Question 6 Flashcards
1
Q
What is Entresto Indicated for?
A
- to reduce the risk of cardiovascular death and hospitalizations for HF in adult patients with chronic HF
- benefits are most evident in patients with left ventricular ejection fraction below normal.
- in pediatric patients, its indicated for treatment of symptomatic HF w/systemic left ventricular systolic dysfunction in patients 1+
2
Q
Normal levels for left ventricular ejection fraction
A
between 55%-70%
3
Q
3 types of systems Entresto works on
A
- Renin-angiotensin-aldosterone system (RAAS)
- Sympathetic nervous system (SNS)
- Natriuretic peptide system.
4
Q
Over-activation in RAAS and SNS Systems leads to increase in
A
- peripheral resistance
- heart rate
- blood volume
- blood pressure
5
Q
Ventricular remodeling changes cause heart to activate
A
natriuretic pepide system
6
Q
In the natriuretic peptide system
A
- ANP and BNP are released following myocardial stretch
- they protect the cardiac and renal functions, in addition to being important prognostic indicators for HF
- they are broken down by neprilysin
7
Q
How does Entresto work?
A
- works in these systems with the use of a neprilysin inhibitor, sacubitril, and valsartan.
- inhibits neprilysin via LBQ657 which is the active metabolite of sacubitril.
- From there valsartan kicks in and blocks angiotensin II type 1 receptor
8
Q
What can occur when taking Entresto?
A
- hypotension
- hyperkalemia
- cough
- dizziness
- renal failure
9
Q
Entresto is not recommended for
A
patients who are pregnant or trying as it has a black box warning for fetal toxicity.
10
Q
Administration for Entresto
A
- taken orally twice daily
- Recommended starting dose is 49/51mg
- the dosage can be adjusted every 2-4 weeks to the target maintenance dose of 97/103mg as tolerated by the patient.
- Recommended that patients starting entresto make sure they do a 36-hour wash-out period if switching from an ACE inhibitor to Entresto. interaction can cause angiodema.
