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Therapeutics > Exam 2 lecture 3 > Flashcards

Exam 2 lecture 3 Flashcards

1
Q

BB drug nmes with brand names

A

Bisoprolol- zebeta
Carvedilol- coreg
metoprolol succinate- toprol

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2
Q

Initial and final doses of BB

A

bisoprolol- initial- 1.25 mg QD, target- 10 mg QD

carvedilol- initial-3.125 mg BID, target- 25-50 BID
ER- initial 10 mg, target 80 mg QD

metoprolol- initial- 12.5-25 mg QD, target- 200 mg QD

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3
Q

how to titrate doses for BB

A

Carvedilol- 3.125 mg BID for 2 weeks
Coreg- 10 mg QD for 2 weeks
Metoprolol- 12.5-25 mg QD for 2 weeks

double dose every 2 weeks and monitor vital signs and symptoms

aim target dose in 8-12 weeks or highest tolerated dose

carvedilol<85 kg - 25 mg BID
>85- 50 mg BID
Coreg- 80 mg QD
Metoprolol- 200 mg QD

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4
Q

BB monitoring

A

BP and HR

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5
Q

what does systolic HF mean

A

HFrEF

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6
Q

COnsensus panel for use o BB

A

Stage B- All patients in stage B should be on B blocker
Stage C- All patients in stage C should be on BB

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7
Q

What happens to aldosterone in HF?

A

It is elevated

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8
Q

What does aldosterone do in HF?

A

SNS activation
PSNS inhibition
cardiac and vascular remodelling

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9
Q

What are the 2 MRAs? How are they different?

A

Spironolactone is non selective
eplerenone is selective

spironolactone causes gynecomastia
Eplerenone is selective with lower affinity for androgen (no anti androgen effect)

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10
Q

how do MRAs affect K, Mg, Na retention, and sympathetic stimulation

A

reduce K and Mg losses
reduce Na retention
reduce sympathetic stimulatio

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11
Q

Eplerenone dosing

A

CrCl>50- initial- 25 mg daily
maintainence- 50 mg daily

CrCl- 30-49- initial- 25 mg every other day
maintenance- 25 mg daily

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12
Q

Spironolactone dosing

A

CrCl>50- initial- 12.5-25 QD
maintenace- 25 mg QD

CrCl 30-49- initial- 12.5-25 QD every other day
maintenance- 12.5-25 QD

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13
Q

when to avoid MRAs

A

SeCr>2.5 for men and 2.0 for women
CrCl<30
K+>5

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14
Q

Do we just skip MRAs if K>5 or if CrCl<30?

A

No. we wait for it to get to normal and try again

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15
Q

What to avoid if taking MRAs

A

Avoid use of K+ sparring diuretics
Avoid NSAIDs

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16
Q

consensus for recommendations for MRAs

A

stage B- avoid
Stage C- Use, but make sure CrCl>30, K<5

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17
Q

effect of SGLT2 on preload and afterload

A

Reduces both preload and afterload

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18
Q

Do SGLT2 decrease CV death? hospitalization?

A

decreases both

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19
Q

which NYHA is SGLT2 used in

A

NYHA II-IV

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20
Q

dosing of SGLT2 i

A

dapagliflozin and empagliflozin 10 mg QD

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21
Q

adverse effects of SGLT2I

A

ketoacidosis in DM
hypoglycemia
infection rise
volume depletion

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22
Q

which drugs need CrCl of >30

A

ACE/ARB/ARNI
spironolactone
SGLT2i

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23
Q

important parameters before starting SGLT2 i

A

SBP>100
eGFR>20T

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24
Q

monitoring parameters for SGLT2i

A

SeCr and SeK
DM monitoring
hypotension

25
Q

when to reduce SGLT2i dose or discontinue

A

Secr>by 30 % within 4 weeks
ketone development

26
Q

ARNI/ARB/ACE important clinical parameters to initiate?
When to follow up? what are the clinical parameters to follow up on?

A

SBP>100
SeK<5.4
eGFR>30

Follow up within 2-4 weeks of initiation and titration

27
Q

when to discontinue RAASi

A

symptomatic hypotension
SeCr increased by 30% within 4 wks
SeK>5.4

28
Q

important clinical parameters to initiate BB

A

SBP>100
HR>60

29
Q

BB monitoring parameters

A

HR
BB

30
Q

when to dx BB

A

HR<50
hypotension

31
Q

important parameters to initiate MRA

A

SBP>100
SeK<5.4
eGFR>30

32
Q

follow up times and parameters for MRA

A

2-4 weeks
hypotension
SeCr
SeK

33
Q

When to reduce or dx MR doses

A

hypotension
SeCr increase by 30% within 4 wks
SeK>5.4

34
Q

What are the drugs to initiate in stage C/D HF

A

ACE/ARB/ARNI
BB
SGLT2i
MRA
(diuretic as needed)

35
Q

When are hydral nitrates used in HF?

A

in NYHA III-IV african american pts

36
Q

ISDN/hydralazine drug name

A

BilDil

37
Q

does ISDN/hydralazine reduce mortality

A

Yes

38
Q

is ISDN/hydralazine arteral dilator, venous dilator or balanced dilator?

A

balanced

39
Q

adverse effects of ISDN/hydralazine

A

h/a, N/V. flushing, lupus like syndrome

40
Q

doses of ISDN/hydralazine

A

starting- 20/37.5 TID
target- 40/75 mg TID

41
Q

consensus recommendation for ISDN/hydralazine

A

stage- no recommendation
stage C- black pts with NYHA III and IV receiving ARNI, BB, MRA and diuretic as add on)

42
Q

lisinopril dose equivalent drugs

A

150 captopril QD= 20 enalapril QD=20 lisinopril QD

43
Q

does ivabredine reduce mortality? hospitalization?

A

reduces hospitalization. not mortality.

44
Q

what are the specific indications of ivabredine

A

symptomatic HF
EF<40 (HFrEF) in normal sinus rhythm
HR>70
on max tolerated BB dose

45
Q

Digoxin MOA

A

2 fold MOA

blocks Na/K ATPase
increase in vagal activity

46
Q

What does digoxin blocking Na/K ATPase do?

A

Ca2+ increase and increases contraction

47
Q

What does digoxin increase in vagal activity lead to?

A

reduce AV conduction
reduce HR

48
Q

what is digoxin used for?

A

used to slow HR in pts who have A-fib and HF

49
Q

does digoxin reduce mortality? hospitalization?

A

reduces hospitalization

50
Q

Digoxin dosing

A

0.125-0.25 mg QD

51
Q

goal serum concentration of digoxin

A

0.5-0.9 ng/ml

52
Q

when to lower digoxin dose

A

> 70 yo
impaired renal function
low weight

53
Q

drug interactions with digoxin (and how much the dose changes by)

A

Amiodarone (doubles digoxin dose)
Quinidine and verapamil (80% increase)
itra/ktz (50-100% increase)

54
Q

use of PUFA (omega 3 polyunsaturated fatty acid) in HF

A

reduce risk in HF (II-IV) patients
use as adjunct

55
Q

long term ASA is used in

A

HF, CAD, ASCVD

56
Q

CCB use in HF? what to use what not to use?

A

Never use diltiazem, verapamil and nifedipine.
Felodipine and amlodipine should be used.

57
Q

most common cause of HFpEF

A

HTN

58
Q

for HFpEF which drugs reduce hospitalization? mortality?

A

digoxin has no effect on mortality or hospitalization
ACE/ARBs do not reduce mortality, they reduce hospitalization.

59
Q
A

Therapeutics (38 decks)

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