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PHRM 845 > HF pt3 > Flashcards

HF pt3 Flashcards

(61 cards)

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1
Q

What is elevated in HF?

A

Aldosterone

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2
Q

What does an elevation in aldosterone cause?

A
  • Continued sympathetic activation
  • Parasympathetic inhibition
  • Cardiac and vascular remodeling
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3
Q

What are the aldosterone receptor antagonists (MRA)?

A
  • Spironolactone
  • Eplerenone
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4
Q

What is the general MOA of aldosterone receptor antagonists?

A

Block aldosterone effects independent of the effects of ACEi and ARBs

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5
Q

What are the effects of spironolactone and eplerenone?

A
  • Decrease K and Mg losses: may protect against arrhythmias
  • Decrease Na retention: decrease fluid retention
  • Decreases sympathetic simulation
  • Blocks direct fibrotic action on myocardium
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6
Q

Which MRA is the nonselective agent?

A

Spironolactone

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7
Q

What is the MOA of spironolactone?

A

Inhibits effects of dihydrotestosterone at receptor site and increases peripheral conversion of test into estradiol

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8
Q

What are the AEs of spironolactone?

A
  • Gynecomastia (about 10%)
  • Impotence
  • Menstrual irregularities
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9
Q

Which MRA is the selective agent?

A

Eplerenone

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10
Q

What is the MOA of eplerenone?

A

Selective agent w a 100- to 1000- lower affinity for androgen, glucocorticoid, and progesterone receptors than spironolactone

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11
Q

What is the benefit to eplerenone over spironolactone?

A

No antiandrogenic effects

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12
Q

What is a possible downside to eplerenone?

A

Substrate of CYP3A4 (not a problem most of the time)

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13
Q

What is the administration of MRAs?

A

Should be added to ACEi/ARB/ARNI and BB therapy

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14
Q

When should MRAs be avoided?

A
  • SCr >2.5 in males or >2 in females OR CrCl <30 and serum K >5
  • Hx of severe hyperkalemia or recent worsening renal fx
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15
Q

Use of what other therapies must be avoided w MRAs?

A
  • Concomitant use of K sparing diuretics or supps (unless hypokalemia of serum K <4)
  • Avoid NSAIDs and caution in high dose ACEi/ARB
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16
Q

What are the benefits of SGLT2i in HF?

A
  • Decreased arterial pressure and stiffness
  • Preload and afterload reduction and associated reduction in hypertrophy and fibrosis (reduced myocardial remodeling)
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17
Q

What is the indication of SLGT2i?

A

Reduce risk of CV death or hospitalizations for HFrEF pts w NYHA class 2-4

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18
Q

What are the drugs in the SGLT2i class?

A

Dapagliflozin and empagliflozin

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19
Q

What is the dosing of dapa and empa?

A

Both 10 mg once daily

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20
Q

What eGFR must pts have to be on dapa?

A

eGFR >= 30

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21
Q

What eGFR must pts have to be on empa?

A

eGFR >= 20

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22
Q

What are the AEs of SGLT2i?

A
  • Volume depletion
  • Ketoacidosis in DM
  • Hypoglycemia
  • Infection risk
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23
Q

What are the titration strategies after 42 days?

A
  • Maintenance or additional titration of four foundational therapies
  • Consideration of EP device therapies or transcatheter mitral valve repair
  • Consideration of add on meds or advanced therapies, if refractory
  • Manage comobidities
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24
Q

What brand name drug is ISDN/hydralazine?

