Chronic Heart Failure

Question 1

common symptoms of HF

Answer 1

fluid overload
SOB
edema

Question 2

EF of what indicates systolic dysfunction or heart failure with reduced ejection fraction

Answer 2

<40%

Question 3

normal EF

Answer 3

55-70%

Question 4

Labs for HF

Answer 4

inc. BNP (normal is <100)

inc. NT-proBNP (normal is <300)

Question 5

Define Cardiac output

Answer 5

the volume of blood that is pumped by the heart in one minute

Question 6

When to notify MD about weight gain

Answer 6

2-4 lbs in one day

3-5 lbs in one week

Question 7

Drugs that worsen HF

Answer 7

"Drug Information NATION"
DPP-4 inhibitors
Immunosuppressants
Non-DHP CCB
Antiarrhythmics-class 1
Thiazolidinediones
Itraconazole
Oncology agents
NSAIDs

Question 8

Medications in HF that decrease mortaility

Answer 8

ACEi/ARB
ARNI (entreso)
BB
Aldosterone receptor antagonists

Question 9

Medication in HF that decrease mortality for select patients

Answer 9

Hydralazine and nitrates
-dec. in black patients with NYHA class 3-4

Question 10

medication in HF that do not decrease HF

Answer 10

loop
digoxin
ivabradine

Question 11

furosemide: bumetanide: torsemide: ethacynic acid equivalent dosing

Answer 11

furosemide 40
bumetanide 1
torsemide 20
ethacrynic acid 50

Question 12

NSAIDs and HF

Answer 12

avoid b/c NSAids inc Na and H20 retention

Question 13

Angioedema is more common ACE vs ARB

Answer 13

ACE

Question 14

Main point about dosing ACEi and ARB in HF

Answer 14

titrate to target dose not BP

Question 15

Enalapril target dose in HF

Answer 15

10-20 BID

Question 16

lisinopril target dose in HF

Answer 16

20-40

Question 17

Quinapril target dose in HF

Answer 17

20

Question 18

Ramipril target dose in HF

Answer 18

10

Question 19

Losartan target dose in HF

Answer 19

50-150

Question 20

Valsartan target dose in HF

Answer 20

160 BID

Question 21

only BB recommended for HF

Answer 21

bisoprolol
carvedilol (IR and ER)
metoprolol succinate ER

Question 22

metoprolol target dose in HF

Answer 22

200mg QD

Question 23

Carvedilol IR target dose in HF

Answer 23

< 85 kg 25 mg BID

> 85 kg 50 mg BID

Question 24

carvedilol ER target dose in HF

Answer 24

80 mg QD

Question 25

target spironolactone dose in HF

Answer 25

25 mg QD or BID

Question 26

Hydralazine MOA

Answer 26

direct arterial vasodilator which decrases afterload

Question 27

Digoxin MOA

Answer 27

inhibits the Na/K ATPase pump which results in a positive inotropic effect (inc. in CO). also exerts a parasympathetic effect which provides a negative chronotropic effect (dec. HR)