CHF (not done)

What are the major adverse effects of ACE inhibitors, ARBs, and ARNIs?

Angioedema, cough, hyperkalemia, renal impairment, and fetal injury/death

What are the signs and risk of angioedema with ACE inhibitors, ARBs, and ARNIs?

Swelling of the lips, tongue, face, and upper airway; highest risk with ACE inhibitors and ARNIs due to increased bradykinin

What should you do if angioedema occurs with an ACE inhibitor, ARB, or ARNI?

Do not rechallenge the patient

How is the cough caused by ACE inhibitors and ARNIs described?

Dry, hacking cough

Which drugs have the highest risk of causing cough due to increased bradykinin?

ACE inhibitors and ARNIs

What should be done if an ACE inhibitor causes a cough?

Switch to an ARB

Who is at increased risk for hyperkalemia with ACE inhibitors, ARBs, or ARNIs?

Patients with CKD or those taking other medications that increase potassium

What should be monitored to detect hyperkalemia during ACE inhibitor, ARB, or ARNI therapy?

Serum potassium

Who is at increased risk for renal impairment with ACE inhibitors, ARBs, or ARNIs?

Patients with bilateral renal artery stenosis, heart failure, or acute volume loss/dehydration

What should be monitored to detect renal impairment during ACE inhibitor, ARB, or ARNI therapy?

Serum creatinine

What is the pregnancy warning for ACE inhibitors, ARBs, and ARNIs?

Boxed warning for fetal injury or death

What should be done if pregnancy is detected while taking an ACE inhibitor, ARB, or ARNI?

Discontinue the medication as soon as pregnancy is detected

What is Entresto (sacubitril/valsartan)?

An angiotensin receptor-neprilysin inhibitor (ARNI) that is first-line and reduces mortality in HFrEF

What two medications make up Entresto (sacubitril/valsartan)?

Sacubitril + valsartan

Why is Entresto (ARNI) preferred over an ACE inhibitor or ARB in HFrEF?

It targets two different neurohormonal pathways and reduces mortality

How does valsartan work in Entresto?

Blocks angiotensin II (AT II) receptors, reducing vasoconstriction and aldosterone release

How does sacubitril work in Entresto?

Inhibits neprilysin, increasing natriuretic peptides and causing vasodilation and diuresis

What are the clinical features of drug-induced lupus erythematosus (DILE)?

Malar ("butterfly") rash, fever, fatigue, weight loss/anorexia, photosensitivity, myalgia/arthralgia, positive ANA and antihistone antibodies

Which antihypertensives commonly cause drug-induced lupus?

Methyldopa and hydralazine

Which thionamides commonly cause drug-induced lupus?

Propylthiouracil (PTU) and methimazole

Which antiarrhythmics commonly cause drug-induced lupus?

Procainamide and quinidine

Which anti-infectives commonly cause drug-induced lupus?

Minocycline, terbinafine, and isoniazid

Which biologic class is associated with drug-induced lupus?

All TNF inhibitors

How is drug-induced lupus managed?

Discontinue the causative drug; symptoms usually resolve within weeks to months

What is the target dose of sacubitril/valsartan (ARNI) for HFrEF?

97 mg/103 mg BID

What is the target dose of most ACE inhibitors for HFrEF?

40 mg daily in 1-2 divided doses

What is the target dose of ramipril for HFrEF?

10 mg daily

What is the target dose of losartan for HFrEF?

50-150 mg daily

What is the target dose of valsartan for HFrEF?

160 mg BID

What is the target dose of metoprolol succinate for HFrEF?

200 mg daily

What are the target doses of carvedilol for HFrEF?

IR: ≤85 kg 25 mg BID, >85 kg 50 mg BID; CR: 80 mg daily

What is the target dose of spironolactone for HFrEF?

25-50 mg daily

What is the target dose of SGLT2 inhibitors for HFrEF?

Dapagliflozin and empagliflozin: 10 mg daily