HF drugs 2 Flashcards
Name the MRA
eplerenone
spironolactone
When are MRA contraindicated
RI - egfr less than 30
hyperkalaemia
MRA - mineralocorticoid receptor agonist or antagonoist?
antagonist
max dose of eplerenone if concurrent amiodarone (and other moderate inhibitors)
25mg daily
when is eplerenone used for HF (2 indications)
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%
dose of eplerenone
initially 25mg OD, increased to 50mg daily within 4 weeks of initial treatment
monitoring requirements for eplerenone
plasma potassium before, during initiation and when dose changed
spironolactone dose for moderate to severe HF adjunct
25mg initially OD
adjust according to response, to 50mg OD
Can you use spironolactone in addisons diseae
No
monitoring for spironolactone
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
why can entresto not be used concomitantly with ACEi
risk of angioedema
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
angioedema
how long after last dose of ACEi can you start entresto when you are switching treatment
- 24h
- 36h
- 72h
36h
Can you use entresto concomitantely with ARB
no
contraindications to entresto
- 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
true or false - daily dose of up to 10mg daily is preferably taken in 2 divided doses for ramipril in symptomatic HF
true
pt is on aliskerin for hypertension. They are going to be initiated on ramipril for their HF. any important notes?
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
why are ACEi cautioned in diabetes
may lower blood glucose; increased risk of hyperkalaemia
is there first dose hypotension with ACEi
yes
advice pt to take first dose before bed if taking for hypertension
pt is on arb/ace + MRA. what would you be concerned about
hyperkalaemia
is hydralazine given alone in pt intolerant of ACE or ARB
no in combination with long acting nitrate (e.g. isosorbide mono, dinitrate)
inititated in hospital or under specialist supervision
dose of digoxin in HF for pt with sinus rhythm
62.5–125 micrograms once daily, reduce dose in the elderly.
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
6 hours
digoxin monitoring
serum electrolytes and renal function
