HF Pharmacotherapy

Question 1

treatment goals of HF

Answer 1

reduce symptoms, mortality and morbidity. prevent its progression

Question 2

all proven therapies for HF are for?

Answer 2

systolic HF aka ejection fraction <0.4 aka HF rEF

Question 3

3 non pharmacologic therapies for HF

Answer 3

fluid/sodium restriction. physical activity. patient/family education

Question 4

general summary of HFrEF pharmacotherapy?

Answer 4

all patients should get ACE inhibitor and bet blocker + diurectics as needed. if symptoms still poorly controlled then: ARB, aldosterone antagonist, digoxin

Question 5

diuretics: name? type of diuretic? mechanism?

Answer 5

furosemide. loop diuretic. inhibit Cl (and Na) reabsoprtion in ascending loop of henle

Question 6

diuretics: indications? contraindications? adverse effects?

Answer 6

acute/chronic treatment of pulmonary edema in HF. contra: pregnancy, anuria, hypovolemia

Question 7

diuretics: adverse effects?

Answer 7

dehydration, hypotension, hypokalemia, tinnitus/hearing loss. hyperuricemia, hypocholermic metabolic alkalosis

Question 8

other diuretics

Answer 8

other loop: ethacrynic acid/bumetanide. metolazone (synergistic with loop). thiazides

Question 9

ACE inhibitors: evidence? mechanism?

Answer 9

lots of RCTs show benefits on mortality and morbidity. blocks formation of angiotensin (so more vasodilation and less cardiac remodeling)

Question 10

ACE inhibitors: indications. contraindications

Answer 10

first line therapy for HF, hypertension, asymptomatic LV dysfunction (preheart failure, used for prevention). cntra: pregnancy, renal problems, angioedema

Question 11

ACE inhibitors adverse effects:

Answer 11

hyptension, worsening of renal function, hyperkalemia, dry cough, skin rash, angioedema, taste disturbance –> also be wary of additive effects w/ beta blockers and diuretics = hypotensive

Question 12

beta blockers: mechanism

Answer 12

competitively blocks beta adrenergic receptors = reduce HR, cardiac output short term, blood pressure, anti-arrhythmic

Question 13

adverse effects of beta blockers

Answer 13

worsening of HF symptoms at first. fatigue, lethargy, nightmares, hypotension, bradycardia, AV block

Question 14

beta blockers contraindications

Answer 14

poorly controlled asthma, bradycardia, 2/3 degree AV block. *can worse HF initially so start low and go slow with dosing

Question 15

digoxin: mechanism

Answer 15

inhibits Na/K ATPase = increased calcium = stronger cardiac contraction