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CDM 2 Exam 2 > Lecture 1: Heart Failure > Flashcards

Lecture 1: Heart Failure Flashcards

1
Q

Diastolic HF

A

Thick heart walls are a sign

HFpEF > 50%

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2
Q

Systolic HF

A

Thin heart walls are a sign

HFrEF < 40%

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3
Q

HF w/ mid-range ejection fraction

A

HFmEF 40-49%

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4
Q

HF w/ recovered EF

A

used to have rEF but improved to > 50%

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5
Q

Most important risk for HF?

A

HTN

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6
Q

Preventative measures for HF?

A
  1. Maintain BP at desired target < 130/80
  2. Control DM and lipids
  3. Aerobic activity 20-30 min 3-5 x wk
  4. BMI < 30
  5. Stop smoking
  6. Max sodium 2-3g/day
  7. Limit alcohol to 1-2 drink/day (m) and 1 drink/day (w)
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7
Q

4 determinants of Cardiac Output

A

HR
Preload
Afterload
Contractility

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8
Q

Stage A

A

At risk for HF

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9
Q

Stage B

A

Pre-heart failure (newly added)

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10
Q

Stage C

A

Symptomatic HF

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11
Q

Stage D

A

Advanced HF

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12
Q

Stage A drugs

A

ACEi or ARB appropriate for vascular disease or diabetes

Stains as appropriate

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13
Q

Stage B drugs

A

ACEi or ARB
B-Blockers
Statins as appropriate

select patients: ICD or revascularization or valvular surgery

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14
Q

Goal Directed Medication Therapy (GDMT)

A

ACEi/ARB/ARNi + B-Blocker+ Mineralocorticoid Antagonist + SGLT2i

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15
Q

Meds to be used on Stage C (1st line)

A

ACEi/ARB/ARNi + B-Blocker + Mineralocorticoid Antagonist + SGLT2i

diuretics as needed

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16
Q

Lisinopril Dosing Info

A

Initial Daily Dose: 2.5-5mg QD
Target Dose: 20-40mg QD
Mean Doses Achieve in CT: 32.5-35mg QD

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17
Q

Losartan Dosing info

A

Initial Daily Dose: 25-50mg QD
Target Dose: 50-150mg QD
Mean Doses Achieved in CT: 129 mg QD

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18
Q

Sacubitril - Valsartan (ARNi) Dosing Info

A

Initial Daily Dose: 49mg Sacubitril + 51mg valsartan BID ( can start on 24mg/26 mg BID)

Target Dose: 97mg Sacubitril + 103mg Valsartan BID
Mean Doses Achieved in CT: 182mg Sacubitril + 193 valsartan QD

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19
Q

Carvedilol Dosing info

A

Initial Daily Dose: 3.125 mg QD
Target Dose: 25-50mg QD
Mean Doses achieved in CT: 37 mg QD

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20
Q

Metoprolol succinate CR/XL Dosing info

A

Initial Daily Dose: 12.5-25 mg QD
Target Dose: 200mg QD
Mean Doses achieved in CT: 159mg QD

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21
Q

Spironolactone Dosing info

A

Initial Daily Dose: 12.5mg-25mg QD
Target Dose: 25-50mg QD
Mean Doses achieved in CT: 26mg QD

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22
Q

Dapagliflozin Dosing Info

A

Initial Daily dose: 10 mg QD
Target Dose: 10mg QD
Mean Doses achieved in CT: 9.8mg QD

23
Q

Empagliflozin Dosing Info

A

Initial Daily dose: 10 mg QD

Target Dose: 10mg QD

24
Q

How often should you titrate these therapies?

A

Guidelines recommend titrating dose at 2 wk intervals until at max tolerated or target dose

25
Q

ACEi info

A

No differences between available ACEi

Caution:
Cough - 20%
Angioedema
Monitor SCr and K

most recommended over ARBs

26
Q

Natriuretic Peptides

A

ANP + BNP

BNP secreted by ventricles in response to wall stress, used to detect presence of or worsening of HF + Overall lvl increased in HF

ANP + BNP promotes Natriuresis and Diuresis

27
Q

Neprilysin

A

Breaks down NPs

Inhibiting Neprilysin will inc BNP conc

AT2 is substrate for Neprilysin, so AT2 targeting agent required for co-admin….ARB

28
Q

Why cant combine Neprilysin w/ ACEi?

