Heart Failure Drugs Flashcards

1
Q

drugs for HFrEF

A

ARNI
Beta Blocker
MRA
SGLT2 Inhibitor

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2
Q

1st line therapy in de novo RASi-naïve patients

A

ARNI (sacubitril/valsartan)

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3
Q

If a patient is being switched from an ACEi to an ARNI, they require _______ to decrease the risk of angioedema

A

a 36 hour wash out period

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4
Q

contraindication for ARNI

A

Avoid using in patients with symptomatic hypotension (SBP ≤ 100 mmHg); eGFR < 30 mL/min; hyperkalemia (K > 5.4); or symptomatic hypotension
Avoid using ARNI in patient with history of angioedema

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5
Q

Monitor ___ for ARNI

A

Monitor serum electrolytes (for hyperkalemia) & creatinine (renal function

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6
Q

Angiotensin Converting Enzyme Inhibitor (ACEI)
MOA

A

Inhibit the production of angiotensin II
Decrease afterload & preload
Increase SV
Decrease activation of SNS
Inhibit degradation of bradykinin (vasodilator)

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7
Q

Monitor for ACEI

A

Monitor serum electrolytes (potassium) and creatinine

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8
Q

Angiotensin Receptor Blocker (ARB) indication

A

can be used if ACEi intolerant

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9
Q

ACEI side effects

A

cough

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10
Q

pregnancy and breastfeeding considerations

A

ARNI, ACEi, ARB are all contraindicated during pregnancy

Enalapril is the preferred ACEi during breastfeeding

ARNI contraindicated during breastfeeding

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11
Q

If ARB has to be used during breastfeeding, use

A

candasartan and valsartan due to shorter half life

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12
Q

beta blockers MOA

A

Reduce myocardial workload and oxygen demand (decrease HR and BP/SVR); ↑ SV, ↓ PCWP —— negative inotropic effect

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13
Q

adverse effects of beta blockers

A

Hypotension (orthostatic hypotension)
Dizziness
Bradycardia, AV block
Fatigue

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14
Q

Carvedilol

A

Nonselective beta-blocker & alpha adrenergic blocking activity

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15
Q

Bisoprolol

A

More cardioselective β-1 blockage; Used in reactive airway disease such as COPD

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16
Q

MRAs (Mineralocorticoid Receptor Antagonist)
MOA

A

spironolactone; eplerenone
* Block the detrimental effects of aldosterone on the heart; Increase Na and water
excretion while conserving potassium
* Maintain serum potassium levels (particularly in patients who are on diuretic therapy)

17
Q

MRAs can increase _______

A

MRAs can increase potassium and creatinine
Hold/reduce dose if K > 5.6 mmol/L or evidence of worsening renal dysfunction (↑baseline Cr by 30%)
Avoid using if eGFR < 30 mL/min

18
Q

SGLT2 Inhibitors MOA

A

Diuretic effect, reduction in preload
- Antihypertensive effect, reduction in afterload
- Weight loss
- Improved endothelial function
- Cardiac metabolism, calcium homeostasis in myocardium - Induce autophagy

19
Q

SGLT2 contraindication

A

Allergy or known intolerance to SLGT2 Inhibitors
* CKD eGFR < 25 mL/min
T1DM

20
Q

adverse effects of SGLT2 inhibitors

A

History of severe hypoglycemia (DM), DKA
Hypotension (SBP< 95 mmHg)
Volume depletion
Active genital mycotic infection

21
Q

examples of SGLT2 inhibitors

A

Dapagliflozin
Empagliflozin

22
Q

Ivabradine
MOA and therapeutic use

A

inhibits a depolarizing current in the sinus node; negative chronotropic effect on SA node

NSR (normal sinus rhythm) with a resting heart rate of ≥ 70 bpm

adjunctive therapy for a patient who is on maximally tolerated beta- blocker dose or who is intolerant to beta-blockers

23
Q

Contraindications for Ivabradin

A

Resting HR < 70 bpm prior to initiation of therapy
* ADHF (Acute decompensated heart failure)
* Prolonged QT interval
* Hypotension
* Atrial fibrillation; Heart Block
* Advanced liver disease
* Pregnancy
* Severe renal impairment eGFR < 15

24
Q

Hydralazine, ISDN
MOA and therapeutic use

A

HFrEF, NYHA III-IV as additional therapy or if cannot tolerate ACEi/ARB/ARNI due to CKD

  • Hydralazine arterial vasodilator (reduces afterload/BP)
  • ISDN venodilator (reduces preload/myocardial oxygen demand)
25
Q

Digoxin therapeutic use

A

Used in patients with HFrEF, NYHA FC III-IV, and
persistent symptoms despite GDMT
* Control of ventricular rate in patients in atrial fibrillation

26
Q

Loop Diuretic (Furosemide) MOA

A

relieve symptoms of congestion/fluid retention
Inhibit Na/K/Cl co-transporter at thick portion of ascending loop of Henle (this is where 1/3 of filtered Na is reabsorbed)
* Inhibit Na and water reabsorption

27
Q

Adverse effect of Loop diuretics

A
  • Electrolyte abnormalities (hypokalemia, hyponatremia, hypomagnesaemia)
  • Hypotension
  • Renal dysfunction
  • Ototoxicity (high doses)
28
Q

Oral sGC Stimulator: Vericiguat
MOA

A

Enhances cyclic guanylate monophosphate (GMP) production + endogenous sGC sensitivity to NO

29
Q

Dehydrating Illness > 24 hours
(fever, vomiting, diarrhea)
Temporarily hold medications: SADMANS

A

S: Sulfonylureas
A: ARNI or ACEI
D: Diuretics (Lasix, MRA, Metolazone) M: Metformin
A: ARBs
N: NSAIDs
S: SGLT2 Inhibitors

30
Q

avoid ____ in HF because

A

Increased risk of HF exacerbation
NSAIDs inhibit prostaglandin synthesis
Impair renal function – decrease renal blood flow and GFR Increase retention of sodium & water