DI Vaso/venodilators

Question 1

What is the usual starting dose for Hydralazine?

Answer 1

25mg TID

Question 2

What is the usual starting dose for Isosorbide dinitrate?

Answer 2

20 mg TID

Question 3

What is the usual starting dose for BiDil?

Answer 3

1 tablet TID

Tablet contains 20mg isosorbide dinitrate + 37.5 mg hydralizine

Question 4

What is the target dose for Hydralazine?

Answer 4

75 mg TID

Question 5

What is the target dose for Isosorbide dinitrate?

Answer 5

40 mg TID

Question 6

What is the target dose for BiDil?

Answer 6

2 tablets TID

Tablet contains 20mg isosorbide dinitrate + 37.5 mg hydralizine

Question 7

What is the direct vasodilator?

Answer 7

Hydralazine

Question 8

What is the direct venodilator?

Answer 8

Isosorbide dinitrate

Question 9

What are the adverse effects of hydralazine?

Answer 9

Reflex tachycardia, peripheral edema, palpitations, DILE

Question 10

What are the adverse effects of isosorbide dinitrate?

Answer 10

Headache

Question 11

What are the contraindications for direct venodilators?

Answer 11

Concomitant use with PDE5 inhibitors or riociguat

Question 12

What are the monitoring parameters for direct venodilators?

Answer 12

BP

HR

Question 13

What are the monitoring parameters for direct vasodilators?

Answer 13

BP
HR
Drug induced lupus (dose dependent)

Question 14

What are the clinical pearls for direct venodilators? (2)

Answer 14

1. Isosorbide dinitrate is approved for HFrEF in combo with hydralazine
2. Need to provide nitrate free period to prevent nitrate intolerance (10-14 hours while sleeping)

Question 15

When would you give a vaso/veno dilator?

Answer 15

HFrEF, NYHA III-IV
Persistently symptomatic
Black Patients
Already on ARNI/BB/MRA/SGLT-2 inhibitor