PHARM-- heart failure Flashcards
3 things for primary prevention of HF (stage A)
- control BP
- SGLT2i in T2DM and CVD or high risk for CVD
- optimal CVD managment in pt w/ CVD
2 things for preventing the HF syndrome (stage B)
- ACE in pt w/ LVEF < 40% (arb if intolerant)
- BB in pt w/ LVEF < 40%
4 core stage C HFrEF meds and 1 PRN
- ARNI (or ACEi, ARB)
- BB
- AA
- SGLT2inhibitors
- Loop diuretics PRN
black pt w/ persistent HFrEF should get what med
hydralazine/ISDN
pt w/ persistent HFrEF w/ EF < 35% should get what
ICD
- Single most effective for mortality benefit in HFrEF
- Proven to delay HF progression at all stages
- in HFpEF its used to manage HTN, DM, CKD
ACEi
if pt on ACE has cough what do you do first?
- assess fluid status first before stopping
which two classes should you abrupt discontinuation
ACE
ARB
- Sacubitril inhibits neprilysin to increase levels of natriuretic peptides which counters ATII
- Reduces mortality & hospitalization for chronic HF (class II-III) w/ reduced EF
- higher risk of angioedema than ARB alone; not to be used in h/o angioedema
ARNI (sacubitril/valsartan)
these are C/I of what
- Pregnancy
- h/o angioedema
- Severe hepatic imp. (child-pugh C)
- Concurrent Use of ACEi, aliskiren in DM or other ARB
ARNI
Must use NT-proBNP to monitor BNP levels in HF diagnosis when prescribing which med?
ARNI
- blocks NE to decrease afterload & HR while improving SV
- decreases remodeling
- increases EF longterm (after initial decline)
- prevents arrhythmias
- metroprolol
- carvedilol
when is BB used in HF
- used in HFrEF w/ no or minimal evidence of fluid retention
- added in stage B usually after ACE/ARB
which class has these C/I
High degree heart block
Sick sinus syndrome
Severe asthma/COPD (caution)
Vasospastic angina
BB
which class has these ADRs
- Hypotension, brady
- 1st deg. Heart block
- Bronchospasms
- Glucose intolerance (non-vasodilating BB)
- Impotence
- Feeling cold
BB
when do we use BB in HFpEF
only if they have an arrhythmia like afib or aflutter too
if patient is ____ and ____ do not start BB therapy
not euvolemic and hospitalized d/t HF excerbation
to manage many ADR of BB, you should adjust does of what two meds beforehand?
ACE & diuretics
3 requirements inorder to use spironolactone in Stage C HFrEF
- EF < 35
- CrCl >30 or SCr 2.5+
- K+ < 5
3 requirements inorder to use spironolactone in Stage C HFpEF
- EF over 45 + elevated BNP or HF hospitalization w/in 1 yr
- CrCl over 30 or SCr under 2.5
- K+ < 5
which med has these C/I
renal failure
hyponatremia
spironolactone
these are ADR of what med
- Hyperkalemia
- Gynecomastia, breast tenderness
- Hirsutism
- Menstrual changes
- Metabolic acidosis
spironolactone
a weak diuretic and aldosterone antagonist that decreases mortality
spironolactone
Inhibits water transport across loop of Henle → increased water, Cl-, Na+, K+ excretion
furosemide
recommended in anyone w/ evidence of fluid retention to improve sx and prevent worsening HF
diuretics
why must furosemide be used in combo w/ vasodilator (ARNI/ACE/ARB)?
to minimize RAAS stimulation since increasing diuresis will decrease preload
why are loop diuretics preferred in HF (2)
- superior fluid clearance that works despite renal impairment
- increasing dose increases diuretic response
these ADRs belong to what medication
- hypotension
- electrolyte imablanc
- alkalosis
- dehydration
- gout
- ototoxicity w/ IV form
furosemide
2 indications for for hydralazine/ISDN
- intolerant to ACE/ARB/ARNI
- add-on in black pts w/ stage C HFrEF who remain symptomatic
reduces resistance to LV ejection
decreases ventricular filling pressure
increases SV
hydralazine/ISDN
role of hydralazine & ISDN in the combo form
- hydralazine: direct vasodilator (decreases afterload)
- ISDN: increases NO concentration (decreases preload & afterload)
vasodilator added after optimizing GDMT in patients w/ symptomatic HF to decrease hospitalization
digoxin
- (+) inotrope
- (-) chronotrope
- inhibit renin production
digoxin (digitalis)
which med should you Monitor doses w/ pulmonary artery catheter
milrinone
these are ADRs of what
- Hypotension
- Ventricular arrhythmia
- Reflex tachycardia
- thrombocytopenia
the IV positive inotropes (dobutamine & milrinone)
with which med is concurrent BB use a C/I?
dobutamine
- CNS– fatigue, weakness, confusion, insomnia
- GI- anorexia, N/V/D
- Visual– halos, hazy, blurry
- Cardiac– SA/AV node dep., AV block, arrhythmias
- Predispose. Low K,Mg and high Ca
digoxin ADR
toxicity that causes hyperkalemia; managed with DSFab, Mg
digitalis toxicity
combining which 3 meds increases risk of hyperkalemia
ACE + ARB + AA
which 3 meds have no mortality benefit
- digoxin
- furosemide
- IV positive inotropes
