Chronic Heart Failure

Question 1

What is Heart Failure

Answer 1

occurs when the heart is not able to supply sufficient oxygen rich blood to the body

SX: fluid overload (edema), shortness of breath

Question 2

percentage

Heart Failure with reduced ejection fraction HFrEF

HF - heart failure; rEF = reduce ejection fraction

Answer 2

Ejection Fraction < 40%

normal: EF > 55%

Question 4

consequences of angiotensin II

name 3 activities of angiotensin II

Answer 4

1. Vasoconstriction
2. aldosterone release: Na and water retention, K excretion
3. Vasopression release from pituitary gland: vasoconstriction and water retention

Question 6

eGFR to use spironolactone

Answer 6

eGFR > 30

Question 7

eGFR to use SGLT2

Answer 7

eGFR > 20

Question 8

Entresto (esp. sacubitril) moa

Answer 8

sacubitril - a neprilysin inhibitor

neprilysin is an enzyme that breaks down vasodilatory peptides (natriuretic peptides), bradykinin

if you inhibit neprilysin –> you get vasodilation and diuresis (decrease edema)

Question 9

entresto target dose

Answer 9

entresto 93/103 BID

Question 10

Enalapril target dose

Answer 10

20 mg BID

Question 11

Lisinopril target dose

Answer 11

40 mg daily

Question 12

Quinapril target dose

Answer 12

20 mg BID

enalapril and quinapril - same target dose

Question 13

Ramipril target dose

Answer 13

10 mg daily

Question 14

name the 3 ARB used in HF

Answer 14

1. Candesartan (Atacand)
2. Losartan (Cozaar)
3. Valsartan (Diovan)

Question 15

candesartan target dose

Answer 15

32 mg daily

Question 16

losartan target dose

Answer 16

150 mg daily (heart failure)

max: 100 mg, in heart failure = 150 mg target dose

Question 17

valsartan target dose

Answer 17

160 mg BID

Question 18

RAAS (ARNI, ACE, ARB) + lithium

Answer 18

can decrease lithium clearance

Question 19

clinical

identify the 3 beta blockers use in HF

Answer 19

1. Metoprolol ER –> lopressor is not recommended
2. Bisoprolol
3. Carvedilol (Ir or ER)

beta-blockers are recommended for all patient with HF

only d/c if pt has decompensated HF, hypotension or hypoperfusion

Question 20

metoprolol target dose

Answer 20

200 mg daily

Question 21

bisoprolol target dose

Answer 21

10 mg daily

Question 22

Carvedilol target dose

Answer 22

< 85 kg (190 lb): 25 mg BID

> 85 kg (190 lb): 50 mg BID

typical adult obese male will be greater than 85 kg (190 lb)

look at me

Question 23

what makes it unique

Kapspargo Sprinkle

Answer 23

metoprolol ER sprinkle

can open and sprinkle onto applesauce

Question 24

clinical

metoprolol IV to PO ration

Answer 24

1 to 2.5

Question 25

Spironolactone target dose

Answer 25

50 mg daily

Question 26

Eplerenone target dose

Answer 26

50 mg daily | Eplerenone and spironolactone: same target dose

Question 27

# 2 differences between eplerenone and spironolactone Eplerenone vs spironolactone

Answer 27

Eplerenone * selectie aldosterone receptor antagonist * MAJOR SUBSTRATE of CYP3A4 - avoid strong inhibitors * increase TG Spironolactone * endocrine side effects (no selective) * less side effects | Same target dose: 50 mg daily

Question 28

when not to initiate spironolactone (2)

Answer 28

K > 5 mEq/L eGFR (CrCL) < 30