Heart Failure

Question 1

SGLT inhibitors

Answer 1

dapagliflozin (farxiga), empagliflozin (jardiance), sotagliflozin (inpefa)

Question 2

sglt inhibitor moa

Answer 2

increases urine output by osmotic diuresis
SGLTI: decrease absorption of glucose

increases excretion of water, decreases preload and afterload, reduces edema

Question 3

sglti contraindications

Answer 3

dapagliflozin and sotagliflozin require an eGFR >25 for initiation
empagliflozin does not need renal adjustment

Question 4

sglti adr

Answer 4

dehydration, genital myotic infection/uti, hypoglycemia, euglycemic ketoacidosis (stop surrounding surgery)

Question 5

sglti notes

Answer 5

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

Question 6

vaso/venodilators

Answer 6

hydralazine + isosorbide dinitrate (BiDil)

Question 7

vasodilator

Answer 7

hydralazine (apresoline)

Question 8

hydralazine moa

Answer 8

direct vasodilation of arterioles (reduces afterload), increases cardiac output

Question 8

hydralazine contraindications

Answer 8

CAD- may cause reflex tachycardia, can cause angina, MI

Question 9

hydralazine adr

Answer 9

dizziness, reflex tachycardia, DILE

Question 10

hydralazine notes

Answer 10

dosing in HF is 3x daily even with combination BiDil tablet
mortality reducing drug

Question 11

isosorbide dinitrate moa

Answer 11

increases cGMP, stimulating NO, allowing for vasodilation

Question 12

isosorbide dinitrate contraindications

Answer 12

use with PDE5 inhibitors

Question 13

isosorbide dinitrate adr

Answer 13

ha, dizziness, syncope

Question 14

isosorbide dinitrate notes

Answer 14

pk/pd depends on formulation, F is low as it undergoes extensive first pass
mortality reducing drug

Question 15

If channel inhibitor

Answer 15

ivabradine (corlanor)

Question 16

ivabradine moa

Answer 16

acts on SA node “funny channel”, slowing firing and reducing HR

Question 17

ivabradine contraindications

Answer 17

severe hepatic impairment, acute decompensated HF, clinically significant hypotension, sick sinus syndrome, sinoatrial block, third degree AV block

Question 18

ivabradine adr

Answer 18

bradycardia, atrial fibrillation

Question 19

ivabradine notes

Answer 19

use with food to ensure adequate absorption
major substrate of CYP3A4

Question 20

soluble guanylate cyclase stimulator

Answer 20

vericiguat (verquvo)

Question 21

vericiguat moa

Answer 21

enhances production cGMP, stimulating NO, allowing for vasodilation

Question 22

vericiguat contraindications

Answer 22

pregnancy

Question 23

vericiguat adr

Answer 23

hypotension, anemia

Question 24

vericiguat notes

Answer 24

use with food to ensure adequate absorption, category X use with PDE5, formulation may contain lactose, must show negative pregnancy test to administer

Question 25

cardiac glycoside

Answer 25

digoxin

Question 26

digoxin moa

Answer 26

increased intracellular Na and Ca –> increased contractility
may also improve baroreceptor sensitivity

Question 27

digoxin contraindications

Answer 27

none

Question 28

digoxin adr

Answer 28

arrhythmia, heart block, gi side effects, neurologic side effects, tachycardia or bradycardia, anorexia, nausea, vomiting,

Question 29

digoxin notes

Answer 29

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)