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UBSPPS PHM601 Cardio/Renal Pharmacotherapeutics > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Which beta-blockers decrease mortality in HFrEF?

A

Carvedilol, metoprolol succinate (XL), Bisoprolol

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2
Q

BB AEs

A

Bradycardia, bronchospasm (esp non-selective BB)

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3
Q

BB management in HF exacerbation

A

Do not initiate while in a heart failure exacerbation
Reduce dose if patient experiencing an exacerbation (try not to discontinue if possible)

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4
Q

Bisoprolol: Specificity, starting, and target dose

A

Specificity: B1 selective
Starting dose: 2.5 mg daily
Target dose: 10 mg daily

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5
Q

Metoprolol succinate: Specificity, starting, and target dose

A

Specificity: B1 selective
Starting dose: 12.5-25 mg daily
Target dose: 200 mg daily

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6
Q

Carvedilol: Specificity, starting, and target dose

A

Specificity: alpha 1, B1, B2
Starting dose: 3.125 mg - 6.25 mg twice daily
Target dose: 25 mg twice daily (if > 85 kg: 50 mg twice daily)

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7
Q

BB decrease mortality in HFrEF (T/F)

A

TRUE

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8
Q

Preferred agent in HFrEF: ACEI/ARB/ARNI?

A

ARNI

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9
Q

Sacubitril/valsartan brand name

A

Entresto

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10
Q

Sacubitril MOA

A

Blocks breakdown of B-type natriuretic peptide → vasodilation and natriuresis

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11
Q

ARNI washout

A

ACEI: 36 hours
ARB: NONE

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12
Q

ACEi/ARB/ARNI decrease mortality in HFrEF (T/F)

A

TRUE

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13
Q

MRA MOA

A

Competitive antagonists of the mineralocorticoid receptor → decreasing sodium reabsorption and increasing potassium reabsorption

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14
Q

What is the eGFR or SCr or K+ requirement for initiating an MRA?

A

GFR>30, SCr<2.5 (male), SCr<2 (females), K<5

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15
Q

MRA Monitoring (HF)

A

Electrolytes and renal function 2-3 days after initiation, then again 7 days after initiation/titration. Then check monthly for 3 months and every 3 months afterwards

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16
Q

Selective MRA

A

Eplerenone

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17
Q

Spironolactone AE

A

HyperK, gynecomastia, breast tenderness, impotence

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18
Q

Eplerenone: Starting and target dose

A

25mg daily, 50 mg daily

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19
Q

Spironolactone: Starting and target dose

A

12.5-25mg daily, 25-50 mg daily

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20
Q

MRAs decrease mortality in HFrEF (T/F)

A

TRUE

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21
Q

SGLT2 inhibitor MOA

A

Osmotic diuresis via glucose excretion, likely improvement in cardiac metabolism

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22
Q

SGLT2i AE

A

Dehydration, UTI, hypoglycemia (if they also have diabetes)

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23
Q

Dapagliflozin brand name

A

Farxiga

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24
Q

Dapagliflozin dose

A

10 mg

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25
Q

eGFR must be above ___ for dapagliflozin initiation

A

30 mL/min/1.73m2

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26
Q

Empagliflozin brand name

A

Jardiance

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27
Q

Empagliflozin dose

A

10 mg (only titrate up to 25 mg for glycemic control)

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28
Q

eGFR must be above ___ for empagliflozin initiation

A

20 mL/min/1.73 m2

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29
Q

Indication for hydralazine/isosorbide

A

NYHA III IV: persistently symptomatic Black patients on ARNI/BB/MRA/SGLT 2 inhibitor

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30
Q

Hydralazine: starting and target dose

A

25 mg TID, 75 mg TID

31
Q

Hydralazine AE

A

Reflex tachycardia, peripheral edema, palpitations, DILE

32
Q

Isosorbide dinitrate: starting and target dose

A

20 mg TID, 40 mg TID

33
Q

Isosorbide dinitrate AE

34
Q

BiDil: starting and target dose

A

1 tablet BID, 2 tablets BID

1 tablet = 37.5 mg hydralazine, 20 mg isosorbide dinitrate

35
Q

Signs and symptoms of congestion

A

Weight gain, SOB, orthopnea, paroxysmal nocturnal dyspnea, pleural effusion, crackles/rales, S3, S4, peripheral edema, BNP, JVD

36
Q

Loop diuretics should be initiated when:

