Term
|
Definition
| Consider ACE-I or ARB (risk factor mngmnt) |
|
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Term
|
Definition
| Consider ACE-I or ARB, B-Blockers (Slow disease progression) |
|
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Term
|
Definition
| Consider ARNI, diuretics, digoxin, MRAs,H/N, Ivabradine (cntrl sx,dec morbid/mortality) |
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Term
|
Definition
| Options: LVADs, Inotropes, transplant |
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Term
|
Definition
#1 Tx
Started in all C/D
recommended in high risk A and asymptomatic B
unless contra |
|
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Term
| ACE-I/ARB check what / when |
|
Definition
rena func/K+
AT BASELINE ; 1-2 WEEKS AFTER INITIATION OR DOSE TITRATION;1,3,6 MONTHS ONCE STABLE; THEN EVERY 6 MONTHS |
|
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Term
| Avoid concomittant use of _____ with ACE-I |
|
Definition
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Term
|
Definition
|
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Term
|
Definition
2nd line
-Pt intolerant to ACE-I bc cough/angioedema
unless contra |
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Term
| ARBs lower risk of ______ than ACE-I |
|
Definition
|
|
Term
ENALAPRIL
CAPTOPRIL
FOSINOPRIL |
|
Definition
ENALAPRIL strt=2.5mg bid Trgt=10-20mg bid
CAPTOPRIL strt=6.25mg tid trgt=50mg tid
FOSINOPRIL strt=5-10mg D trgt40mg D |
|
|
Term
LISINOPRIL
RAMIPRIL
TRANDOLAPRIL |
|
Definition
LISINOPRIL strt=2.5-5mg D trgt=20-40mg D
RAMIPRIL strt=1.25-2.5mg D trgt=10mg D
TRANDOLAPRIL strt=1mg D trgt=4mg D |
|
|
Term
VALSARTAN
CANDESARTAN
LOSARTAN |
|
Definition
VALSARTAN strt=20-40mg BID trgt=160mg BID
CANDESARTAN strt=4-8mg D trgt=32mg D
LOSARTAN strt=25-50mg D trgt=150mg D |
|
|
Term
ACE/ARB K+ 5.5-6.0 do what
ACE/ARB K+ >6.0 do what |
|
Definition
-1/2 the dose
-discontinue |
|
|
Term
| ACE/ARB sx hypotention do what |
|
Definition
reduce diuretic or other htn rx
-reduce dose or discontinue if absolutely needed |
|
|
Term
| ACE/ARB inc in SCr up to _____is acceptable |
|
Definition
|
|
Term
|
Definition
-Pt w/ stable HF
-Dont need to wait until ACE/ARB dose at target
-Recommended in Stage B |
|
|
Term
| Beta blockers shown to reduce mortality= |
|
Definition
| Carvedilol and Metoprolol Succinate (Bisoprolol no longr used) |
|
|
Term
| Titrate B-Blockrs q ______ |
|
Definition
|
|
Term
| Bisoprolol doses and why not used |
|
Definition
Strt 1.25mg D
Trgt=10 mg d
(smallest commercially available is 5mg)
[not FDA approved for HF] |
|
|
Term
| CARVEDILOL CARVEDILOL PHOSPHATE METOPROLOL SUCCINATE |
|
Definition
| CARVEDILOL Strt=3.125mg BID wf trgt=50mg BID wf CARVEDILOL PHOSPHATE strt= 10mg D wf trgt=80 mg D wf METOPROLOL SUCCINATE strt=25mg D(CII) 12.5 mg(CIII&IV) D trgt= 200mg D |
|
|
Term
|
Definition
all pt w evidece of fluid overload
-relief of acute Sx in euvolemia in STAGE C&D
[most req loop diur] |
|
|
Term
| Diuretics alert MD if..... |
|
