heart failure (NAPLEX)

LVEF categories (5)

• 55-70% = normal

• ≥50% = HFpEF

• 41-49% HFmrEF

• ≤40% = HFrEF

• ≤40% @ BL but improves = HFimpEF

ACC/AHA stages (A-D)

• A: at risk for HF

• B : pre-HF; without symptoms

• C: with symptoms

• D: advanced (refractory): severe symptoms

NYHA functional classes (I-IV)

• I: no limitations

• II: symptoms with ordinary physical activity (stairs)

• III: symptoms with minimal exertion (bathing)

• IV: symptoms at rest

What neurohormonal pathways are included with HF? (2)

• RAAS and vasopressin activation

• Sympathetic Nervous System (epi & NE) activation

What drugs can worsen HF? (Its the Drug Info NATION)

• DDP-4 inhibitors

• Immunosuppressants (TNF inhibitors)

• Non-DHP CCB

• Antiarrhythmics (flecainide, drondarone)

• Thiazolidinediones (pioglitazone)

• Itraconazole

• Oncology meds (doxorubicin, trastuzumab)

• NSAIDs

Its the Drug Information NATION

Sodium restriction to <_____ mg/day

1,500

Treatment for HFpEF

• SGLT2 inhibitors preferred

• Spirolonactone, ARB, diuretics can be considered

Target dose for entresto

97/103 BID

Target HF doses for ACEIs and ARBs (6) LEQRLV

• Lisinopril 20-40 mg QD

• Enalapril 10-20 mg BID

• Quinapril 20 mg BID

• Ramipril 10 mg QD

• Losartan 50-150 mg QD

• Valsartan 160 mg BID

Metoprolol succinate target dose

200 mg QD

Beta blockers for HF

• Metoprolol succinate

• Carvedilol

• Bisoprolol

Carvedilol target dose

IR FORM:

• ≤85kg = 25 BID

• >85kg = 50 BID

ER FORM:

• 80 mg QD

Dapagliflozin target dose

10 mg QD

Empagliflozin target dose

10 mg QD

SGLT2 inhibitors should not be started if eGFR< ___-___

< 20-25 mL/min/1.73m2

Spironolactone target dose

25-50 mg QD

Loop diuretics MOA

Inhibit Na-K-2Cl cotransporter in the thick ascending limb of the LOH

Loops examples (4)

• Furosemide (lasix)

• Bumetanide (Bumex)

• Torsemide (Demadex)

• Ethacrynic Acid (Edecrin)

T/F: loops do not improve survival but are often required for symptom control

True

Loops warnings (3)

• Sulfa allergies (besides ethacrynic acid)

• Ototoxicity (Ethacrynic Acid (Edecrin)

• AKI

What loop can be used in sulfa allergies?

Ethacrynic acid

Loops adverse effects (6)

• Decreased Na, K, Cl, Mg, Ca

• Increased uric acid, blood glucose, TG, total cholesterol

• Metabolic alkalosis (inc HCO2)

• Photosensitivity

• Orthostatic hypotension

• Ototoxicity (asked about on uworld)

Furosmide IV:PO ratio

IV:PO ratio is 1:2

Loop diuretic DDI (3)

• NSAIDs

• Ototoxic medications

• Lithium

Hydralazine/isodil MOA combo **

• Hydral decreases afterload as a arterial vasodilator

• Isosorbide dinitrate decreases preload as a venous vasodilator

Ivabradine target HR

50-60 BPM

Ivabradine criteria for use (2)

• Normal sinus rhythmn

• Resting HR ≥70 bpm

T/F: ivabradine can cause an increased risk of atrial fibrillation

True due to bradycardia which can flip into arrhythmias

Ivabradine causes bradycardia or tachycardia?

BRADYCARDIA

Digoxin therapeutic monitoring range for HF

0.5-0.9 ng/mL

Digoxin dosing

0.125-0.25 mg PO QD

• CrCl <60: decrease dose or frequency

• Decrease dose by 20-25% when switching from PO to IV

Digoxin toxicity is at increased risk with what electrolytes (3)

• HypoK

• HypoMg

• HyperCa

Vericiguat MOA

Soluble guanylate cyclase stimulator leading to vasodilation

T/F: KCL tablets can be crushed and sprinkle on food

FALSE - KCl capsules can be opened and sprinkled on small amount of applesauce or pudding

Klor Con vs Klor Con M

• KlorCon: do not crush, crew or suck on tabs

• Klor-Con M can be cut in half or dissolved in water

Klor Con oral solution

• KCl 10% = 20 mEq/15 mL

• Mix each 15 mL with 6 oz water

Complementary and Alternative Medicine (CAM) products for HF (3)

• Coenzyme Q10

• Hawthorn

• Omegas

Loop diuretic conversions PO KNOW :(

Ethacrynic Acid 50 mg = Furosemide 40 mg = Torsemide: 20 mg = Bumetanide 1 mg

Notify provider if weight gain > __-___ lbs in 1 day or ≥ ___ lbs in 1 week.

2-4 lbs or ≥5 lbs in 1 week

Dont start spironolactone if K>____

5

Can eplerenone cause gynecomastia?

No only spironolactone does

ENTRESTO MOA

• Valsartan: Blocks Ang-II from binding to its receptors, preventing peripheral vasoconstriction and the release of aldosterone

• Sacubitril: neprilysin inhibitor that prevents the degradation of and therefore increases the concentration of vasodilatory peptides that promote vasodilation & diuresis

T/F: ARBs decrease Ang-II

FALE - they just block the effects but do not decrease the concentrations

• ACE inhibitors would decrease the conentration by inhibiting the conversion of Ang-I to Ang-II