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CHF
| Question | Answer |
|---|---|
| what are the compensatory mechanisms to a low cardiac output state? | RAAS, SNS, and vasopressin |
| what does Angiotensin II do? | causes systemic vasoconstriction and stimulates the release of aldosterone from the adrenal gland and vasopressin from the pituitary gland |
| what does aldosterone cause: | sodium and water retention and increases potassium excretion |
| what does vasopressin cause: | vasoconstriction and water retention |
| what does the SNS activation compensatory mechanism do? | NE and EPI release cause an increase in HR, contractility (positive inotropy) and vasoconstriction |
| activation of what neurohormonal pathways causes vasoconstriction | Angiotensin II, vasopressin, NE and Epi |
| which antiarrhythmics are preferred in HF? | amiodarone and dofetilide |
| what natural product is reasonable to give to decrease mortality and CV hospitalizations? | omega 3 |
| which natural products may improve HF symptoms? | hawthorn and coenzyme q10 |
| is there mortality benefits with loops diuretics? | no |
| is there mortality benefit with digoxin? | no |
| what type of benefit does digoxin have? | only morbidity |
| what are the 3 BB that can be used in HF? | bisoprolol, carvedilol, and metoprolol succinate |
| where does the sacubitril act in the HF cascade? | positive effect on the natriuretic peptides |
| what are the benefits to using hydralazine/isosorbide? | decrease morbidity and mortality in self-identified black patients who remain symptomatic on optomized first-line medications |
| which medication decreases symptoms and cardiac hospitalizations by increasing cardiac output? | digoxin |
| which medications decreases risk of hospitalization and CV death after recent HF hospitalization or need for IV diuretics? | vericiguat |
| what medications are indicated in patients with HFmrEF or HFpEF? | SGLT2i |
| what are the benefits to using an ARNI, ACE, OR ARB in HF patients | decrease preload and afterload, decrease cardiac remodeling, improve left ventricular function and decrease morbidity and mortality |
| what is the target dose to entresto? | 97/103 BID |
| what is the BBW of entresto | can cause injury to the developing fetus when used in the 2nd or 3rd trimester |
| what contributes to the side effect of cough and angioedema? | the ACEi also block the degradation of bradykinin |
| both ACE and ARBs do what? | both result in decrease vasoconstriction and aldosterone secretion |
| which medication gets affected by ARNI, ACE, ARBS | lithium, they can decrease lithium renal clearance leading to lithium toxicity |
| can metoprolol succinate be cut in half | yes but don't crush or chew, take with or immediately after meals |
| whenever using BB with what other drugs do you need to be cautious with? | digoxin, verapamil, diltiazem, amiodarone |
| carvedilol can increase concentrations of P-gp substrates such as: | digoxin, cyclosporine, dabigatran, and ranolazine |
| when should you generally not initiate a SGLT2? | if eGFR <20-25 |
| what's the difference between spironolactone and eplerenone? | spironolactone is non-selective and blocks androgen and exhibits endocrine side effects. Eplerenone is selective and does not exhibit endocrine side effects? |
| can you use spironolactone in addisons disease? | no |
| what does eplerenone increase: | triglycerides |
| what is the target dose for someone weighing <85kg and starting on carvedilol IR? | 25mg PO BID |
| can you use Eplerenone with CYP3A4 inhibitors? | yes |
| what electrolyte do loop diuretics decrease than thiazides increase? | calcium |
| what are the warnigns to using loop diuretics? | sulfa allergy, ototoxicity including hearing loss, tinnitus and vertigo |
| which loop diuretic has the increased risk of ototoxicity | ethacrynic acid or rapid IV administration |
| the combination product of hydralazine/isosorbide is indicated for what population? | self-identified black patients who remain symptomatic despite optimal treatment |
| what is the preferred formulation for systolic HF, isosorbide dinitrate or mononitrate | dinitrate |
| what are the side effects to isosorbide dinitrate | hypotension, headache, dizziness, tachyphylaxis (need 10-12 hour nitrate-free interval) |
| what is the criteria for using ivabradine? | normal sinus rhythm and a resting HR >70 bpm |
| which med has a warning for an increased risk of atrial fibrillation? | ivabradine |
| what are the warnings to using ivabradine? | can cause bradycardia, increase risk of AF, and fetal toxicity |
Created by:
KaHerre12