Heart Failure Flashcards
SGLT inhibitors
dapagliflozin (farxiga), empagliflozin (jardiance), sotagliflozin (inpefa)
sglt inhibitor moa
increases urine output by osmotic diuresis
SGLTI: decrease absorption of glucose
increases excretion of water, decreases preload and afterload, reduces edema
sglti contraindications
dapagliflozin and sotagliflozin require an eGFR >25 for initiation
empagliflozin does not need renal adjustment
sglti adr
dehydration, genital myotic infection/uti, hypoglycemia, euglycemic ketoacidosis (stop surrounding surgery)
sglti notes
may require loop diuretic does adjustment (increased dehydration), discontinue 3 days prior to surgery to prevent euglycemic ketoacidosis
SGLT 1 increases gi side effects
mortality reducing drug
vaso/venodilators
hydralazine + isosorbide dinitrate (BiDil)
vasodilator
hydralazine (apresoline)
hydralazine moa
direct vasodilation of arterioles (reduces afterload), increases cardiac output
hydralazine contraindications
CAD- may cause reflex tachycardia, can cause angina, MI
hydralazine adr
dizziness, reflex tachycardia, DILE
hydralazine notes
dosing in HF is 3x daily even with combination BiDil tablet
mortality reducing drug
isosorbide dinitrate moa
increases cGMP, stimulating NO, allowing for vasodilation
isosorbide dinitrate contraindications
use with PDE5 inhibitors
isosorbide dinitrate adr
ha, dizziness, syncope
isosorbide dinitrate notes
pk/pd depends on formulation, F is low as it undergoes extensive first pass
mortality reducing drug
If channel inhibitor
ivabradine (corlanor)
ivabradine moa
acts on SA node “funny channel”, slowing firing and reducing HR
ivabradine contraindications
severe hepatic impairment, acute decompensated HF, clinically significant hypotension, sick sinus syndrome, sinoatrial block, third degree AV block
ivabradine adr
bradycardia, atrial fibrillation
ivabradine notes
use with food to ensure adequate absorption
major substrate of CYP3A4
soluble guanylate cyclase stimulator
vericiguat (verquvo)
vericiguat moa
enhances production cGMP, stimulating NO, allowing for vasodilation
vericiguat contraindications
pregnancy
vericiguat adr
hypotension, anemia
vericiguat notes
use with food to ensure adequate absorption, category X use with PDE5, formulation may contain lactose, must show negative pregnancy test to administer
cardiac glycoside
digoxin
digoxin moa
increased intracellular Na and Ca –> increased contractility
may also improve baroreceptor sensitivity
digoxin contraindications
none
digoxin adr
arrhythmia, heart block, gi side effects, neurologic side effects, tachycardia or bradycardia, anorexia, nausea, vomiting,
digoxin notes
major substrate of PGP, minor CYP3A4 substrate
monitor HR and SCr- ideally 0.5-0.9ng/ml
almost exclusively used in patients with HFrEF and atrial fibrillation, beers list
toxicity risk
high volume of distribution- 6-8hrs to distribution, 36-40hr t1/2 in normal renal function
levels must be drawn at least 10-12 hrs after administration and at steady state (5-7 days after)
