HFrEF Medications

Question 1

What are the possible DDIs with ACE Inhibitors?

Answer 1

1. Potassium Sparing
2. NSAIDs = decrease antihypertensive effect
3. Lithium = increase lithium
4. Tizanidine = hypotension

Question 2

What are the indications of ACE Inhibitors?

Answer 2

HFrEF, HTN, Diabetic Nephropathy, and Post ACS

Question 3

What ACE drugs are approved for Diabetic Nephropathy?

Answer 3

Catopril
Off Label for others

Question 4

What ACE drugs are approved for Post ACS?

Answer 4

Lisinopril
Ramipril
Catopril
Off Label: Enalapril

Question 5

What are the AEs of ACE Inhibitors?

Answer 5

Dry Cough, Renal Dysfunction, Hyperkalemia, and Angioedema

Question 6

What are the CIs of ACE Inhibitors?

Answer 6

1. Previous Angioedema from ACE
2. Pregnancy

Question 7

What ACE is NOT hepatic ally metabolized and a good choice for liver disease?

Answer 7

Lisinopril

Question 8

What is the HFrEF Target for Ramipril?

Answer 8

5 BID

Question 9

What is the HFrEF Target for Captopril?

Answer 9

50 TID

Question 10

What are the pearls of Captopril?

Answer 10

Shortest half life
AE = loss of taste

Question 11

What is the HFrEF Target for Enalapril?

Answer 11

10-20 TID

Question 12

What is the HFrEF Target for Lisinopril or Lisinopril/HCTZ?

Answer 12

40 QD

Question 13

What are the indications for ARBs?

Answer 13

HTN, HFrEF, HFpEF, Diabetic Nephropathy, LV Dysfunction of Failure Post MI

Question 14

What ARB drug is approved for HFrEF/HFpEF?

Answer 14

Candesartan and Valsartan
Losartan Off Label

Question 15

What ARB drug is approved for Diabetic Nephropathy?

Answer 15

Irbesartan and Losartan

Question 16

What ARB drug is approved for LV Post MI?

Answer 16

Valsartan
Losartan Off Label

Question 17

What is the counseling point for Valsartan?

Answer 17

Take on an empty stomach, food will decrease absorption

Question 18

What ARBs can metabolized via 2C9?

Answer 18

Candesartan, Losartan, Irbesartan, and Valsartan

Question 19

What ARBs are metabolized via 3A4?

Answer 19

Losartan

Question 20

What are the CIs of ARBs?

Answer 20

1. Concomitant use with Aliskiren in patients with DM
2. Pregnancy

Question 21

What is the HFrEF target dose for Candesartan?

Answer 21

32 QD

Question 22

What is the HFrEF target dose for Valsartan?

Answer 22

160 BID

Question 23

What drugs may decrease the activation of Losartan?

Answer 23

Fluconazole

Question 24

What patient population is most susceptible to angioedema?

Answer 24

African American Women

Question 25

What is the indication and pharmacology of Aliskiren?

Answer 25

HTN, direct renin inhibitor

Question 26

What can decrease the bioavailability of Aliskiren?

Answer 26

High fat meal

Question 27

What is CI’d with Aliskiren use?

Answer 27

1. ACE/ARBS in DM
2. Pregnancy

Question 28

What are the AEs of Alikskiren?

Answer 28

Hyperkalemia, Hypotension, Renal Effects

Question 29

What is Entresto and its indication?

Answer 29

Sacubitril/Valsartan (neprilysin inhibitor/arb)
HFrEF

Question 30

What is CI’d with Entresto?

Answer 30

1. Angioedema with ACE/ARB
2. Concomitant use within 36 hrs of ACEs

Question 31

What are the AEs of Entresto?

Answer 31

Hypotension and Hyperkalemia

Question 32

What drug needs a 36 hr washout period when switching from or to an ACE?

Answer 32

Entresto