HF drugs

Question 1

In BP=HRxSVxSVR, where do ACES,ARBs, and Aldosterone antagonists work?

Answer 1

SV and SVR–> Decrease SV and SVR

Decrease Afterload and preload

Question 2

What are the aldosterone antagonists

Answer 2

eplarinone and spironolactone

Question 3

SIs of Aces and ARBs

Answer 3

HyperKalemia
Renal injury (Sr CReatinine)
Cough
Angioedema
Fetaltoxicity

Question 4

DHP CCBs

Answer 4

-dipene
Amlodipine
nifedipine

Decrease Afterload, no effect on inotropy or chronotropy

Question 5

Non DHP CCBs

Answer 5

Diltazam, Verapamil
Decrease Chronotropy, slow SA node excitability and AV node conduction
Decrease inotropy and contractility

Question 6

Which medication do you avoid giving with BBs

Answer 6

Non DHP CCBs (Diltiazem, verapamil) because they have additive effects

Question 7

A1 agonism effects and medications

Answer 7

Agonism= constriction
antagonism= vasodilation

• Zosins (Prazosin)

Question 8

A2 agonist effect

Answer 8

Opposite of A1
A2 receptors inhibit release of norepi, so decreases sympathetic tone

Clonidine, methyldopa

Question 9

Preferred agents for HTN in pregnancy

Answer 9

Lower HTN for New Moms
- Lobetolol (BB– B blocker and A1 blocker, cause decrease inotropy, decrease chronotropy, bronchoconstriction, vasoconstriction)
- Hydralazine (Vasodilator, direct acting, Last line for HTN, Cause Hypotension, tachy, Na and H2O retention)
- Nifedipine (DHP CCB)
- Methyldopa ( A2 agonist)

Question 10

AEs for ARNIs

Answer 10

BP low
Serum Cr
Serum K
Angioedema

Question 11

What do you have to washout before starting an ARNI

Answer 11

if the patient is on an ACE, wait 36 hours before starting ARNI to avoid angioedema risk

Question 12

Which HF BB can you give to someone who also has severe asthma

Answer 12

Bisoprolol or Metropolol, NOT Carvedilol as carvedilol also has B2 affects on bronchoconstriction

Question 13

If you are starting a patient on spironolactone, what are you counceling them on specifically?

Answer 13

Potassium in their diet– keep to a minimum as their spironolactone causes K retention.

Question 14

If a patient is getting UTIs from their HF meds, which meciation is most likely the culpirit?

Answer 14

SGLT2 inhibitor- causes excretion of glucose through urine
Dapagliflozin or empagliflozin

Question 15

An asymptomatic patient with an EF of 38% wants to start HF treatment. What should they begin?

Answer 15

• ACE/ARNI– use in C-D
• BB – use in stage A-D
• MRA – if less than 40% use this

WAIT to start SGLT2 until you see sx in order to see benifits from this