NAPLEX 2026-Chronic Heart Failure

Hypercalcemia

Hypokalemia

Hypomagnesemia

What electrolyte abnormalities increase risk of digoxin toxicity?

- Amiodarone

- Dofetilide

What antiarrhymics are preferred to maintain normal sinus rhythm in patients with comorbid atrial fibrillation and heart failure with reduced ejection fraction?

Ivabradine

What is a heart rate lowering agent ie, a (negative chronotrope), that can be added to optimized first line treatments for heart failure with reduced ejection fraction to decrease hospitalizations?

normal sinus cardiac rhythm

resting HR >70 BPM

What are use criteria for ivabradine?

negative chronotrope (slows HR)

positive inotrope (increases contraction)

What are the hemodynamic effects of digoxin?

40 mg daily in 1 - 2 divided doses

What target dose should most ACE Inhibitors be titrated to in patients with heart failure with reduced ejection fraction?

20 mEq / 15 mL

Potassium chloride 10% oral solution contains how many milliequivalents of potassium chloride?

Valsartan / Sacubitril

Entresto =

HR x SV

CO =

CO / BSA

CI =

omega 3 fatty acid

hawthorne

coenzyme Q10

What are natural products for HF?

Ephedra (Ma huang)

What natural products to avoid for HF?

Drug Information NATION

- Dipeptidyl Peptidase-4 Inhibitors

- Immunosuppressants

- Non-dihydropyridine calcium channel blockers

- Antiarrhythmics

- Thiazolidinediones

- Itraconazole

- Oncology drugs

- NSAIDs

What are drugs that cause or worsen heart failure?

Monitor and document weight daily

call provider if weight increase by 2 to 4 pounds in one day or ≥ 5 pounds in one week or if symptoms worsen

Lifestyle management: Patients with heart failure should be instructed to:

ACE/ARB/ARNI

Beta blocker

Aldosterone receptor antagonist

SGLT2 inhibitor

What are the guideline directed medical therapy for heart failure with reduced ejection fraction for all patients without contraindications?

loop diuretics

hydralazine and nitrate (Bidil)

ivabradine

digoxin

vericuat

What are additional medications, add-on in select patients?

Hydralazine and nitrate (Bidil)

Which medication decrease morbidity and mortality in self identified black patients with NYHA class III - IV HF when added to optimized initial medication's?

* Can be considered for patients who cannot receive a RAAS inhibitor due to intolerance or renal insufficiency

24/26mg BID

If previously taking a moderate-high dose of ACE inhibitor or ARB start 49/51mg BID

What is the starting dose for Entresto?

97/103mg BID

What is the target dose for Entresto?

can cause fetal death. do not use in the second or third trimester

What is a black box warning for Entresto?

do not use within 36 hours of an ACE

do not use if hx of angioedema

do not use with aliskiren in diabetes

What are contraindications for Entresto?

cough

angioedema

hyperkalemia

renal impairment (increased risk with bilateral artery stenosis)

hypotension/dizziness (especially when used with a thiazide)

What are side effects for Entresto?

Angioedema

Hyperkalemia

Renal impairment (increased risk with bilateral artery stenosis)

Hypotension / dizziness (especially when used with a thiazide)

What are warnings for Entresto?

BP, potassium, SCr, s/sx of HF, angioedema

What are monitoring parameters for Entresto?

ACE / ARB

Do not use Entresto with?

Washout period

When switching to Entresto from an ARB there is no ___________ required.

6.25mg TID 1 hour before meals

What is the starting dose for captopril?

50mg TID

What is the target dose for captopril?

2.5mg BID

What is the starting dose for enalapril?

10 - 20 mg BID

What is the target dose for enalapril?

5-10mg daily

What is the starting dose for fosinopril?

40mg daily

What is the target dose for fosinopril?

2.5-5mg daily

What is the starting dose for lisinopril?

20-40 mg daily

What is the target dose for lisinopril?

2mg daily

What is the starting dose for perindopril?

8-16mg daily

What is the target dose for perindopril?

5mg BID

What is the starting dose for quinapril?

20mg BID

What is the target dose for quinapril?

can cause fetal death. do not use in the second or third trimester

What are the box warnings for ACE inhibitors?

do not use within 36 hours of Entresto

do not use if hx of angioedema

do not use with aliskiren in diabetes

What are contraindications for ACE inhibitors?

cough
angioedema

hyperkalemia

renal impairment (increased risk with bilateral renal artery stenosis)

hypotension/dizziness (especially when used with a thiazide)

What are warnings for ACE inhibitors?

Cough

Angiodema

Hyperkalemia

Renal impairment (avoid use in bilateral renal artery stenosis)

Hypotension / dizziness (especially if used with a thiazide)

What are side effects for ACE inhibitors?

BP, potassium, SCr, s/sx HF, angioedema

What are monitoring parameters for ACE inhibitors?

4-8mg daily

What is the starting dose for Candesartan?

32mg daily

What is the target dose for Candesartan?

25-50mg daily

What is the starting dose for losartan?

50-150mg daily

What is the target those for losartan?

40mg bid

What is the starting dose for valsartan?

160mg BID

What is the target dose for valsartan?

same as ACE

less cough

less angioedema

hyperkalemia

renal impairment (increased risk with bilateral renal artery stenosis)

hypotension/dizziness (especially if used with a thiazide)

no washout period required when switching to Entresto

What are warnings / SE / black box / monitoring parameters for ARBs?