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Naplex
Heart Failure - clinical pearl
| Question | Answer |
|---|---|
| Drugs That Cause or Worsen Heart Failure - D I N A T I O N | DPP-4 inhibitors, Thiazolidinediones, Non-DHP CCBs, Antiarrhythmics (less risk with amiodarone & dofetilide), etanercept (Enbrel) and adalimumab (Humira), Itraconazole, anthracyclines, NSAIDs |
| Target dose for Entresto | 97/103 BID |
| Entresto SEs | same as ACE / ARB (Cough & angioedema, increase K, renal impairment, box warning for Pregnancy) |
| Prior initiate Entresto, ACE washout duration | 36 hrs |
| Prior initiate Entresto, ARB washout duration | No need for wash out |
| Target daily dose for ACE in HF | 40 mg, except Altace (ramipril) 10mg |
| Target daily dose for ARB in HF | Valsartan: 160mg BID, losartan: 150 mg QD |
| Beta blocker for HF and target daily dose | Bisoprolol, metoprolol succinate (200mg QD) and carvedilol (25-50mg BID) |
| DON't use ARAs (Spironolactone, Eplerenone) for HF if lab value shows | K ≥ 5 mEq/L or CrCI ≤ 30 mL/min |
| Target daily dose for ARAs | 25-50 mg QD |
| Loop used if Sulfa allergy | ethacrynic acid |
| Loop - Electrolyte abnormalities | hypokalemia, hypomagnesemia, and hypocalcemia |
| Potassium ER capsules Administration | Capsule contents can be sprinkled on a small amount of applesauce or pudding |
| K-Tab, Klor-Con administration | Swallow whole; DON'T chew, crush, cut or suck on the tablet |
| Klor-Con M administration | Can be cut in half or dissolved in water (stir for 2 minutes and drink immediately) |
| Potassium Oral packet | Dissolve contents in water and drink immediately |
| Potassium Oral solution | • КСІ 10% = 20 mEq/15 mL • Mix each 15 mL with 6 oz of water |
| Ototoxicity | Loop diuretics (increase risk with ethacrynic acid or rapid IV administration) |
| Loop Oral equivalent dosing F T B | Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg |
| Furosemide IV:PO | 1:2 |
| Bumetanide and ethacrynic acid IV to PO | 1:1 |
| Torsemide IV | NO |
| Avoid use with PDE-5 inhibitors | BiDil (Hydralazine + isosorbide dinitrate) |
| Digoxin Therapeutic range HFrEF | 0.5-0.9 ng/mL |
| Lower Digoxin dose for | older patients, Iow lean body weight, renal insufficiency |
| Digoxin Antidote | DigiFab |
| Digoxin Therapeutic range AFib | 0.8 to 2.0 ng / mL |
| Digoxin Typical maintenance dose | 0.125 and 0.25 mg daily |
| Digoxin loading dose | can be considered for treatment of Afib |
| digoxin is a PGP and CYP3A4 substrate | YES |
| BNP < 100 pg/mL | Rule out HF |
| HF dianogsis | Echocardiogram (echo), BNP (>100) |
| Photosensitivity | Thiazide (most is HCTZ), loop |
| Can cause acute kidney injury & orthostatic hypotension | loop |
| HF pt can use naproxen if an OTC analgesic is needed. | WRONG, instead use tylenol |
| pt w HF experiences weight gain (eg, 2-4 Ibs in one day) or worsening symptoms (eg, increased number of pillows needed to sleep) | Notify provider |
| Digoxin dose for Low lean body weight | Dose reduction |
| Digoxin PO to IV conversion | reduce dose by 20-25% |
| Digoxin - concurrent use of P-glycoprotein inhibitors (amiodarone, diltiazem, verapamil, ritonavir, cobicistat, cyclosporine) | Dose reduction |
| ARB MoA | Inhibits the renin-angiotensin-aldosterone system (RAAS) by: blocking (1) angiotensin II (AT Il) from binding to its receptors, thereby preventing peripheral vasoconstriction and (2) the release of aldosterone (Choice A) |
| Sacubitril MoA | it is a neprilysin inhibitor: prevents the degradation of (and therefore increases the concentration of) beneficial vasodilatory peptides (eg, natriuretic peptides that promote vasodilation and diuresis) |
| Ivabradine use criteria | • Symptomatic (NYHA class II-III) HFrEF on optimized GDMT • Resting HR ≥ 70 bpm • Normal sinus rhythm |
| Ivabradine treatment goals | • Resting HR 50-60 bpm |
| Ivabradine SEs | Afib, bradycardia & HTN |
| Digoxin hemodynamic effects | (1) Negative chronotropy (reduce HR) (2) Positive inotropy (increase cardiac contraction) |
| Coreg (carvedilol) MoA | Inhibits beta-1, beta-2, and alpha-1 receptors |
| Digoxin occurrent use w amiodarone, dose adjustment | reduce 50% |
| Neurohormonal changes in HF | Increase levels of angiotensin II, aldosterone, norepinephrine |
| Diagnostic tests for HF | Serum B-type natriuretic peptide (> 100), Transthoracic echocardiography |
| Electrolyte abnormalities which are risk factors for in digoxin toxicity, need to adjust prior initiate digoxin | hypokalemia, hypomagnesemia, hypercalcemia |
| Digoxin IV to PO conversion dose | increase by 20-25% |
| Guideline recommended beta blocker for HF | Metoprolol succinate, bisoprolol, and carvedilol |
| recommended target dose of Coreg IR for HF | ≤ 85 kg: 25 mg BID > 85 kg: 50 mg BID |
| Add on treatment for LVEF ≤ 40%, to reduce hospitalization | digoxin |
| Add on treatment for LVEF ≤ 40%, to improve mortality | Ivabradine, BiDil, vericiguat |
| Initiate ACE inhibitors, ARBs & ARNIs, what lab values need to be monitored | Creatinine, potassium |
| medication can cause you to see greenish-yellow halos | digoxin |
| HF meds must be taken w food | metoprolol, carvedilol |
| Metoprolol succinate administration | can be cut half |
| Natural products for HF | Coenzyme Q10 (ubiquinone), Hawthorn, Omega-3 fatty acids (fish oil) |
| recommended target dose of Carvedilol CR for HF | 80 mg daily |
| Abrupt discontinuation of beta blocker causes | acute hypertension and tachycardia |
| antiarrhythmics which worsen HF | Class I antiarrhythmics (eg, flecainide, disopyramide) Class III antiarrhythmics (eg, dronedarone, sotalol) |
| antiarrhythmics which DON'T worsen HF | Amiodarone & dofetilide |
| Meds increase lithium level | Thiazide diuretics, ACE inhibitors & ARBs, NSAIDs |
| BiDil (hydralazine/isosorbide dinitrate) SEs | Vasodilatory adverse effects: Flushing, Headache, Hypotension & dizziness, Peripheral edema, Reflex tachycardia & palpitations • Hydralazine: DILE • Isosorbide CI: IPDE-5 |
| HF meds cause impotence | beta blockers, spironolactone |
Created by:
dao.vo11017