HF treatment II

Question 1

Contraindications of digoxin

Answer 1

Ventricular arrythmias without HF, Wolf-Parkinson-White syndrome,
hypertrophic obstructive cardiomyopathy, incomplete AV nodal block

Question 2

Drug interactions of digoxin

Answer 2

• Agents affecting digoxin metabolism
• Depressants of AV node
• Agents affecting potassium levels
• Agent affecting absorption from GIT

Question 3

Explain the summary treatment of HFreEF

Answer 3

Diuretics for congestion
Cornerstone of treatment:
* B-blockers, ACEI/ARBs & mineralocorticoid (aldosterone) receptor
antagonists
Additional benefit:
* SGLT2 inhibitors & angiotensin receptor / neprilysin inhibitors
Other adjunctive agents:
* Nitrate/hydralazine combination, digoxin, ivabradine

Question 4

Effects of Hydralazine/nitrates

Answer 4

Improves the composite endpoint of mortality, hospitalizations for
HF, and quality of life in Black patients receiving guidelines -directed
medical therapy (GDMT) for HFrEF.

Question 5

When should you prescribe Hydralazine/nitrate

Answer 5

Hydralazine and nitrates should be used in Black patients with
persistent symptoms despite GDMT.
* Hydralazine and a nitrate might be reasonable in patients unable to
tolerate either an ACE inhibitor or ARB because of renal insufficiency,
hyperkalemia, or possibly hypotension