HF - part 2 Flashcards
QUAD therapy for reduced HF
ARNI (ACEi or ARB then sub for ARNI)
Beta-blocker
MRA
SGLT2
when would we ideally like to have therapies at target or max tolerated doses by?
3-6 months after diagnosis
why quad therapy?
complementary mechanism of actions
what add on do we consider if Hr is above 70 bpm and sinus rhythm ?
add ivradine
what add on do we consider if recent HF hospitalization?
vericiguat
what atherapy we consider if black or unable to tolaerate ARNI/ACEi/ARB
consider H-ISDN
what add on do we consider if suboptial contolr for AF and persistent symptoms despite quad therpy?
digoxin
if dehydrated what med do we avoid?
Beta blockers.
Dehydration can cause hypotension and beta blaockers can also cause hypotension
diruetics role in reduced HF?
what dose should we satrt at
contorl of symtpoms
- no target dose
- dose adjusted as needed
start low then increase until urine output increases and weight decreases
- use lowest effect dose
if congestion is not resolved with diuretics what can we do?
we can restrict daily fluid intake
what monitoring for toxicity needs to occur with diuretics
where should k levels be?
chcek Scr and K when?
other SE?
Electrolyte depletion
- decreasd K and Mg whihc can cause arrhymthimas
- K should be between 4-5
- concimiitant admin of ACEi or K sapring can prevnt hypokalemia
- check Scr and K within week of giving drug
hypotension and dizziness
how do we initate Acei /ARB in reduced HF?
if hospitalized we can increase the dose q 3-7days if outpatient wiat 2-4 weeks
when changing Acei /ARB what should we moniotr for?
SCr and K
if Scr increases by more then 30% do not increase dose fruther and consider lowering dose
how are Acei /ARB and diuretics dosages linked?
diuretic dose should be optimized because dehydration can worsen the renal effects of ACEi and ARB
also, fluid overload can blunt effects of ACEi and ARB
big ADE of ACEi and ARB?
- hypotension
- worsening renal fucntion
- hyperkalameia
rare - cough
ARNI in reduced
pateinst with new dignosis - satrted on ARNI
Patients already on ACEi/ARB should be switched to ARNI
ARNI drug name?
Sacubitril/valsartan
- ARNI has an ARB in it!
ARNI dosing consdierations
- can not be combined with ACEi or ARB
- if on ACei need a36 hours washhout periodde due avoid angioedmea
- start low and titrate up
- consider decreasing diuretic dose for 3-4 days when satrt ARNI
ARNI ADE and CI
- can cause hypotension, hyperkalemia, and increase SCr
-avoid in patients with history of angioedema
- avoid in patients with eGFR less then 30 ml/min
MRAs ADE, interactions
- hyperkalemia - interaction with TXX-SMX
if K.5.2mmol/L then intervention - Scr and K monitoring first 3 days then 1 week then monthly for 3 months and then q3 months
- gynecomastia
MRA, renal, titration, avoid
renal reduce dose if less than 50, avoid if less than 30ml/min
titration every 2-4 weeks
avoid: NSAIDS
which beta blocker in reduced HF and why
Carvedilol, bisoprolol, metoprolol because cardio selective(beta1)
dosing for Beta-blockers
satrt low then double dose every 2-4 weeks
beta-blockers effect seen when?
clinically in 2-3 months, heart function may improve in 6-12 months
