Dosing for Exam 2 (HF)

Question 1

What is the initial dose for furosemide?

Answer 1

20-40mg daily (can be divided)

Question 2

What is the initial dose for bumetanide?

Answer 2

0.5-1mg daily (can be divided)

Question 3

What is the initial dose for torsemide?

Answer 3

10-20mg daily (can be divided)

Question 4

What is the initial dose for ethacrynic acid?

Answer 4

25-50mg daily (can be divided)

Question 5

What are the equivalent doses of the loop diuretics?

Answer 5

F 40mg = B 1mg = T 10-20mg = E 50mg

Question 6

What is the max outpatient dose of the three loop diuretics for a patient with CrCl over 50 mL/min?

Answer 6

Furosemide 80-160mg
Bumetanide 1-2mg
Torsemide 20-40mg

Question 7

What is the max outpatient dose of the three loop diuretics for a patient with CrCl 20-50 mL/min?

Answer 7

Furosemide 160mg
Bumetanide 2mg
Torsemide 40mg

Question 8

What is the max outpatient dose of the three loop diuretics for a patient with CrCl under 20 mL/min?

Answer 8

Furosemide 400mg
Bumetanide 8-10mg
Torsemide 100-200mg

Question 9

What is the initial dose for enalapril? Target dose?

Answer 9

Initial: 2.5-5mg BID
Target: 10mg BID

Question 10

What is the initial dose for captopril? Target dose?

Answer 10

Initial: 6.25-12.5mg TID
Target: 50mg TID

Question 11

What is the initial dose for lisinopril? Target dose?

Answer 11

Initial: 2.5-5mg daily
Target: 20-40mg daily

Question 12

What is the initial dose for ramipril? Target dose?

Answer 12

Initial: 1.25-2.5mg daily
Target: 5mg BID - 10mg daily

Question 13

What is the initial dose for losartan? Target dose?

Answer 13

Initial: 25-50mg daily
Target: 50-150mg daily

Question 14

What is the initial dose for valsartan? Target dose?

Answer 14

Initial: 20-40mg daily
Target: 160mg BID

Question 15

What is the initial dose for candesartan (Atacand)? Target dose?

Answer 15

Initial: 4-8mg daily
Target: 32mg daily

Question 16

What is the initial dose for carvedilol? Target dose?

Answer 16

Initial: 3.125mg BID
Target: 25mg BID if under 85kg or 50mg BID if over 85kg

Question 17

What is the initial dose for Coreg CR? Target dose?

Answer 17

Initial: 10mg daily
Target: 80mg daily

Question 18

What is the initial dose for metoprolol XL? Target dose?

Answer 18

Initial: 12.5-25mg daily
Target: 200mg daily

Question 19

How quickly should you titrate beta blockers up in HF?

Answer 19

Double the dose every 2 weeks and monitor closely. Aim for target in 8-12 weeks.

Question 20

What is the initial dose for eplerenone based on CrCl? Target dose?

Answer 20

Initial: CrCl over 50 mL/min – 25mg daily
CrCl 30-49 mL/min – 25mg every other day
Target: CrCl over 50 mL/min – 50mg daily
CrCl 30-49 mL/min – 25mg daily

Question 21

What is the initial dose for spironolactone based on CrCl? Target dose?

Answer 21

Initial: CrCl over 50 – 12.5-25mg daily
Crcl 30-49 – 12.5mg daily or every other day
Target: CrCl over 50 – 25mg daily
CrCl 30-49 – 12.5-25mg daily

Question 22

What is the initial dose for hydralazine alone or in combination? Target dose? Max dose?

Answer 22

Initial: 10-25mg daily alone or 37.5mg TID combo
Target: 75mg TID alone or 75mg TID combo
MAX: 100mg TID

Question 23

What is the initial dose for ISDN alone or in combination? Target dose? Max dose?

Answer 23

Initial: 10mg TID alone or 20mg TID combo
Target: 40mg TID alone or in combo
MAX: 80mg TID

Question 24

What is a normal dose of digoxin?

Answer 24

0.125-0.25mg daily

Question 25

What three drugs require empiric dose reductions for digoxin?

Answer 25

Amiodarone, Itra/ketoconazole, Verapamil

Question 26

What is the initial dose of Entresto (sacubitril/valsartan)? Target dose?

Answer 26

Initial: 49/51mg BID (or 24/26mg BID if no/low dose ACE/ARB, eGFR under 30, or moderate hepatic impairment) Target: 97/103mg BID

Question 27

What is the appropriate dose of ivabradine?

Answer 27

5mg BID, adjusted q2weeks to HR 50-60. MAX 7.5mg (2.5mg if bradycardia is concern)

Question 28

How is furosemide dosed IV in ADHF?

Answer 28

40-120mg IV bolus or 10mg/hr infusion MAX 200mg bolus or 960mg/24 hours Assess urine output over 2-4 hours before re-dosing

Question 29

How is nitroprusside dosed in ADHF?

Answer 29

0.25mcg/kg/min, titrated to response (max 3)

Question 30

How is nitroglycerin dosed in ADHF?

Answer 30

5mcg/min initially, increase by 5mcg/min every 5-10 minutes (max 200)

Question 31

How is nesiritide dosed in ADHF?

Answer 31

2mcg/kg IV bolus | 0.01 mcg/kg/min infusion, increase by 0.005mcg/kg/min (max 0.03)

Question 32

How is dobutamine dosed in ADHF?

Answer 32

2.5-5mcg/kg/min titrated to response | MAX 20 mcg/kg/min

Question 33

How is milrinone dosed in ADHF?

Answer 33

50mcg/kg IV LD followed by 0.1-0.375mcg/kg/min infusion | MAX 0.75mcg/kg/min

Question 34

How is dopamine dosed for its various purposes?

Answer 34

Increase urine output: 0-3 mcg/kg/min Increase contractility: 3-10 mcg/kg/min Increase vasoconstriction: over 10 mcg/kg/min