HFpEF Treatment Flashcards
What are the drugs to avoid in HFpEF?
Nitrates, PDE5 inhibitors, Digoxin
What was the first agent specially approved to treat HFpEF
Entresto (sacubitril/valsartan)
What is the EF associated with HFprEF?
EF > 50%
What is the patho behind HFpEF?
The LV doesn’t fill properly, but does contract. AKA Diastolic HF.
treatment goals:
Underlying comorbidities that can further reduce blood flow to heart.
fluid management primary goal:
concern:
Reduction of edema
Over diuresis because removal of excess fluid can lead to lower perfusion
Chlorthalidone
Slows progression to HFpEF
On Spironolactone, hypotension without hyperkalemia
Reduce other anti hypertensives first
rx to avoid
Nitrates, digoxin, PDE-5
rx treatments
entresto, sglt2
Both help with diuresis mechanism
entresto is show to help with remodeling
entresto (ARNI) generic name
Sacubitril/valsartan
Contra ARNI
Pregnancy
ARNI DDI
ACEi 36hr washout
do no use with other RAAS rx
ARNI Monitoring
BP, electrolytes and renal function 2 - 4 wks
ARNI ADE
Hyperkalemia, acute renal failure, hypotension
ARNI is not initiated when……is D/C when…..
Do not initiate K greater than or equal to 5.5 mol/L
DC if K greater than or equal to 5.6 mol/L
Empagliflozin brand name
Jardiance
Jardiance monitor for
Volume status, blood glucose and ketones in T2DM
Jardiance and loop diuretic, which adjusted to avoid hypovolemia?
Adjust loop diuretic
What are some common AE’s of Jardiance (Empagliflozin)
Dehydration, Genetical mycotic infections/UTIs, and Hypoglycemia
What are the contraindications of Entresto?
pregnancy
What are contraindications of Empagliflozin?
eGFR<20 ml/min/1.73m2
What are the primary agents for fluid management in HFpEF?
Loop Diuretics
What is the primary goal of HFpEF?
NaCl and water excretion + Reduction of edema
What drug interactions does Entresto have?
ACEi need a 36 hour wash out period
What do we want to monitor while taking Empagliflozin (Jardiance)?
Monitor volume status: blood glucose and ketones in diabetic patients
