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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
ACEi info
No differences between available ACEi Caution: Cough - 20% Angioedema Monitor SCr and K most recommended over ARBs
26
Natriuretic Peptides
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
Neprilysin
Breaks down NPs Inhibiting Neprilysin will inc BNP conc AT2 is substrate for Neprilysin, so AT2 targeting agent required for co-admin....ARB
28
Why cant combine Neprilysin w/ ACEi?
led to more angioedema
29
Entresto reduced dose is...
24/26mg BID It is for those that haven't been on ACEi or ARB before Severe renal impairment
30
CI of Entresto
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
Carvedilol vs Metoprolol Succinate
Carvediolol = A/B block...impacts BP Metoprolol is ony B Block, minimal BP effect
32
Which Beta-blockers are best....
Carvedilol Metoprolol Bisoprolol
33
Beta-blocker considerations
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
Aldosterone Antagonist recommended in pts w/
NYHA Class II - 4 HF with systolic HF (LVEF < 35%) unless CI
35
Aldosterone Antagonist Cautions
Renal impairment, SCr should be < 2.5 m, < 2.0 w | K+ should be less than 5 mEq
36
GFR cut off for Dapagliflozin
> 30ml/min
37
GFR cute off Empagliflozin
> 20ml/min
38
Role of Aldosterone Antagonist is to...
antagonist effects of aldosterone on ventricular remodeling not used for diuresis effects
39
Diuretics Equivalents
Bumetanide 1mg = Torsemide 20mg = Furosemide 40 mg (oral)
40
IV vs PO Furosemide
20mg = 40mg
41
Which diuretic highest albumin bound? lowest?
``` Highest = furosemide Lowest = Bumetanide ```
42
Metolazone often used as...
"pre-diuretic" before loop ~ 30min or same time cautions with high dose metolazone in elderly, recommended 2.5mg 2-3 times weekly
43
Why is metolazone used prior to loop diuretic
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
Oral Nitrates and Hydralazine
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
Oral Nitrates an Hydralazine combo recommended to...
reduce morbidity and mortality for self-described AA with NYHA Class 3-4 receiving optimal therapy with ACEi/B-Blocker unless CI
46
Isosorbide dinitrate + Hydralazine Dosing
20mg (DN) + 37.5mg (Hyd) Target: 40mg + 75mg
47
Ivabradine (Corlanor) indication
only in pt with Stable HF, EF < 35% and a resting HR of at least 70 bpm on maximally tolerated B-Blockers
48
Ivabradine Dose
2.5mg BID to 7.5 mg BID
49
Maximally tolerated B-Blockade
When you cant go up in dose due to side effects and cant handle it
50
Digoxin can be beneficial in patients with....
Systolic HF to decrease hospitalizations for HF Most beneficial in pts in Classes 3-4 with lower EFs
51
Nitrates + Vasodilator therapy, Ivabradine, Digoxin, and Vericiguat are all used as....
add ons the the original 4 if you can increase any of those therapies
52
Vericiguat indicated for....
Pts in NYHA Class 2 - 4, on GDMT still experiencing elevated BNP lvls > 300, or NT pro-BNP > 1000
53
Vericiguat Caution
Combo with nitrates and/or PDE-5i give profound risk of hypotension

CDM 2 Exam 2 (16 decks)

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