Heart Failure

Question 1

Diuretics

Answer 1

First line for all pts with V overload or Hx of
Thiazide: moderate diuresis, long term therapy
Loop: profound, preferred
K+ sparing

Question 2

RAAS Inhibitors

Answer 2

ACE
ARB
Aldosterone antagonists
Entresto

Question 3

Looop diuretics

Answer 3

Furosemide (Lasix), Bumetanide, Torsemide
BOX: profound diuresis w/water and electrolyte depletion
Inhibit reabsorption of Na and Cl in ascending loop, proximal, and distal tubules
CONTRA: Anuria
ADR: Ototoxicity, hypokalemia

Question 4

SaKubitril and Valsartan

Answer 4

Heart failure
BOX: Fetal toxicity
Vasodilation and natriuresis
CONTRA: Hx of angioedema to previous ACE or ARB. If using ACE or aliskiren (DM)
ADR: Hypotension, hyperkalemia, AKI
Renal and hepatic adjustment required

Question 5

Beta Blockers

Answer 5

Negative feedback in B adrenergic cells. Overstimulation leads to adrenergic kinase formation. BARK phosphorylates the B receptor. Then Beta arrestin binds to the receptors and causes down regulation to desensitive the cell to epinephrine. Limited ability to stimulate and leads to clinical heart failure if we block the last receptors.
Start LOW go SLOW

Question 6

SGLT-2 Inhibitors

Answer 6

T2DM, HF, CKD
Reduce reabsorption of glucose
CONTRA: Dialysis
ADR: UTI and increased urinary output, genitourinary fungal inf., hypotension, hypovolemia
-gliflozin, Ertugliflozin is contra for renal impairment as well

Question 7

Vericiguat

Answer 7

HFrEF
BOX: embryo-fetal toxicity
produce cGMP to relax smooth muscle = vasodilation
ADR: hypotension

Question 8

Ivabradine

Answer 8

HFrEF
Slows SA node
CONTRA: acute decompensated HF, hypotension, bradycardia, sick sinus, 3 AV block, severe live impairment, pacemaker, CYP3A4 inhibitors
ADR: bradycardia

Question 9

Nitrates
Isosorbide
Nitroglycerin

Answer 9

HF and angina
forms a free radical nitric oxide and blah blah blah…potent vasodilator and decreases preload
CONTRA: PDE-5 inhibitors can lead to life threatening hypotension
Dosing far apart
ADR: headache, dizzy, hypotension

Question 10

Digoxin

Answer 10

HfrEF, afib/aflutter
Retains Ca by working on NaK Pump
CONTRA: V fib
ADR: Digoxin toxicity - visual disturbances (halos, yellow/blurred vision, lethargy, N/V, arrhythmias
Renal dosing required

Question 11

HFpEF

Answer 11

Antihypertensives
W/co-morbid conds: First line therapy for that condition
W/o: thiazide diuretic and aldosterone antagonist

Diuretics (loop)

NYHA class 2 or 3 AND elevated B type natriuretic peptide level: SGLT2 inhibitor or
Aldosterone antagonist