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Pharm Chronic HF > Chronic HF Pharm 1 > Flashcards

Chronic HF Pharm 1 Flashcards

1
Q

Name 4 mortality reducing agents used in HF

A

ACE/ARS, BB, Aldosterone blocking agents, Vasodilators

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2
Q

Morbidity reducing agent in HF

A

Digoxin, Diuretics

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3
Q

Beta Blockers Dosing: can be used in..

A

Stage A or B, should be used in stage C; goal dosing are essential in maximizing mortality/morbidity benefit

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4
Q

Dosing of Metoprolol succinate

A

6.25-12.5mg/day; goal 200mg/day

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5
Q

dosing of Bisopolol

A

1.25mg/day;goal 10mg/day

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6
Q

dosing of Carvedilol

A

3.125mg twice daily; goal 25 mg twice daily

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7
Q

ADR BBs

A

Bradycardia
Worsening of HF if dose is started too high or up titrated too quickly
Respiratory issues

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8
Q

Why don’t we use metoprolol tartrate in HF?

A

MERIT HF clinical trial showed metoprolol succinate is superior to metoprolol tartate

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9
Q

MOA of Beta blockers

A

blockage of beta receptors leading to decreased HR, decreased BP, increased coronary artery blood flow

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10
Q

ACEi/ARBs MOA

A
  • Interference wuth RAAS ending with disruption of angiotensin II
  • decreases BP, Na/H2O retention
  • Afterload reducer
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11
Q

Key PK note re ACEi/ARBs:

A

Highly excreted via kidneys;dose reductions often necessary as long as K is within normal limits

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12
Q

ACEi/ARBs Dosing (used in all stages of HF): 3 bullet points

A
  • All ACEi/ARBS have been used in HF
  • Goal doses are essential in maxing mortality/morbidity benefit
  • Lisinopril: start 5mg/day, goal dose of 20-40 mg daily
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13
Q

Three ADRs of ACEi/ARBs

A

Hyperkalemia
Cough (acei)
Hypotension

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14
Q

Absolute contraindications for ACEi/ARBs

A

-pregnancy
Hyperkalemia
Bilateral renal artery stenosis
Angioedema

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15
Q

MOA Aldosterone Blockers (spironalactone or eplirinon)

A

Competes with aldosteron for intracellular mineralcorticoid receptors-> Na and H20 excretion (this also increases K in the blood)
-decreases preload

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16
Q

Key PK notes re Aldosterone blockers

A

Highly protein bound

primarily renally excreted

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17
Q

Aldosterone Blockers Dosing used in which stages of HF?

A

C an D

18
Q

Aldosterone blocker dosing spironalactone

A

12.5-25mg/day

19
Q

eplerenone dosing

A

25mg/day

20
Q

ADRs of Aldosterone blockers

A

Hyperkalemia

Gynecomestia

21
Q

Absolute contraindications of Alosterone blockers

A

hyperkalemia

22
Q

MOA Vasodilators

Hyralazine

A

direct arterial vasodilator

preom. vasodilates in coronary, cerebral, and renal arteries

23
Q

Isosorbide dinitrate MOA

A

direct venodilator

Converts into NO which produces vasodilation

24
Q

Key PK notes re Vasodilators

A

used in place of ACEi contraindications;not renally excreted

25
Q

Dosing of Vasodilators used in what stage?

A

used in stage C in african americans and in B/C/D if a contraindication to ACEi exists, race does not matter

26
Q

Hydralazine/ISDN Dosing

A

:37.5/20mg 3x daily titrating to goal of 75mg/40mg 3x daily

27
Q

Vasodilators ADRS

A

tolerance to nitrates

hypotension

28
Q

Loop diuretics MOA

A
  • exert their action at the loop of henle
  • increase na and h20 excretion
  • all diuretics reduce preload and edema
29
Q

Key PK notes re Loop diuretics

A

may require higher than usual doses to induce diuresis in pts with renal failure

30
Q

Loop Diuretics initial dosing should be used only for which classes of HF?

A

symptomatic (C or D)

31
Q

Furosemide dosing

A

10-40mg/day

32
Q

bumetanide dosing

A

.5-1mg/day

33
Q

torsemide dosing

A

10-20mg/day

34
Q

Goal of loop diuretic dosing

A

after initial diuresis and reduction of fluid try to get to the lowest dose possible or even consider d/c’ing

35
Q

ADRs of Loop Diuretics

A 
Electrolyte imbalances (MC)
hyperglycemia
hyperuricemia
hypokalemia
hypomagnesemia
36
Q

Digoxin MOA

A

positive inotropic activity and negative chronotropic activity
-increase in intracellular na and ca increase in force of contraction

37
Q

Key PKA notes Digoxin

A

large VD, larger in obsese/smaller in elderly

-primarily renally excreated

38
Q

Digoxin dosing

A

recommended low dose for normal renal function .125mg/day (should only be used in symptomatic HF-stageC/D)

39
Q

Digoxin dosing elderly or renal insuficiency

A

.125 mg every other day
monitor digoxin levels only for toxicity not efficacy
-literature shows worse outcomes with higher normal levels when compared to lower normal levels

40
Q

Digoxin ADRs

A 
high potential for toxicity
Electrolyte disturbances
-hypomagnesmia
-hypokalemia
Bradycardia
GI disturbances (MC)
41
Q

Digoxin “Additional Comments..”

A

Hypokalemia increases the effects of digoxin

Hyperkalemia decreases the effects of digoxin

Pharm Chronic HF (1 decks)

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