Phamcotherapy of Heart Failure with Reduced Ejection Fraction Flashcards
How does angiotensin II contribute to HF-Reduced
Increased preload, vascular congestion, increased afterload, lower stroke volume, higher myocardial demand, lower cardiac output, arrhythmias
How does Aldosterone contribute to HF-Reduced
Increased prelaod, vascular congestion, lower cardiac output, arrhythmias
How does norephinephrine contribute to HF-Reduced
Increased myocardial demand, apoptosis, lower cardiac output, arrhythmias
How do ACE-I and ARBs aid in treatment of HF-Reduced
Decrease preload, decrease afterload, decrease cardiac remodeling
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
True
What are the ACE-I used in HF-Reduced, what is the initial dose and Target high dose
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
What is the drug class that should be used if ACE-I are not tolerate for HF-Reduced
ARBs
T/F: ACEs and ARBs should never be combined
True
What are the ARBs used in HF-Reduced, what is the initial dose and Target high dose
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
What should be monitored when using ACE-I and ARB, what is key contraindication
Renal function and Potassium 1-2 weeks of initiation and after increases then every 6 months, Pregnancy
How do beta-blockers aid in treatment of HF-reduced
Decrease Afterload, Decrease cardiac Remodeling
T/F: Beta-blockers should be added to alongside ACEs/ARBs for HF-Reduced regimen
True
When should a beta-blocker be started
AFTER acute exacerbations are resolved (significant or worsening volume overload)
T/F: If a patient is having an acute exacerbations of their HF-Reduced they must be D/C immediately
False: Beta-blockers should not be D/C if already taking and exacerbations occur afterwards
What are the beta-blockers used in HF-Reduced, what is the initial dose and Target hgih dose
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
What should be done to the Beta-blocker if signs and symptoms HF worsen
Give more diuretic or increase the dose in small increments
What should be done to the beta-blocker if there is symptomatic Bradycardia, If 2nd/3rd heart block
Lower the dose, D/C if not resolved with lowering the dose
What should be done to the beta-blocker if there is symptomatic hypotension
Possibly lower the diuertic dose, Seperate the ACE and BB dose by am and pm, Change carvedilol to metoprolol
How do diuretics aid in the treatment of HF-Reduced
Decrease preload
T/F: Diuertics can be used for Stage B,C,D HF patients
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
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
Loop, thiazides: If the patient has HTN with only mild fluid overload
What is the initial starting dose for Loop Diuretics used in symptom management of HF-Reduced
Bumetanide: 0.5-1 mg, Furosemide: 20-40 mg, Torsemide: 10-20 mg
T/F: When giving a diuretic the initial dose is greater than the maintenance dose
True
Rank the diuretics by oral bioavailability
Bumetanide, torsemide, furosemide
