HF drugs

Question 1

summarise treatment in pt with HF with REF

Answer 1

1st line ACE (or ARB) + BB

+ MRA (eplerenone, spironolactone) if still symptoms unless contraindicated

If intolerant to ACE/ARB esp if Afro/Caribbean, specialist re use of hydralazine + nitrate

If still symptomatic, specialist re use of SGLT2i (empag, dapag), entresto, ivabradine, amiodarone, digoxin (pt must be in sinus rhythm)

Question 2

If heart failure symptoms persist or worsen despite optimal first-line treatment (ACE or ARB + BB), a mineralocorticoid receptor antagonist such as spironolactone or eplerenone should be offered as add-on therapy unless contraindicated e.g. due to (2)

Answer 2

hyperkalaemia
RI

Question 3

which BB are licensed in HF

Answer 3

bisop
nebiv
carved

Question 4

In patients who are intolerant of both ACE inhibitors and ARBs (in particular those of African or Caribbean origin with moderate to severe heart failure), what can be used instead

Answer 4

Hydralazine hydrochloride combined with a nitrate can be considered under the advice of a heart failure specialist

Question 5

what are the entresto components

Answer 5

sacubitril
valsartan

Question 6

For patients in sinus rhythm, digoxin is recommended as add-on therapy in worsening or severe heart failure despite optimal treatment. How does it help HF?

Answer 6

Although digoxin does not reduce mortality, it may decrease symptoms and hospitalisation due to acute exacerbations.

Question 7

A patient with HF is on digoxin (add on therapy to standard treatment). How often should you measure serum digoxin levels

Answer 7

Routine monitoring of serum levels is not recommended in patients with heart failure.

Question 8

Loop diuretics for breathlessness and oedema in pt with fluid retention are usually 1st line. When may thiazides be of benefit ?

Answer 8

Thiazide diuretics may only be of benefit in patients with mild fluid retention and an eGFR greater than 30 mL/minute/1.73 m2

Question 9

Thiazides are only effective in the following eGFR

Answer 9

eGFR greater than 30 mL/minute/1.73 m2

Question 10

CCBs should be avoided in pt with HF-REF because they reduce cardiac contractility. However, pt with HF and angina may be safely treated with this SA DHPN CCB

Answer 10

amlodipine.

Question 11

Which ARBs are licensed for HF

Answer 11

candesartan
losartan
valsartan

Question 12

Your patient has HF-RED. They are of African descent and you notice that they are not tolerating their ACEi (cough, increased SE, not sufficient help in HF). You decide to commence them on an ARB instead. Are they all licensed in HF?

Answer 12

No
Only candesartan, losartan, valsartan

Question 13

A patient comes in with an Rx for irbesartan. You see on their PMR that they were initially taking ramipril + bisoprolol. They tell you it is a new treatment for their HF because they couldn’t tolerate the ramipril. What do you do?

• dispense the prescription and counsel patient on NMS
• contact the prescriber for an alternative

Answer 13

contact prescriber for alternative
irbesartan is not licensed in HF
only candesartan, losartan and valsartan are

Question 14

ACE + BB licensed for HF (bisop, carvel, nebiv) should be given 1st line for HF-REF because they …

Answer 14

reduce morbidity and mortality

Question 15

Should you use BB in pt with HF who have comorbid diabetes, elderly, interstitial pulmonary disease, COPD, peripheral vascular disease, ED?

Answer 15

Yes, treatment with a beta-blocker should not be withheld because of these.

Question 16

If symptoms persist despite optimal treatment, advice from HF specialist should be sought on the use of the following …

Answer 16

amiodarone hydrochloride, digoxin, sacubitril with valsartan, ivabradine, empagliflozin, or dapagliflozin.

Question 17

Which SGLT2i can be used in HF

Answer 17

empag
dapag

Question 18

What is recommended as add on therapy in pt in sinus rhythm with worsening or severe HF despite optimal treatment

Answer 18

digoxin