A

BiDil

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25
What is ISDN/hydralazine known for?
The first drug combo w reduction in mortality
26
What is BiDil indicated for?
For tx of HF in black pts as an adjunct to standard therapy
27
What are the AEs of ISDN/hydralazine?
- HA, nausea, flushing, dizziness, tachycardia, lupus like syndrome - Hypotension, increased HR, myocardial ischemia, fluid retention
28
What is the principal site of action of hydralazine?
Arteriolar VD
29
What is the initial dose of hydralazine?
25 mg TID/QD
30
What is the target dose of hydralazine?
75 mg TID
31
What is the max dose of hydralazine?
100 mg TID
32
What is the principal dose of ISDN?
Venous VD
33
What is the initial dose of ISDN?
20 mg TID/QD
34
What is the target of ISDN?
40 mg TID
35
What is the max dose of ISND?
80 mg TID
36
What is initial dose of BiDil?
20/37.5 mg TID
37
What target and max dose of BiDil?
40/75 mg TID
38
What is the indication of ivabradine?
Reduce the risk of hospitalization (worsening HF) for sx HF, EF <= 35% in normal sinus rhythm w resting HR >= 70 in max tolerated BB or w BB CI
39
What is the dosing of ivabradine?
2.5-5 mg BID, adjust q2 wks based on HR
40
What is the max dose of ivabradine?
- 7.5 mg BID - 2.5 mg BID if conduction defects or when bradycardia is a concern
41
What are the dosing adjustments of ivabradine?
- HR >60: increase dose by 2.5 (given BID) up to a max dose of 7.5 mg BID - HR 50-60: Maintain dose - HR <50 or s/sx of bradycardia: decrease dose by 2.5 mg (given BID); if current dose is 2.5 mg BID, d/c therapy
42
What are the AEs of ivabradine?
- Fetal toxicity - Afib - Bradycardia and conduction disturbances
43
What is the MOA of digoxin?
Inhibits the Na/K ATPase altering excitation-contraction couping: - Increases intracellular Ca, enhancing force of contraction - relatively mild + inotrope
44
What are the benefits of neurohormonal modulation effects of digoxin?
- Increases parasympathetic activity - Vagolytic effects at AV and SA nodes which reduces HR at rest and slows AVN conduction (afib tx) - Re-sensitization of baroreceptors
45
What is the place of digoxin in HF tx?
Efficacy of digoxin in HF w afib is well established
46
What is the dose of digoxin?
0.125-0.25 mg daily
47
What is the goal serum digoxin conc?
0.5-0.9 ng/mL
48
When do you lower doses in digoxin?
Age >70, impaired renal fx, low weight
49
What does amiodarone do to digoxin conc?
Doubles dig conc
50
What does quinidine and verapamil do to digoxin conc?
70% increase in dig conc
51
What does itra/ktz do to digoxin conc?
50-100% increase in dig conc
52
What are the noncardiac AEs of dig?
Mainly affects CNS: - Anorexia, nausea, vomiting, abdominal pain - Visual disturbances: halos, photophobia, altered color perception - Fatigue, weakness, dizziness, HA, neuralgias, confusion, delirium, psychosis
53
What are the cardiac AEs of dig?
- Ventricular: PVCs, bigeminy, trigeminy, VT, VF - AV block: first, second, and third degree - AV junctional escape rhythms, junctional tachycardia - Atrial arrhythmias w slowed AV conduction or AV block - Sinus bradycardia
54
What drug class is vericiguat?
Soluble guanylate cyclase stimulator
55
What are the clinical effects of vericiguat?
Reduces CV death and hospitalizations
56
What are the safety hazards of vericiguat?
- CI in pregnancy - Hypotensions and anemia most common AEs
57
Where can a pt get omega 3 polyunsaturated fatty acids?
Fish
58
What did several studies suggest about the use of omega 3 polyunsaturated FAs?
Reduce the risk in HF (2-4) pts
59
What is the use of antiplatelets in HF?
Long term therapy w ASA 75-81 mg/day is recommended in pts w HF AND IHD/CAD/ASCVD
60
What is the use of anticoags in HF?
- Recommended in HF if afib w one additional r/f - Pts w other indications (hx of systemic or pulmonary embolism) - Otherwise, routine anticoag is not recommended
61
What is the use of CCBs in HF?
- Diltiazem, verapamil, and nifedipine should not be used - Felodipine and amlodipine may be useful in managing angina/HTN if not effectively managed w HF therapies

PHRM 845 (48 decks)

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