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PHRM 845 > HF pt2 > Flashcards

HF pt2 Flashcards

1
Q

What drug classes are neurohormonal blockers?

A
  • RAS inhibitors
  • BBs
  • SGLT2i
  • MRA
  • Hydralazine/ISDN
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2
Q

What are the suggested benefits of ACEi?

A
  • Reduce sxs, improve NYHA, improve clinical status, decrease hospitalizations (30% RRR), improve exercise tolerance and QOL
  • Reduce mortality, slow progression of HF
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3
Q

What are the mechanisms of ACEi benefit in HF?

A

Inhibition of angiotension 2 formation and enhancement of bradykinin:
- Decreased NE, improved endothelial fx, inhibition of cardiac hypertrophy
- Improved cardiac hemodynamics, reduced aldosterone, decreased endothelin-1
- Decreased arginine vasopressin, reduced vasoconstriction, reduced Na and water rentention

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4
Q

Why are ACEi underdosed and underused?

A
  • CKD: lower doses
  • Hypotension: symptomatic vs low BP
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5
Q

What is the dosing of ACEi?

A

Titrate slowly to target dose used:
- Start low and double dose q1-4 wks

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6
Q

What are the cautions in ACEi dosing?

A
  • Caution if: volume depleted, SBP <80, K >5, SCr >3
  • Lower doses and more monitoring required required w SCr >3 and/or ClCr <30 ml/min
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7
Q

What are the absolute CIs w ACEi?

A
  • Pregnancy or intent to become pregnant
  • Hx of angioedema or hypersensitivity
  • Bilateral renal artery stenosis
  • Hx of WELL DOCUMENTED intolerance due to sx hypotension, decline in renal fx, hyperkalemia, or cough
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8
Q

What are the specifics to ACEi mx of renal function and K?

A
  • Prior to therapy, 1-2 wks after each increase in dose and at 3-6 months intervals
  • When other txs are added that may decrease renal function
  • In pts w hx of renal dysfunction
  • SCr may rise after initiation (<= 30% acceptable)
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9
Q

What are AEs of ACEi?

A
  • Hypotension
  • Functional renal insufficiency
  • Hyperkalemia
  • Skin rash and dysgeusia
  • Cough
  • Angioedema
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10
Q

When are ARBs an alternative to ACEi?

A
  • Unable to take ACEi due to cough
  • ACEi-induced angioedema
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11
Q

What are the monitoring parameters of ACEi?

A
  • Volume status (normalize prior to initiation)
  • Regular mx of renal fx and K
  • BP: avoid sx hypotension
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12
Q

What are the effects of sacubitril/valsartan?

A
  • Sacubitril: metabolite inhibits neprilysin (neprilysin increases natriuretic peptides)
  • Valsartan: ARB effects
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13
Q

What is the indication of entresto?

A

Reduce risk of CV death/hospitalization for HFrEF pts w NYHA class 2-4

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14
Q

What are the AEs and CI of entresto?

A

AEs:
- Hypotension (> risk than enalapril)
- Elevations in SCr, K (< than enalapril)
- Angioedema
CI:
- Pregnancy

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15
Q

What is the initial dose of entresto for high dose ACEi and ARB pop?

A

S 49/V 51 mg BID

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16
Q

What is the max dose of entresto for high ACEi and ARB pop?

A

S 97/V 103 mg BID

17
Q

What is dose of ACEi in high dose ACEi pop?

A

> 10 mg total daily enalapril or therapeutically equivalent

18
Q

What is dose of ARB in high dose ARB pop?

A

> 160 mg total daily valsartan or equivalent

19
Q

What is the initial dose of entresto in low to medium dose ACEi or ARB, ACEi/ARB naive, eGFR <30, moderate hepatic impariment, and/or age >75?

A

S 24/V 26 mg BID

20
Q

What are the high dose ACEi equivalents?

A

Enalapril 20 mg/day = captopril 150 mg/day = lisinopril 20 mg/day

21
Q

What is the ARNI/ACEi/ARB recommendation for stage B?

A

ACEi: class 1 OR ARBs: if intolerant to ACEi

22
Q

What is the ARNI/ACEi/ARB recommendation for stage C?

A
  • ARNI: pts w current or previous sxs
  • ACEi: pts w current or previous sxs when use of ARNI is not feasible
  • ARBs: if tolerant to ACEi when ARNI is not feasible
  • ARNI: pts w current or previous sxs who tolerate ACEi/ARB, replacement w ARNI further reduces mortality
23
Q

What is an important guideline between ARNI and ACEi?

A

ARNI should not be administered concomitantly w ACEi or within 36 h of last dose

24
Q

What is a proposed mechanism of BB that allow its use in HF?

A

Reverse remodeling

25
Q

What are the approved BBs for use in HF?

A

Carvedilol and metoprolol XL in US, bisoprolol in Europe

26
Q

What do BBs decrease in HF?

A
  • Ventricular arrythmias
  • Cardiac hypertrophy and cardiac cell death
  • Vasoconstriction and HR
  • Cardiac remodeling
27
Q

When should BBs be considered?

A

Pts w bronchospastic disease and asymptomatic bradycardia, but cautiously

28
Q

Why should BBs not be d/c abruptly?

A

Causes rebound htn

29
Q

Can BBs be initiated in hospitalized pts?

A

Yes, but later in the hospital stay

PHRM 845 (48 decks)

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