A

WET (warm/wet, cold/wet).
Determine a patient is wet via signs of congestion

37
Q

Typical loop diuretic starting dose

A

20-40mg furosemide PO / equivalent
Bumetanide 0.5mg QD

38
Q

Furosemide brand name

39
Q

Torsemide brand name

40
Q

Bumetanide brand name

41
Q

Ethacrynic acid brand name

42
Q

Loop diuretic monitoring

A

BP, BUN, SCr, electrolytes, fluid/volume status

43
Q

Loop diuretic AEs

A

hypokalemia
hyponatremia
hypovolemia
hypocalcemia

hypotension

44
Q

Loop diuretic equivalents

A

Furosemide: 20mg IV or 40mg PO
Torsemide: 20mg IV and PO
Bumetanide: 1mg IV and PO

45
Q

Loop diuretics decrease mortality in HFrEF (T/F)

46
Q

Ivabradine brand name

47
Q

Ivabradine MOA

A

Impacts the funny channel in the AE node causing a reduced heart rate

48
Q

Ivabradine indication

A

Resting HR 70 bpm or greater, on maximally tolerated BB, sinus rhythm, symptomatic

49
Q

Ivabradine DDI

A

Major substrate of CYP3A4

50
Q

Ivabradine decreases mortality in HFrEF (T/F)

51
Q

How does Vericiguat increase smooth muscle relaxation and vasodilation?

A

It increases sensitivity of sGC (soluble guanylate cyclase) to NO (nitric oxide) and directly stimulates sGC. These ultimately increases cGMP, which causes smooth muscle relaxation and vasodilation.

52
Q

Vericiguat brand name

53
Q

Vericiguat monitoring

A

Negative pregnancy test before initiation

BP for hypotension

54
Q

Vericiguat decreases mortality in HFrEF (T/F)

55
Q

Digoxin MOA

A

Inhibition of the sodium/potassium ATPase pump in myocardial cells results in a transient
increase of intracellular sodium, which in turn promotes calcium influx via the sodium
calcium exchange pump leading to increased contractility.

56
Q

Digoxin DDI

A

P-glycoprotein inducers/inhibitors and CYP3A4 inducers/inhibitors

57
Q

Digoxin monitoring

A

HR and rhythm, serum concentrations

58
Q

Digoxin target concentrations (HF)

A

trough goal: 0.5-0.9 ng/mL

59
Q

Digoxin AE

A

Arrhythmias, heart block, GI side effects, neurologic side effects

60
Q

Digoxin decreases mortality in HFrEF (T/F)

61
Q

Signs and symptoms of hypoperfusion

A

Tachycardia, fatigue, cyanosis, cold extremities, organ dysfunction, increased SCr, increaed LFTs, confusion, altered mental status

62
Q

IV Nitroglycerin MOA

A

Dilates veins and arteries, but more venodilation at lower doses. Increasing dose leads to more arterial dilation

63
Q

IV Nitroglycerin AEs

A

Headache, hypotension

64
Q

IV Nitroprusside MOA

A

Works via direct action and causes NO release > dilates arteries and veins. Much greater impact on BP than IV Nitroglycerin at low doses

65
Q

Nitroprusside Monitoring

A

BP and for Cyanide/Thiocyanate toxicity (especially with renal or hepatic dysfunction (normally if on 3mcg/kg/min for over 3 days))

66
Q

Nitroprusside AEs

A

Hypotension and Cyanide/Thiocyanate toxicity

67
Q

IV NTG/Nitroprusside Use in ADHF (classification and vs inotropes)

A

COLD (Class III & IV (cold/dry & cold/wet))
AND BP is ‘okay’ and can tolerate some lowering

68
Q

Inotropic agents (2)

A

Dobutamine
Milrinone

69
Q

Dobutamine MOA

A

Stimulates B1 in the heart → increased contractility and HR (inotropy, chronotropy)
Stimulates B2 in vasculature → vasodilation

70
Q

Dobutamine AE

A

Arrhythmia, potential hypotension

71
Q

Milrinone MOA

A

Selective PDE-3 inhibitor → vasodilation, inotropy

72
Q

Milrinone AE

A

Hypotension, potential arrhythmia

73
Q

ADHF Class IV (Cold/Wet): Which to address first?

A

Perfusion! Warm them up first (vasodilation/inotropes/pressors) then use diuretics
“Warm them up to dry them out”

UBSPPS PHM601 Cardio/Renal Pharmacotherapeutics (32 decks)

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