

Question 11

Key PK note re ACEi/ARBs:

Answer 11

Highly excreted via kidneys;dose reductions often necessary as long as K is within normal limits

Question 12

ACEi/ARBs Dosing (used in all stages of HF): 3 bullet points

Answer 12

• All ACEi/ARBS have been used in HF
• Goal doses are essential in maxing mortality/morbidity benefit
• Lisinopril: start 5mg/day, goal dose of 20-40 mg daily

Question 13

Three ADRs of ACEi/ARBs

Answer 13

Hyperkalemia
Cough (acei)
Hypotension

Question 14

Absolute contraindications for ACEi/ARBs

Answer 14

-pregnancy
Hyperkalemia
Bilateral renal artery stenosis
Angioedema

Question 15

MOA Aldosterone Blockers (spironalactone or eplirinon)

Answer 15

Competes with aldosteron for intracellular mineralcorticoid receptors-> Na and H20 excretion (this also increases K in the blood)
-decreases preload

Question 16

Key PK notes re Aldosterone blockers

Answer 16

Highly protein bound

primarily renally excreted

Question 17

Aldosterone Blockers Dosing used in which stages of HF?

Answer 17

C an D

Question 18

Aldosterone blocker dosing spironalactone

Answer 18

12.5-25mg/day

Question 19

eplerenone dosing

Answer 19

25mg/day

Question 20

ADRs of Aldosterone blockers

Answer 20

Hyperkalemia

Gynecomestia

Question 21

Absolute contraindications of Alosterone blockers

Answer 21

hyperkalemia

Question 22

MOA Vasodilators

Hyralazine

Answer 22

direct arterial vasodilator

preom. vasodilates in coronary, cerebral, and renal arteries

Question 23

Isosorbide dinitrate MOA

Answer 23

direct venodilator

Converts into NO which produces vasodilation

Question 24

Key PK notes re Vasodilators

Answer 24

used in place of ACEi contraindications;not renally excreted

Question 25

Dosing of Vasodilators used in what stage?

Answer 25

used in stage C in african americans and in B/C/D if a contraindication to ACEi exists, race does not matter

Question 26

Hydralazine/ISDN Dosing

Answer 26

:37.5/20mg 3x daily titrating to goal of 75mg/40mg 3x daily

Question 27

Vasodilators ADRS

Answer 27

tolerance to nitrates | hypotension

Question 28

Loop diuretics MOA

Answer 28

- exert their action at the loop of henle - increase na and h20 excretion - all diuretics reduce preload and edema

Question 29

Key PK notes re Loop diuretics

Answer 29

may require higher than usual doses to induce diuresis in pts with renal failure

Question 30

Loop Diuretics initial dosing should be used only for which classes of HF?

Answer 30

symptomatic (C or D)

Question 31

Furosemide dosing

Answer 31

10-40mg/day

Question 32

bumetanide dosing

Answer 32

.5-1mg/day

Question 33

torsemide dosing

Answer 33

10-20mg/day

Question 34

Goal of loop diuretic dosing

Answer 34

after initial diuresis and reduction of fluid try to get to the lowest dose possible or even consider d/c'ing

Question 35

ADRs of Loop Diuretics

Answer 35

``` Electrolyte imbalances (MC) hyperglycemia hyperuricemia hypokalemia hypomagnesemia ```

Question 36

Digoxin MOA

Answer 36

positive inotropic activity and negative chronotropic activity -increase in intracellular na and ca increase in force of contraction

Question 37

Key PKA notes Digoxin

Answer 37

large VD, larger in obsese/smaller in elderly | -primarily renally excreated

Question 38

Digoxin dosing

Answer 38

recommended low dose for normal renal function .125mg/day (should only be used in symptomatic HF-stageC/D)

Question 39

Digoxin dosing elderly or renal insuficiency

Answer 39

.125 mg every other day monitor digoxin levels only for toxicity not efficacy -literature shows worse outcomes with higher normal levels when compared to lower normal levels

Question 40

Digoxin ADRs

Answer 40

``` high potential for toxicity Electrolyte disturbances -hypomagnesmia -hypokalemia Bradycardia GI disturbances (MC) ```

Question 41

Digoxin "Additional Comments.."

Answer 41

Hypokalemia increases the effects of digoxin | Hyperkalemia decreases the effects of digoxin