A

led to more angioedema

29
Q

Entresto reduced dose is…

A

24/26mg BID

It is for those that haven’t been on ACEi or ARB before
Severe renal impairment

30
Q

CI of Entresto

A

Concomitant ACEi therapy….don’t admin within 36hrs of ACEi due to risk of angioedema

Concomitant use of aliskiren w/ diabetes w/ Entresto

Previous Angioedema w/ ACEi or ARBs

31
Q

Carvedilol vs Metoprolol Succinate

A

Carvediolol = A/B block…impacts BP

Metoprolol is ony B Block, minimal BP effect

32
Q

Which Beta-blockers are best….

A

Carvedilol
Metoprolol
Bisoprolol

33
Q

Beta-blocker considerations

A
  1. Use studied agents only
  2. Start at low dose, titrate up every 2 weeks, reach optimal dose in 8-12 weeks
  3. Start/titrate when pt is stable
  4. Monitor HR, caution < 55 bpm
  5. If pt “congested” best to start ARNi/ARB/ACEi if not already
34
Q

Aldosterone Antagonist recommended in pts w/

A

NYHA Class II - 4 HF with systolic HF (LVEF < 35%) unless CI

35
Q

Aldosterone Antagonist Cautions

A

Renal impairment, SCr should be < 2.5 m, < 2.0 w

K+ should be less than 5 mEq

36
Q

GFR cut off for Dapagliflozin

A

> 30ml/min

37
Q

GFR cute off Empagliflozin

A

> 20ml/min

38
Q

Role of Aldosterone Antagonist is to…

A

antagonist effects of aldosterone on ventricular remodeling

not used for diuresis effects

39
Q

Diuretics Equivalents

A

Bumetanide 1mg = Torsemide 20mg = Furosemide 40 mg (oral)

40
Q

IV vs PO Furosemide

A

20mg = 40mg

41
Q

Which diuretic highest albumin bound? lowest?

A 
Highest = furosemide 
Lowest = Bumetanide
42
Q

Metolazone often used as…

A

“pre-diuretic” before loop ~ 30min or same time

cautions with high dose metolazone in elderly, recommended 2.5mg 2-3 times weekly

43
Q

Why is metolazone used prior to loop diuretic

A

By giving thiazide you’ll clear what leaves in the proximal, increasing what gets filtered in the loop.

Maximizes absorption/removal from descending loop to Henle

44
Q

Oral Nitrates and Hydralazine

A

1st approved for self-ID black pt due to sign mortality benefit

can be used in place of ACEi or ARB in intolerant patients or those with sig renal dysfunction precluding use of an ACEi/ARB

45
Q

Oral Nitrates an Hydralazine combo recommended to…

A

reduce morbidity and mortality for self-described AA with NYHA Class 3-4 receiving optimal therapy with ACEi/B-Blocker unless CI

46
Q

Isosorbide dinitrate + Hydralazine Dosing

A

20mg (DN) + 37.5mg (Hyd)

Target: 40mg + 75mg

47
Q

Ivabradine (Corlanor) indication

A

only in pt with Stable HF, EF < 35% and a resting HR of at least 70 bpm on maximally tolerated B-Blockers

48
Q

Ivabradine Dose

A

2.5mg BID to 7.5 mg BID

49
Q

Maximally tolerated B-Blockade

A

When you cant go up in dose due to side effects and cant handle it

50
Q

Digoxin can be beneficial in patients with….

A

Systolic HF to decrease hospitalizations for HF

Most beneficial in pts in Classes 3-4 with lower EFs

51
Q

Nitrates + Vasodilator therapy, Ivabradine, Digoxin, and Vericiguat are all used as….

A

add ons the the original 4 if you can increase any of those therapies

52
Q

Vericiguat indicated for….

A

Pts in NYHA Class 2 - 4, on GDMT still experiencing elevated BNP lvls > 300, or NT pro-BNP > 1000

53
Q

Vericiguat Caution

A

Combo with nitrates and/or PDE-5i give profound risk of hypotension

CDM 2 Exam 2 (16 decks)

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