Drugs for HTN + HF

Question 1

Can we use Diuretics for both HTN & HF?

Answer 1

YES!
HTN: ↓ Blood volume (arterial resistance)

HF: ↓ Blood volume (Preload) & Workload on heart

• only treats SYMPTOMS
• 1st line therapy for acute pulmonary edema
• usually used in combo w/ other HF drugs

Question 2

How is the dosing of diuretics different in HTN and HF?

What do we use to determine the dosing in HF?

Answer 2

Diuretic Dosing in HF is based on DAILY WEIGHTS

Patients may be given a “Sliding scale” based on daily weight measurements

Question 3

What are the 4 Classes of Adrenergic Agents used for HTN?

Identify the Prototype for each class:

Answer 3

1. Alpha2 AGONIST: Clonidine (Catapres)
2. Alpha1 Blocker: Prazosin (Minipress) “osins”
3. Beta-Blocker: Metoprolol (Lopressor, Topol XL) “lols”
4. Alpha/Beta Blocker: Carvedilol (Coreg)

Question 4

What Adrenergic Agents are approved for use in HF?

Answer 4

1. Beta-Blocker: Metoprolol (Topol XL), Bisoprolol (Zebeta)
2. Alpha/Beta Blocker: Carvedilol (Coreg)

BBs used to be completely contraindicated due to risk of worsening HF due to decreased contractility of the heart

BUT,
If we use them properly, they can block that SNS demand on the heart (↓pressure/vasoconstriction)
Start w/ low doses (1/10th or 1/20th), then double doses every 2 weeks, and by month 3 should be at a full dose.

Question 5

Which of the 4 Classes of Adrenergic Agents is used for Both HTN & HF?

Answer 5

1. Beta-Blocker: Metoprolol (Topol XL), Bisoprolol (Zebeta)

2. Alpha/Beta Blocker: Carvedilol (Coreg)

Question 6

Name the 4 Drug Classes of RAAS drugs used for HF:

Indicate the prototype for each

Answer 6

1. ACE Inhibitors: Lisinopril (Zestril)
2. Angiotensin II Receptor Blockers (ARBs): Valsartan (Cozaar) “sartans”
3. Angiotensin Receptor Neprilysin Inhibitor (ARNI): Sacubitril/Valsartan (Entresto)
4. Aldosterone Receptor Blocker: Spironolactone (Aldactone)