Heart Failure

Question 1

ACE Inhibitors

Answer 1

• inhibit RAAS
• significantly decreases morbidity/mortality
• ‘pril”

Question 2

ARB

Answer 2

• good substitute for pts that can’t ACEI (cough, angioedema)
• “sartan”

Question 3

Sacubitril (w/ valsartan ENTRESTO)

Answer 3

MOA: inhibits the enzyme neprilysin
Lowers blood volume and promotes vasodilation
Indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart and reduced ejection fraction

Question 4

Beta-blockers

Answer 4

Recommended for all heart disease
Except high risk w/o symptoms and acute HF
Reduce morbidity/mortality

Question 5

thiazide vs

loop diuretics

Answer 5

long term

short term

Question 6

positive inotropic drugs

Answer 6

Digitalis aka digoxin
β-agonists
Phosphodiesterase inhibitors

Question 7

digitalis indications

Answer 7

Severe LV systolic dysfunction after initiation of diuretic, ACE-I and β-blocker therapy
Not indicated in diastolic or right-sided HF

Question 8

digoxin ADR

Answer 8

Progressively more severe dysrhythmia due to decrease in intracellular potassium

Question 9

MC Beta agonist used for acute HF in hospital

Answer 9

dobutamine

Question 10

Phosphodiesterase inhibitors for HF

Answer 10

Amrinone, milrinone
Same MOA as β-agonists, vasodilation
Symptomatic relief with short term use in patient with refractory HF

Question 11

spironolactone

Answer 11

Direct antagonist of aldosterone

ADRs-GI (gastritis and PU), gynecomastia, decreased libido, menstrual irregularities

Question 12

HCN channel blocker

Answer 12

Ivabradine, affects SA node speed
Indications:
reduce the risk of hospitalization for worsening heart failure in patients with stable, symptomatic chronic heart failure with left ventricular ejection fraction ≤ 35%, who are in sinus rhythm with resting heart rate ≥70 beats per minute and either are on maximally tolerated doses of beta-blockers or have a contraindication to beta-blocker use