Heart Failure

Question 1

Normal EF

Answer 1

55-70%

Question 2

HFpEF

Answer 2

EF greater than or = 50%

Impaired ventricular relaxation and filling

Question 3

HFrEF

Answer 3

EF < 40%

impaired ability to eject blood

Question 4

Normal BNP

Answer 4

< 100 pg/ml

Question 5

Normal NT-proBNP

Answer 5

< 300 pg/ml

Question 6

Cardiac output (CO) equation

Answer 6

HR x SV

Question 7

Cardiac index (CI) equation

Answer 7

CO/BSA

Question 8

HF pts should check their weight at what time of the day

Answer 8

In the AM after voiding and before eating

Question 9

Sodium restrictions for HF pts (esp stage A and B)

Answer 9

< 1500 mg/day

Question 10

Drugs to avoid in HF

Answer 10

Class 1 anti arrhythmics (flecanide)
Non-dhp CCB (dilt, verapamil)
TZD's (incr. edema)
NSAIDs
TNF inhibitors
itraconzaole

Question 11

Classes of drugs that decrease mortality in HF

Answer 11

ACEi
ARBs
ARNI
Beta blockers
Aldosterone receptor antagonists 
BiDil (only in black pts)

Question 12

Classes/drugs that improve symptoms only

Answer 12

loop diuretics
digoxin
ivabradine (corlanor)

Question 13

Furosemide IV:PO ratio

Answer 13

1:2

Question 14

Loop diuretic dose equivalency (F, B, T,)

Answer 14

40 mg F = 1 mg B = 20 mg T= 50 mg ethacrynic acid

Question 15

target dose of captopril

Answer 15

50 mg TID

Question 16

target dose of enalapril

Answer 16

10-20 mg BID

Question 17

target dose of fosinopril

Answer 17

40 mg daily

Question 18

target dose of lisinopril

Answer 18

20-40 mg daily

Question 19

target dose of perindopril

Answer 19

8-16 mg daily

Question 20

target dose of quinapril

Answer 20

20 mg BID

Question 21

target dose of ramipril

Answer 21

10 mg daily

Question 22

target dose of trandolapril

Answer 22

4 mg daily

Question 23

ARBs studied/approved for HF

Answer 23

candasartan
losartan (off-label)
valsartan

Question 24

target dose of candasartan

Answer 24

32 mg daily

Question 25

target dose of losartan

Answer 25

50-150 mg daily

Question 26

target dose of valsartan

Answer 26

160 mg BID

Question 27

target dose of Entresto

Answer 27

200 (97 sacubitril/103 valsartan) mg BID

Question 28

starting dose of entresto

Answer 28

50-100 mg BID

Question 29

renal dosing for entresto

Answer 29

crcl < 30 | 50 mg BID

Question 30

Beta blockers approved/studied in HF

Answer 30

Bisoprolol Metoprolol succ Carvedilol IR and ER

Question 31

How often should you titrate dose of BB?

Answer 31

every 2 weeks, if tolerated

Question 32

target dose of bisoprolol

Answer 32

10 mg daily

Question 33

target dose of metoprolol er

Answer 33

200 mg daily

Question 34

target dose of carvedilol IR

Answer 34

25 mg BID (<85 kg) | 50 mg BID (>85 kg)

Question 35

target dose of Carvedilol ER

Answer 35

80 mg daily

Question 36

target dose of spirononlactone

Answer 36

25 mg daily or BID

Question 37

target dose of eplerenone

Answer 37

50 mg daily

Question 38

target dose of BiDIL

Answer 38

40/75 mg (2 tabs) TID

Question 39

Digoxin MOA

Answer 39

inhibits Na/K ATPase pump --> positive inotropic effect (inc CO) decreases HR

Question 40

Therapeutic levels of Dig in HF

Answer 40

0.5-0.9 ng/ml

Question 41

Antidote for dig

Answer 41

DigiFab

Question 42

Renal dose adjustment for Dig

Answer 42

crcl < 50

Question 43

When do you measure dig levels?

Answer 43

12-24 hrs after dose is taken

Question 44

initial s/sx of dig toxicity

Answer 44

n/v, loss of appetite, bradycardia

Question 45

other s/sx of dig toxicity

Answer 45

blurred/doubled vision, altered color preception, yellow/green halos around light, confusion, arrhythmias

Question 46

Ivabradine MOA

Answer 46

inhibits "funny" current in the sinus node and leads to decr. HR

Question 47

Target dose of ivabradine

Answer 47

2.5-7.5 mg BID | Target resting HR = 50-60 bpm

Question 48

When should HF pts contact MD about weight gain?

Answer 48

2-4 lbs in 1 day | 3-5 lbs in 1 week