Heart Failure Flashcards
What are lifestyle management choices in patients with heart failure?
Lab values in heart failure?
What drugs cause or worsen heart failure?
Monitor weight, notify when weight increases by 2-4 lbs in a day or 3-5 lbs in a week, sodium restriction of <1500 mg per day.
Increased BNP, Increases NT-proBNP.
D.I. NATION. DPP-4 inhibitors(alogliptin, sitagliptin), Immunosuppressants(TNF), Non-DHP CCB’s, Antiarrhythmics(Class 1 and 3), Thiazolidinediones, Itraconazole, Oncology agents, NSAIDS.
Which medications decrease mortality for all patients without CI’s?
Which medications decrease mortality for select patients?
Which medications improve aspects of HF but not mortality benefit?
ACE inhibitors or ARB’s. ARNI. Beta Blockers, ARA’s.
Hydralazine and nitrates(BiDil) in Class 3-4 black patients when added to ACE or ARB and BB or can’t tolerate ACE or ARB.
Digoxin, Loop diuretics, Ivabradine(Corlanor)
What to know about Furosemide?
What to know about monitoring and starting temp and such of loop diuretics?
Do we avoid NSAIDs with loop diuretics?
Works in the thick ascending limb of the loop of Henle, Increases excretion of Na,K, Cl, Mg, Ca, and Water. Beware in sulfa allergy(this doesn’t apply in ethacrynic acid). Increases HCO3, metabolic alkalosis, hyperuricemia, glycemia, triglycerides, orthostatic hypotension, photosensitivity, ototoxicity(ethacrynic acid).
Renal function, fluid status, BP, audiology, testing with high doses or rapid IV administration, s/sx of HF. Store furosemide at room temp, Oral equivalent is furosemide 40=bumex 1= torsemide 20= ethacrynic acid 50. Furosemide IV to PO is 1:2.
YES
What to know about ACE inhibitors?
What to know about ARB’s?
What to know about the ARNI?
Enalapril(Vasotec), Enalaprilat(Vasotec IV), Lisinopril(Prinivil, Zestril), Quinapril(accupril), Ramipril(altace). Monitor BP, K, renal funcion, s/sx of HF, Angioedema, cough, hyperkalemia, renal impairment, use within 36 hours of neprilysin inhibitor is CI’d, fatal to fetus.
Losartan(Cozaar), Valsartan(Diovan). Less cough and angioedema, no washout period with neprilysin.
Entresto(Sacubitril/Valsartan), Same warnings as ACEi and ARB.
What beta blockers do we use in HF?
What to know about Carvedilol(Coreg)?
What to know about Spironolactone(aldactone)
Metoprolol Succinate(Toprol XL), Carvediolol(Coreg). Do not discontinue abruptly, monitor HR, increase TG, caution in patients with diabetes, asthma, COPD, Metoprolol IV is not equivalent to PO (IV:PO ratio of 1:2.5).
Take with food, dosing conversion are not 1:1.
eplerenone is selective, spironolactone is non selective, added to Class 2-4. Watch for hyperkalemia, anuria, significant renal impairment(CrCl <30),addisons disease or other K increasing disease is CI’d. Do not initiate in HF patients with high K, Increase Scr and dizziness, gynecomastia, breast tenderness, impotence. Monitor heart stuff.
What to know about hydralazine?
What to know about isosorbide mononitrate(monoket, imdur)?
What to know about Ivabradine?
direct arterial vasodilator, decreases afterload. Nitrates decrease preload. Hydralazine +isosorbide dinitrate(BiDil), DILE, headache, hypotension, reflex tachycardia, palpitations.
Use with PDE-5 and riociguat CI’d, hypotension, headache, dizziness, lightheadedness, flushing, tachyphylaxis(need 10-12 hour free interval, syncope.
Reduces sinus rate,sinus rhythm and resting HR >70 recommendation, Target 50-60 BPM, Bradycardia, can increase risk of QT prolongation, and ventricular arrhythmias, luminous phenomena(phosphenes), hypertension.
What to know about potassium supplementation?
Micro K can be opened and sprinkled, do not crush k-tab, klor conor klor-con M. can be cut in half or dissolved in 4 oz of water though.
