PHARM-- heart failure

Question 1

3 things for primary prevention of HF (stage A)

Answer 1

• control BP
• SGLT2i in T2DM and CVD or high risk for CVD
• optimal CVD managment in pt w/ CVD

Question 2

2 things for preventing the HF syndrome (stage B)

Answer 2

• ACE in pt w/ LVEF < 40% (arb if intolerant)
• BB in pt w/ LVEF < 40%

Question 3

4 core stage C HFrEF meds and 1 PRN

Answer 3

• ARNI (or ACEi, ARB)
• BB
• AA
• SGLT2inhibitors
• Loop diuretics PRN

Question 4

black pt w/ persistent HFrEF should get what med

Answer 4

hydralazine/ISDN

Question 5

pt w/ persistent HFrEF w/ EF < 35% should get what

Answer 5

ICD

Question 6

• Single most effective for mortality benefit in HFrEF
• Proven to delay HF progression at all stages
• in HFpEF its used to manage HTN, DM, CKD

Answer 6

ACEi

Question 7

if pt on ACE has cough what do you do first?

Answer 7

• assess fluid status first before stopping

Question 8

which two classes should you abrupt discontinuation

Answer 8

ACE
ARB

Question 9

• Sacubitril inhibits neprilysin to increase levels of natriuretic peptides which counters ATII
• Reduces mortality & hospitalization for chronic HF (class II-III) w/ reduced EF
• higher risk of angioedema than ARB alone; not to be used in h/o angioedema

Answer 9

ARNI (sacubitril/valsartan)

Question 10

these are C/I of what

• Pregnancy
• h/o angioedema
• Severe hepatic imp. (child-pugh C)
• Concurrent Use of ACEi, aliskiren in DM or other ARB

Answer 10

ARNI

Question 11

Must use NT-proBNP to monitor BNP levels in HF diagnosis when prescribing which med?

Answer 11

ARNI

Question 12

• blocks NE to decrease afterload & HR while improving SV
• decreases remodeling
• increases EF longterm (after initial decline)
• prevents arrhythmias

Answer 12

• metroprolol
• carvedilol

Question 13

when is BB used in HF

Answer 13

• used in HFrEF w/ no or minimal evidence of fluid retention
• added in stage B usually after ACE/ARB

Question 14

which class has these C/I

High degree heart block
Sick sinus syndrome
Severe asthma/COPD (caution)
Vasospastic angina

Answer 14

BB

Question 15

which class has these ADRs

• Hypotension, brady
• 1st deg. Heart block
• Bronchospasms
• Glucose intolerance (non-vasodilating BB)
• Impotence
• Feeling cold

Answer 15

BB

Question 16

when do we use BB in HFpEF

Answer 16

only if they have an arrhythmia like afib or aflutter too

Question 17

if patient is ____ and ____ do not start BB therapy

Answer 17

not euvolemic and hospitalized d/t HF excerbation

Question 18

to manage many ADR of BB, you should adjust does of what two meds beforehand?

Answer 18

ACE & diuretics

Question 19

3 requirements inorder to use spironolactone in Stage C HFrEF

Answer 19

• EF < 35
• CrCl >30 or SCr 2.5+
• K+ < 5

Question 20

3 requirements inorder to use spironolactone in Stage C HFpEF

Answer 20

• EF over 45 + elevated BNP or HF hospitalization w/in 1 yr
• CrCl over 30 or SCr under 2.5
• K+ < 5

Question 21

which med has these C/I

renal failure
hyponatremia

Answer 21

spironolactone

Question 22

these are ADR of what med

• Hyperkalemia
• Gynecomastia, breast tenderness
• Hirsutism
• Menstrual changes
• Metabolic acidosis

Answer 22

spironolactone

Question 23

a weak diuretic and aldosterone antagonist that decreases mortality

Answer 23

spironolactone

Question 24

Inhibits water transport across loop of Henle → increased water, Cl-, Na+, K+ excretion

Answer 24

furosemide

Question 25

recommended in anyone w/ evidence of fluid retention to improve sx and prevent worsening HF

Answer 25

diuretics

Question 26

why must furosemide be used in combo w/ vasodilator (ARNI/ACE/ARB)?

Answer 26

to minimize RAAS stimulation since increasing diuresis will decrease preload

Question 27

why are loop diuretics preferred in HF (2)

Answer 27

* superior fluid clearance that works despite renal impairment * increasing dose increases diuretic response

Question 28

# these ADRs belong to what medication * hypotension * electrolyte imablanc * alkalosis * dehydration * gout * ototoxicity w/ IV form

Answer 28

furosemide

Question 29

2 indications for for hydralazine/ISDN

Answer 29

* intolerant to ACE/ARB/ARNI * add-on in black pts w/ stage C HFrEF who remain symptomatic

Question 30

reduces resistance to LV ejection decreases ventricular filling pressure increases SV

Answer 30

hydralazine/ISDN

Question 31

role of hydralazine & ISDN in the combo form

Answer 31

* hydralazine: direct vasodilator (decreases afterload) * ISDN: increases NO concentration (decreases preload & afterload)

Question 32

vasodilator added after optimizing GDMT in patients w/ symptomatic HF to **decrease hospitalization**

Answer 32

digoxin

Question 33

* (+) inotrope * (-) chronotrope * inhibit renin production

Answer 33

digoxin (digitalis)

Question 34

which med should you Monitor doses w/ pulmonary artery catheter

Answer 34

milrinone

Question 35

# these are ADRs of what * Hypotension * Ventricular arrhythmia * Reflex tachycardia * thrombocytopenia

Answer 35

the IV positive inotropes (dobutamine & milrinone)

Question 36

with which med is concurrent BB use a C/I?

Answer 36

dobutamine

Question 37

* CNS-- fatigue, weakness, confusion, insomnia * GI- anorexia, N/V/D * Visual-- halos, hazy, blurry * Cardiac-- SA/AV node dep., AV block, arrhythmias * Predispose. Low K,Mg and high Ca

Answer 37

digoxin ADR

Question 38

toxicity that causes hyperkalemia; managed with DSFab, Mg

Answer 38

digitalis toxicity

Question 39

combining which 3 meds increases risk of hyperkalemia

Answer 39

ACE + ARB + AA

Question 40

which 3 meds have no mortality benefit

Answer 40

* digoxin * furosemide * IV positive inotropes