Cardio Exam 5 (Hoehns Drugs)

In patients who are pre heart failure, is it appropriate to treat with ACE inhibitors, ARBs or beta blockers?

All three are appropriate

What drugs are the “four pillars” of HFrEF treatment?

ARNi/ACEi/ARB, beta blocker, MRA, SGLT2i

Which type of diuretic is preferred in heart failure treatment?

Loop

The use of hydralazine and nitrates have level 1 evidence in which patient population?

African americans

Can the four pillars (and diuretics) of HFrEF also be used in patients with HFmrEF?

Yes, but they have a lower level of evidence

Can the four pillars (and diuretics) of HFrEF also be used in patients with HFpEF?

No, beta blockers should not be used

Lisinopril initial dose for HFrEF

2.5-5 mg QD

Lisinopril target dose for HFrEF

20-40 mg QD

Sacubitril-valsartan target dose for HFrEF

97/103 mg BID

Carvedilol target dose for HFrEF

25 mg BID

Metoprolol succinate ER target dose for HFrEF

200 mg QD

Spironolactone target dose for HFrEF

25-50 mg QD

Dapagliflozin target dose for HFrEF

10 mg QD

Empagliflozin target dose for HFrEF

10 mg QD

T/F: both dapagliflozin and empagliflozin have a starting dose of 10 mg

True

Which drug can not be used within 36 hours of taking an ACE inhibitor?

Sacubitril/valsartan

All patients with an EF less than 40% (symptomatic and asymptomatic) should be on what drug class if sacubitril/valsartan is not tolerated?

ACE inhibitors

T/F: ARBs are better than ACE inhibitors in the treatment of heart failure

False, they are the same

Which beta blocker is nonselective and also has some alpha 1 inhibitory effects? (others are beta 1 selective)

Carvedilol

Which drug should NOT be started in acutely decompensated chronic HF?

Carvedilol

The following are absolute contraindications of which drug class?

• 2nd or 3rd degree block

• Symptomatic bradycardia

• Symptomatic hypOtension

• Decompensated heart failure

• Severe reactive airway disease like asthma

Beta blockers

T/F: it is recommended to restart a beta blocker in a recently decompensated patient AFTER IV diuretics are discontinued and volume status is stable

True

T/F: in patients with chronic HF, beta blockers should be stopped during an exacerbation

False, they can be continued, possibly at a lower dose

T/F: beta blockers are NOT recommended in patients with COPD and heart failure

False, they are recommended

Which thiazide/like diuretic is used in HF if a loop diuretic is not enough?

Metolazone

T/F: in studies, digoxin showed that all-cause mortality was WORSE than other HF drugs

False, there was no difference in all-cause mortality

Digoxin should be reserved for use in which type of patient?

Severe heart failure, EF<25%

Spironolactone should NOT be used in which patient?

HypERkalemic, poor renal function

T/F: spironolactone is recommended over eplerenone

False, they are equally recommended

T/F: SGLT2 inhibitors should only be used in HF patients who also have diabetes

False, they improve HF outcomes regardless of if the patient has diabetes

SGLT2 inhibitor MOA

Increase glucose excretion through the urine (diuretic effect)

Which drug can be used in HFrEF with the following conditions?

• stable but symptomatic

• in sinus rhythm

• HR greater than or equal to 70 BPM

Ivabradine

Which drug can be used in HFrEF that has the following characteristics?

• EF less than 45%

• doesn’t have great efficacy

• promotes vasodilation

Vericiguat

T/F: the CCBs diltiazem and verapamil may be used in heart failure patients if there is another compelling indication

False, only amlodipine may be used

T/F: it is easy to distinguish between HFrEF and HFpEF patients by visual exam

False, they present very similarly

What is the first line treatment for HFpEF?

SGLT2 inhibitors