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What drugs are usually used to treat Tachycardia caused by receded CO?
What drugs are usually used to treat Increased preload caused by receded CO?
ACEIs and Diuretics
What drugs have Negative inotropic effects on HF?
- Beta-blockers (other than the 3)
- CCB (non-dihydropyridine CI in Systolic HF)
What drugs have Cardiotoxic effects on HF?
What drugs have Na/Water retention effects in HF?
- COX-2 Inhibitors
- Na-containing drugs
What CCB’s are always CI in Systolic HF?
Non-dihydropyridine CCB (verapamil and diltiazem)
Do Diuretics provide a mortality benefit for HF?
No, symptom relief only
What aspects of HF are Diuretics used to treat in HF?
- Symptoms only:
- Improve exercise tolerance
- Improve QOL
- Reduce hospitilizations
- Reduce preload (main mechanism)
How should you initiate a diuretic in HF?
- Start low
- Adjust based on s/s
How should you monitor Diuretic use in HF?
- By s/s (i.e. body weight)
- See HCP if:
- More than 1 lb/day weight gain for several consecutive days
- More than 3lb/week
What is the main diuretic used in HF?
What is the peak effect time from time of dosing for Loops?
30-90 minutes after admin
What is the benefit of Loops over other diuretics?
Maintain efficacy in Renal impairment
What Loops have a long DOA?
What loops have a short DOA?
Butenamide and Furosemide
What is the MOA of loops?
Inhibit Na-K transporter in the ascending loop of henle
What is the usually PO dose of Furosemide?
20-160 mg QD
What is the Ceiling dose for Furosemide in Normal renal function, CrCl 20-50 and CrCl <20?
- Normal renal function: 80-160 mg
- CrCL 20-50 mL/min: 160 mg
- CrCL < 20 mL/min: 400 mg
What is the DOS for Furosemide?
What are the beneficial Mechanisms of ACEIs in HF?
- Decrease BP: reduce AgII and aldosterone
- Prevent RAAS mediated worsening of myocardial function and remodeling
- Decrease preload and afterload
What are the benefits of ACEIs in HF?
- Mortality benefit
- Reduce reinfarction, hospitalizations, symptoms, QOL, NYHA functional class and Exercise tolerance
Do ACEIs have a mortality benefit for HF?
What should you monitor when giving and ACEI to a HF patient?
Should patients stop their ACEI if they are symptomatic?
No, should be on for the rest of their lives
Should a patient be on an ACEI if they have renal insufficiency?
Yes, benefits outweigh the risks
What are the potential adverse reactions of ACEIs in HF?
- Renal insufficiency
What are the indications for ACEIs in Stage A HF?
Atherosclerotic disease (PAD or CAD) or DM and HTN
What stages are ACEIs indicated for in HF?
What are the indications for ACEIs in Stage B HF?
- History of MI and EF < 40%
- EF < 40%
What are the indications for ACEIs in Stage C HF?
EF < 40%
What are the indications for ACEIs in Stage D HF?
Continue only if tolerating
What are the BBs with a mortality benefit in HF?
- Metoprolol succinate
What is the MOA of BBs in HF?
- Antagonize Sympathetic NS effects
- Antiarrhythmic effects
- Decrease HR/ventricular wall stress
What are the benefits of BBs in HF?
- Mortality benefit
- LV systolic function
- Reverses remodeling
- Helps with: symptoms, QOL and exercise tolerance
Do BBs have a mortality benefit?
If a patient is having a symptomatic exacerbation to a BB, what would you do?
- Temorarily reduce dose
- Only stop dose under dire situations
- Don’t start a BB under these conditions
What are the key adverse events realetd to BB use in HF?
- Fluid retention and worseneinf HF
What are the CIs for BB in HF?
- Bronchospastic disease
- Severe bradycardia
- Heart Block
- Very severe acute decompensated HF
What diseases are BBs precautioned in, but should be used unless symptoms make impossible?
DM, COPD, asthma and PVD
What is the difference in MOA of the various BBs for HF?
- Metoprolol succinate and Bisoprolol: Only B1 antagonist
- Carvedilol: B1, B2 and a1 antagonist
Why might Carvedilol cause more BP lower than Metoprolol succinate and Bisoprolol?
B/C it is an a1, B1 and B2 antagonist and the others are just B1
What is the Initial dose of Carvedilol CR?
10 mg QD
What is the target dose of Carvedilol?
80 mg QD
At what interval should you push up the dose of BB?
Q2weeks, unless symptomatic, then wait, maybe a month
Typically, should you initiate a BB or ACEI first?
What stage of HF should you use BBs in?
- Stage B: History of MI and EF <40% or <40%
- Stage C: all patient with <40%
- Stage D if tolerated
When should you initiate a BB before and ACEI?
- Excessive SNS activity (high HR)
- ACEI CI due to renal dysfunction or K concentration
Why might you stop a BB in Stage D?
Makes you feel pretty groggy and sluggish sometimes and Stage D, we just want patients to be comfortable
What are the core agents for HF?
ACEI and BB
What ARBs are usually used in HF clinical trials?
Valsartan and Candesartan
What are the benefits of ARBs in HF?
- Mortality benefit
- Reduction in hospitalizations
What is the MOA of ARBs in HF?
- BP control by blocking Ag II and aldosterone
- Prevents RAAS mediated worsening of myocardial function
How should you monitor ARBs?