Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics III > Sowinski Heart Failure Part 2 > Flashcards

Sowinski Heart Failure Part 2 Flashcards

1
Q

Which drugs treat mortality or mortality and hospitalization?

A

-Beta-blockers
-ACEI/ARB/ARNI
-Mineralocorticoid receptor antagonists (MRA)
-Isosorbide/hydralazine
-SGLT2I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which drugs treat hospitalizations?

A

-Digoxin
-Ivabradine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which drugs treat hemodynamic or physical function?

A

-Digoxin
-Isosorbide/hydralazine
-Inotropes
-Milrinone
-Sodium nitroprusside
-Nesiritide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which drugs treat QOL or symptoms?

A

-Digoxin
-Diuretics
-Nesiritide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the neurohormonal blockers?

A

-ARNI/ACE/ARB
-Beta-blockers
-SGLT2i
-MRA
-ISDN/hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In which patients should ACE inhibitors be used?

A

Must be used in all who do not have contraindications regardless of etiology or severity of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In which patient populations see additional benefits with ACE use?

A

-IHD
-CKD
-Post-MI
-DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ACE inhibitor mechanism of action

A

-Prevents conversion of angiotensin I to angiotensin II
-Blocks the conversion of bradykinin to inactive peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is it beneficial to block the conversion of bradykinin to inactive peptides?

A

Allows activation of the bradykinin receptor leading to improved endothelial function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is it beneficial to block the conversion of angiotensin I to angiotensin II?

A

Angiotensin II cause increased afterload disease progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ACE inhibitor benefit in heart failure

A

-Improved endothelial function
-Decreased NE
-Inhibition of cardiac hypertrophy
-Improved cardiac hemodynamics
-Reduced aldosterone
-Decreased endothelin-1
-Decreased arginine vasopressin
-Reduced vasoconstriction
-Reduced Na and water retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Initial dose of enalapril

A

2.5-5 mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Target dose of enalapril

A

10 mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Initial dose of captopril

A

6.25-12.5 mg TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Target dose of captopril

A

50 mg TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Initial dose of lisinopril

A

2.5-5 mg QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Target dose of lisinopril

A

20-40 mg QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ACE dosing conversions

A

20 mg E = 150 mg C = 20 mg L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to dose ACEi

A

-Titrate dose to target dose
-Start low and double dose every 1-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When to be cautious with ACEi use

A

-Volume depleted
-SBP less than 80
-K over 5
-SeCr over 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ACEI absolute contraindications

A

-Pregnancy or intending to become pregnant
-History of angioedema or hypersensitivity
-Bilateral renal artery stenosis
-History of WELL-DOCUMENTED intolerance due to symptomatic hypotension, decline in renal function, hyperkalemia or cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What to monitor in patients taking ACEi

A

-Volume status
-Renal function
-Serum potassium
-Blood pressure
-Other adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ACEi adverse effects

A

-Hypotension
-Functional renal insufficiency
-Hyperkalemia
-Skin rash and dysgeusia
-Cough
-Angioedema

24
Q

Losartan initial dose

A

25-50 mg daily

25
Q

Losartan target dose

A

150 mg daily

26
Q

Valsartan initial dose

A

20-40 mg BID

27
Q

Valsartan target dose

A

160 BID

28
Q

Candesartan initial dose

A

4 mg daily

29
Q

Candesartan target dose

A

32 mg daily

30
Q

When to use ARBs

A

If unable to take ACEi due to cough, angioedema, etc.

31
Q

Sacubitril/Valsartan indication

A

Reduce the risk of CV death/hospitalization for HFrEF patients with NYHA Class II-IV

32
Q

Adverse effects of sacubitril/valsartan

A

-Hypotension
-Elevations in SeCr, SeK
-Angioedema (rare)
-Pregnancy
-Expensive (~$600/month)

33
Q

What is more effective ACE or ARNI?

A

ARNI showed a 20% reduction in primary endpoint

34
Q

Initial dose of ARNI when switching from a high dose ACEI/ARB

A

S 49/V 51 mg BID

35
Q

Max dose of ARNI when switching from a high dose ACEI/ARB

A

S 97/V 103 mg BID

36
Q

Initial dose of ARNI when switching from low-to medium dose ACEI/ARB or if the patient is ACEI/ARB naive, EGFR <30, moderate hepatic impairment, or age >75 years

A

S 24/V 26 mg BID

37
Q

What is considered a high dose of ACEI?

A

Greater than E 10 mg/day = C 75 mg/day = L 10-20 mg/day

38
Q

ARNI contraindications

A

-Within 36 hours of ACEI use
-Angioedema with an ACEI or ARB previously
-Pregnancy
-Lactation
-Severe hepatic impairment
-Concomitant use of aliskiren in patients with diabetes
-Known hypersensitivity to either ARB or ARNI

39
Q

Stage B recommendations for ARNi/ACEi/ARB use

A

-ACEIs
-ARBS: if intolerant to ACEIs

40
Q

Stage C recommendations for ARNi/ACEi/ARB use

A

-ARNi: patients with current or previous symptoms (patients with current or previous symptoms who tolerate an ACEi or ARB, replacement with ARNi further reduces mortality)
-ACEi: patients with current or previous symptoms when use of ARNI is not feasible (financial)
-ARBs: If intolerant to ACEis when ARNI is not feasible (ARBs are reasonable alternatives as first-line agents especially if taking an ARB for another indication)
-

41
Q

Which beta-blockers are approved for the treatment of HF?

A

-Carvedilol
-Metoprolol CL
-Bisoprolol

42
Q

How do beta-blockers benefit patients with HF?

A

-Decrease ventricular arrhythmias
-Decrease cardiac hypertrophy and cardiac cell death
-Decrease VC and HR
-Decrease cardiac remodeling

43
Q

Carvedilol (Coreg) target dosing

A

25-50 mg BID

44
Q

Bisoprolol target dosing

A

10 mg QD

45
Q

Metoprolol CR/XL target dosing

A

200 mg QD

46
Q

Which HF patients are candidates for beta-blocker treatment?

A

-STABLE and euvolemic patients
-Symptomatic patients should receive diuretics also, especially with current or recent history of fluid retention
-Should be considered in patients with bronchospastic disease and asymptomatic bradycardia, but cautiously
-For hospitalized patients start later in hospital stay
-Do not abruptly discontinue

47
Q

Carvedilol (Coreg CR) target dosing

A

80 mg daily

48
Q

Bisoprolol initial dosing

A

1.25 mg daily

49
Q

Carvedilol (Coreg) initial dosing

A

3.125 mg BID

50
Q

Carvedilol (Coreg CR) initial dosing

A

10 mg daily

51
Q

Metoprolol CR/XL initial dosing

A

12.5-25 mg daily

52
Q

How to dose beta-blockers

A

-Double the dose every 2 weeks and MONITOR closely vital signs and symptoms
-Planned dose increases can be slowed if necessary to manage
-AIM FOR TARGET DOSE in 8-12 weeks or highest tolerated dose

53
Q

Beta-blocker monitoring

A

-BP
-HR (Goal HR not defined but aim for around 50-60 bpm)
-Edema and fluid retention
-Fatigue or weakness

54
Q

Stage B recommendations for beta-blocker use

A

All patients should be on beta-blocker unless contraindicated

55
Q

Stage C recommendations for beta-blocker use

A

All patients should be on beta-blocker unless contraindicated

Therapeutics III (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions