Heart Failure Flashcards
Ace Inhibitors
Recommended in all pts w/symptomatic HF or systolic dysfxn (improved survival and reduced hospitalizations)
Avoid in pts w/: angioedema, bilateral renal artery stenosis, severe aortic stenosis, labile BP & hypotension, pregnancy.
Monitor sCr and K within 1-2 weeks and periodically
ADE: cough
Angiotensin receptor blockers
Use for ACEI intolerant pts (e.g. cough)
can still cause renal changes, hyperkalemia
combo ACEI and ARB not typically recommended
B-Blockers
are cornerstone of HF pharmacotherapy (in conjunction with ACEIs)
use: bisoprolol, carvedilol, or metoprolol succinate
reduction in all-cause mortality
only use if clinically stable and euvolemic
mineralocorticoid receptor antagonists (MRA)
spironolactone, eplerenone
recommended for pts with systolic dysfunction & severe HR sxs despite optimal therapy
ADE: hyperkalemia
eplerenone is selective and has fewer endocrine ADE (e.g. gynecomastia)
hydralazine & isosorbide dinitrate
combo used in pts w/symptomatic systolic HF intolerant of ACEi or ARBs b/c of renal insuf, hyperkalemia, or angioedema.
can be used as add-on therapy in african americans
can be reasonable to add-on to anyone maximized on ACEi and BBlocker and still symptomatic
Diuretics
Loop diuretics generally preferred for HF pts with hypervolemia - provide only symptomatic relief, not mortality benefit
furosemide 40mg : spironolactone 100mg dose ratio
digoxin
therapeutic range = 0.5-1.0 ng/mL
can be used in those w/symptomatic HF; particularly useful in pts with afib and HF
PDE5 Inhibitors
sildenafil
may be used in pts w/stable systolic HF
drugs to avoid in HF
NSAIDS
CCBs with negative inotropic effects (e.g. verapamil, diltiazem, nifedipine)
thiazolidinediones
high-dose corticosteroids
cilostazol, anagrelide, itraconazole, minoxidil, ziprasidone, infliximab
calcium channel blockers
amlodipine, felodipine only
adjunctive therapies for angina or HTN despite optimal doses of ACEI, BBlockers, and MRAs
