HF drugs 2

Question 1

Name the MRA

Answer 1

eplerenone
spironolactone

Question 2

When are MRA contraindicated

Answer 2

RI - egfr less than 30
hyperkalaemia

Question 3

MRA - mineralocorticoid receptor agonist or antagonoist?

Answer 3

antagonist

Question 4

max dose of eplerenone if concurrent amiodarone (and other moderate inhibitors)

Answer 4

25mg daily

Question 5

when is eplerenone used for HF (2 indications)

Answer 5

adjunct in stable pt with LFEF less than or equal to 40% following an MI (start within 3-14 days of event)

adjunct in chronic mild HF with LVEF less than or equal to 30%

Question 6

dose of eplerenone

Answer 6

initially 25mg OD, increased to 50mg daily within 4 weeks of initial treatment

Question 7

monitoring requirements for eplerenone

Answer 7

plasma potassium before, during initiation and when dose changed

Question 8

spironolactone dose for moderate to severe HF adjunct

Answer 8

25mg initially OD
adjust according to response, to 50mg OD

Question 9

Can you use spironolactone in addisons diseae

Answer 9

No

Question 10

monitoring for spironolactone

Answer 10

electrolytes

discontinue if hyperkalaemia occurs

in severe HF, monitor Cr and K 1 week after initiation, after any dose increase, monthly for first 3 months and then 3 months for 1 year then every 6 months

Question 11

why can entresto not be used concomitantly with ACEi

Answer 11

risk of angioedema

Question 12

select the correct option - entresto cannot be used concomitantly with ACEi because

• increased risk of side effects
• increased risk of toxicity
• increased risk of angioedema
• increased risk of toxicity

Answer 12

angioedema

Question 13

how long after last dose of ACEi can you start entresto when you are switching treatment

• 24h
• 36h
• 72h

Answer 13

36h

Question 14

Can you use entresto concomitantely with ARB

Answer 14

no

Question 15

contraindications to entresto

Answer 15

• concomitant ACEi (risk angioedema, do not start until at least 36h after last dose)
• concomitant use with ARB
• hereditary or idiopathic angioedema
• known Hx angioedema related to previous ACEi or ARB

Question 16

true or false - daily dose of up to 10mg daily is preferably taken in 2 divided doses for ramipril in symptomatic HF

Answer 16

true

Question 17

pt is on aliskerin for hypertension. They are going to be initiated on ramipril for their HF. any important notes?

Answer 17

the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m2

the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus

Question 18

why are ACEi cautioned in diabetes

Answer 18

may lower blood glucose; increased risk of hyperkalaemia

Question 19

is there first dose hypotension with ACEi

Answer 19

yes
advice pt to take first dose before bed if taking for hypertension

Question 20

pt is on arb/ace + MRA. what would you be concerned about

Answer 20

hyperkalaemia

Question 21

is hydralazine given alone in pt intolerant of ACE or ARB

Answer 21

no in combination with long acting nitrate (e.g. isosorbide mono, dinitrate)

inititated in hospital or under specialist supervision

Question 22

dose of digoxin in HF for pt with sinus rhythm

Answer 22

62.5–125 micrograms once daily, reduce dose in the elderly.

Question 23

therapeutic drug monitoring of digoxin serum levels in pt with HF is not recommended. However, under normal circumstances not in HF, how many hours after dose should blood be taken

Answer 23

6 hours

Question 24

digoxin monitoring

Answer 24

serum electrolytes and renal function

Question 25

digoxin toxicity is precipitated by …

Answer 25

hypokalaemia

Question 26

4 important SE of amiodarone

Answer 26

Corneal microdeposits
Thyroid function
Hepatotoxicity
Pulmonary toxicity