Phamcotherapy of Heart Failure with Reduced Ejection Fraction

Question 1

How does angiotensin II contribute to HF-Reduced

Answer 1

Increased preload, vascular congestion, increased afterload, lower stroke volume, higher myocardial demand, lower cardiac output, arrhythmias

Question 2

How does Aldosterone contribute to HF-Reduced

Answer 2

Increased prelaod, vascular congestion, lower cardiac output, arrhythmias

Question 3

How does norephinephrine contribute to HF-Reduced

Answer 3

Increased myocardial demand, apoptosis, lower cardiac output, arrhythmias

Question 4

How do ACE-I and ARBs aid in treatment of HF-Reduced

Answer 4

Decrease preload, decrease afterload, decrease cardiac remodeling

Question 5

T/F: ACEs and ARBs are the cornerstone of therapy of symptomatic HF-Reduced (stage C/D) and asymptomatic (Stage B),should be used in all patients unless contraindicated or cannot tolerate

Answer 5

True

Question 6

What are the ACE-I used in HF-Reduced, what is the initial dose and Target high dose

Answer 6

Enalapril: 2.5-5 mg BID, 10 mg BID
Lisinopril: 2.5-5 mg every day, 20-40 mg every day
Ramipril: 1.25- 2.5 mg every day, 10 mg every day

Question 7

What is the drug class that should be used if ACE-I are not tolerate for HF-Reduced

Answer 7

ARBs

Question 8

T/F: ACEs and ARBs should never be combined

Answer 8

True

Question 9

What are the ARBs used in HF-Reduced, what is the initial dose and Target high dose

Answer 9

Valsartan: 40 mg BID, 160 mg BID
Candesartan: 4-8 mg every day, 32 mg every day
Losartan: 25-50 mg every day, 150 mg every day

Question 10

What should be monitored when using ACE-I and ARB, what is key contraindication

Answer 10

Renal function and Potassium 1-2 weeks of initiation and after increases then every 6 months, Pregnancy

Question 11

How do beta-blockers aid in treatment of HF-reduced

Answer 11

Decrease Afterload, Decrease cardiac Remodeling

Question 12

T/F: Beta-blockers should be added to alongside ACEs/ARBs for HF-Reduced regimen

Answer 12

True

Question 13

When should a beta-blocker be started

Answer 13

AFTER acute exacerbations are resolved (significant or worsening volume overload)

Question 14

T/F: If a patient is having an acute exacerbations of their HF-Reduced they must be D/C immediately

Answer 14

False: Beta-blockers should not be D/C if already taking and exacerbations occur afterwards

Question 15

What are the beta-blockers used in HF-Reduced, what is the initial dose and Target hgih dose

Answer 15

Metoprolol Succinate: 12.5-25 mg every day, 200 mg every day
Bisoprolol: 1.25 mg every day, 10 mg every day
Carvedilol: 3.125-6.25 mg BID, 25-50 mg BID

Question 16

What should be done to the Beta-blocker if signs and symptoms HF worsen

Answer 16

Give more diuretic or increase the dose in small increments

Question 17

What should be done to the beta-blocker if there is symptomatic Bradycardia, If 2nd/3rd heart block

Answer 17

Lower the dose, D/C if not resolved with lowering the dose

Question 18

What should be done to the beta-blocker if there is symptomatic hypotension

Answer 18

Possibly lower the diuertic dose, Seperate the ACE and BB dose by am and pm, Change carvedilol to metoprolol

Question 19

How do diuretics aid in the treatment of HF-Reduced

Answer 19

Decrease preload

Question 20

T/F: Diuertics can be used for Stage B,C,D HF patients

Answer 20

False: Diuretics are only used for the symptomatic management of fluid overload in Stage C and D, not stage B where there are no symptoms

Question 21

What type of diuretics are usually used in treating symptoms of heart failure, what is another type of diuretic that can be used and what would it be used for

Answer 21

Loop, thiazides: If the patient has HTN with only mild fluid overload

Question 22

What is the initial starting dose for Loop Diuretics used in symptom management of HF-Reduced

Answer 22

Bumetanide: 0.5-1 mg, Furosemide: 20-40 mg, Torsemide: 10-20 mg

Question 23

T/F: When giving a diuretic the initial dose is greater than the maintenance dose

Answer 23

True

Question 24

Rank the diuretics by oral bioavailability

Answer 24

Bumetanide, torsemide, furosemide

Question 25

What should be done if there is diuretic resistance

Answer 25

Decrease Na diet, combine Loop and thiazide diuretic

Question 26

What would suggest that the diuretic is not working and the patient should seek medical help

Answer 26

Increase 2-3 pounds overnight or 5 pounds in a week

Question 27

How can diuretics cause ototoxicity

Answer 27

Very high doses and rapid IV push

Question 28

T/F: Beta-Blockers and ACEs/ARBs should be reduced if symptoms and BP return to normal or reduce further

Answer 28

False: Beta-blockers and ACEs/ARBs should titrate to target high dose even if symptoms improve and even if the BP is normal