HFpEF Treatment

Question 1

What are the drugs to avoid in HFpEF?

Answer 1

Nitrates, PDE5 inhibitors, Digoxin

Question 2

What was the first agent specially approved to treat HFpEF

Answer 2

Entresto (sacubitril/valsartan)

Question 3

What is the EF associated with HFprEF?

Answer 3

EF > 50%

Question 4

What is the patho behind HFpEF?

Answer 4

The LV doesn’t fill properly, but does contract. AKA Diastolic HF.

Question 5

treatment goals:

Answer 5

Underlying comorbidities that can further reduce blood flow to heart.

Question 6

fluid management primary goal:

concern:

Answer 6

Reduction of edema

Over diuresis because removal of excess fluid can lead to lower perfusion

Question 7

Chlorthalidone

Answer 7

Slows progression to HFpEF

Question 8

On Spironolactone, hypotension without hyperkalemia

Answer 8

Reduce other anti hypertensives first

Question 9

rx to avoid

Answer 9

Nitrates, digoxin, PDE-5

Question 10

rx treatments

Answer 10

entresto, sglt2

Both help with diuresis mechanism

entresto is show to help with remodeling

Question 11

entresto (ARNI) generic name

Answer 11

Sacubitril/valsartan

Question 12

Contra ARNI

Answer 12

Pregnancy

Question 13

ARNI DDI

Answer 13

ACEi 36hr washout

do no use with other RAAS rx

Question 14

ARNI Monitoring

Answer 14

BP, electrolytes and renal function 2 - 4 wks

Question 15

ARNI ADE

Answer 15

Hyperkalemia, acute renal failure, hypotension

Question 16

ARNI is not initiated when……is D/C when…..

Answer 16

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

Question 17

Empagliflozin brand name

Answer 17

Jardiance

Question 18

Jardiance monitor for

Answer 18

Volume status, blood glucose and ketones in T2DM

Question 19

Jardiance and loop diuretic, which adjusted to avoid hypovolemia?

Answer 19

Adjust loop diuretic

Question 20

What are some common AE’s of Jardiance (Empagliflozin)

Answer 20

Dehydration, Genetical mycotic infections/UTIs, and Hypoglycemia

Question 21

What are the contraindications of Entresto?

Answer 21

pregnancy

Question 22

What are contraindications of Empagliflozin?

Answer 22

eGFR<20 ml/min/1.73m2

Question 23

What are the primary agents for fluid management in HFpEF?

Answer 23

Loop Diuretics

Question 24

What is the primary goal of HFpEF?

Answer 24

NaCl and water excretion + Reduction of edema

Question 25

What drug interactions does Entresto have?

Answer 25

ACEi need a 36 hour wash out period

Question 26

What do we want to monitor while taking Empagliflozin (Jardiance)?

Answer 26

Monitor volume status: blood glucose and ketones in diabetic patients