Definition
-gain 1lb/day for several consec days(3-5LBs/week)
[some pts counseled on self adj dose] |
|
|
Term
| W/ ceiling effect on diuretics u can.... |
|
Definition
-inc freq of dosing
-add thiazide |
|
|
Term
Furosemide
Bumetanide
Torsemide |
|
Definition
Furosemide
strt=20-40mg d-BID trgt=20-160mg D-BID
Bumetanide
strt=0.5-1mg D-BID trgt=1-2mg D-BID
Torsemide
strt= 10-20mg D trgt=10-80mg once daily |
|
|
Term
|
Definition
Sx HF in conjunction w/ ACE/ARB,BB, & diuretic
-pt w/ optimal Tx but still Sx |
|
|
Term
|
Definition
0.125-0.25mg D
Target lower conc <0.9ng/mL |
|
|
Term
|
Definition
Lo dose added to ACEand BB
-NYHA FC III-IV HFrEF
-NYHA FC II w/ recent hospitalztn or elevated BNP
-Post MI EF<40, HF Sxs or DM |
|
|
Term
|
Definition
|
|
Term
|
Definition
K+ >5
SCr >2.5 men >2women |
|
|
Term
|
Definition
SPIRONOLACTONE
strt=12.5mg D trgt=25-50mg D
EPLERENONE
strt=25mg D trgt=50 mg D |
|
|
Term
|
Definition
renal func & electorlytes
at BASELINE,3 days, 1wk, 1 month after starting/titrating dose
monthly for first 3 months then q 3 months |
|
|
Term
|
Definition
alternative vasodilator in pt who cant take ACE/ARB
class III/IV
-ADD ON in AFR amer w/ HFrEF & persistent sx |
|
|
Term
| BIDIL= Hydralazine/Isosorbide dinitrate |
|
Definition
strt=37.5/20 mg tid
target dose=75/40 mg tid |
|
|
Term
|
Definition
VALSARTAN/SACUBITRIL
-pt w/ chronic HFrEF & NYHA II-III who tolerate an ACE/ARB to further reduce morbid/mortality
-Replaces ACE/ARB(dnt combine) |
|
|
Term
|
Definition
| 36 hours for risk of edema w/ ACE |
|
|
Term
| ENTRESTO CONTRAINDICATIONS |
|
Definition
-h/o ANgioedema w/ ACE/ARB
-dont combine w/ ACE
-dont use w/ aliskiren in pt w/ DM
-CAUTION IN PREGO
[36 hr washout w/ace] |
|
|
Term
| ENTRESTO on target dose of ACE/ARB |
|
Definition
|
|
Term
| low dose or no ACE/ARB, eGFR <30ml/min or mod hepatic impairment |
|
Definition
|
|
Term
| Double ENtresto in ____-____ weeks to trgt dose of ____ |
|
Definition
| 2 - 4 wks to dose of 97/103 (200mg) BID |
|
|
Term
| Monitor this with entresto |
|
Definition
-BP
-K+ and SCr q 2 weeks after initiatn/titrating
then q 4-6 months |
|
|
Term
|
Definition
| SLOWS HR W/O OTHER CARDIOVASCULAR EFFECTS THRU INHIB EFFECTS ON If CURRENT |
|
|
Term
|
Definition
REDUCE RISK OF HOSPITAL IN PT W/ STABLE SYMPTOMATIC CHRONIC HF W/
-LVEF </= 35%
-SINUS RYTHM W/ HR >/= 70 BPM ON MAX TOLERATED DOSE B-BLOCKER |
|
|
Term
| IVABRADINE (CORLANOR) ADD TO STANDRD TX IN___ |
|
Definition
-NYHA CLASS II-III
-EF </=35%
-HF HOSPITALIZATION W/IN 12 MNTHS
-RESTING HR >/= 70 BPM, SINUS RYTHM -ON MAX TOLERATED DOSE bb |
|
|
Term
|
Definition
STRT=5MG BID WF
TRGT=7.5MG BID WF
[DOSE INC AT 2 WKS IF HR>60]
[DOSE DEC TO 2.5MG BID OR DISCONTINUE IF HR <50] |
|
|
Term
| IVABRADINE CONTRAINDICATIONS |
|
Definition
ACUTE DECOMPENSATED HF
BP <90/50MMHG
3RD DEGREE AV BLK,SICK SINUS SYNDROME,SA BLK
PACEMAKER DEPENDENCE
STRONG CYP3A4 INHIBITOR |
|
|
Term
|
Definition
BRADYCARDIA
NEW AFIB
LUMINOUS PHENOMENA |
|
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