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CHF 2: medications
Archived series ("Inactive feed" status)
When? This feed was archived on April 19, 2019 07:10 (). Last successful fetch was on February 08, 2018 18:20 ()
Why? Inactive feed status. Our servers were unable to retrieve a valid podcast feed for a sustained period.
What now? You might be able to find a more up-to-date version using the search function. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.
Manage episode 152064819 series 1047810
Tina revisits ACEI, ARB, BB, and Thiazides, which were covered previously with the hypertension episodes, and introduces a few new medications as well:
- Mineralocorticoid Receptor Antagonists: spironolactone and eplerenone
- Loop diuretic: furosemide
- Digoxin
- Vasodilators: hydralazine and isosorbite dinitrate
For a quick summary of the CCS 2013 recommendations:
ACE inhibitors:
- all asymptomatic patients with an EF < 35%
- all symptomatic HF patients and EF < 40%
ARB:
- if intolerant to ACEI
- add to ACEI if intolerant or contraindicated for BB
- add to ACEI and BB if NYHA class II-IV HF and EF ? 40% deemed at increased risk of HF events
BB:
- all HF patients with an EF ? 40%
- initiated at a low dose and titrated to the target dose or maximal tolerated dose
MRA:
- patients > 55 years with mild to moderate HF during standard HF treatments with EF ? 30% (or ? 35% if QRS duration > 130 ms) and recent (6 months) hospitalization for CV disease or
- with elevated BNP or NT-proBNP levels
- after an MI with EF ? 30% and HF or
- EF ? 30% alone in the presence of diabetes
- EF < 30% and severe chronic HF (NYHA IIIB-IV) despite optimization of other recommended treatments
Diuretics:
- for congestive symptoms
- When acute congestion is cleared, the lowest dose should be used that is compatible with stable signs and symptoms
- persistent volume overload despite optimal medical therapy and increases in loop diuretics, cautious addition of a second diuretic (a thiazide or low dose metolazone) may be considered as long as it is possible to closely monitor morning weight, renal function, and serum potassium
Digoxin:
- patients in sinus rhythm who continue to have moderate to severe symptoms, despite optimized HF therapy
- patients with chronic atrial fibrillation (AF) and poor control of ventricular rate
Isosorbide dinitrate and hydralazine:
- black Canadians with HF-REF
- non-black HF patients unable to tolerate an ACE inhibitor or ARB
Drug information from:
- Drug monographs
- CPS: http://www.e-therapeutics.ca/
- Therapeutic Choices: http://www.e-therapeutics.ca/
- Rx Files: http://www.rxfiles.ca/rxfiles/modules/druginfoindex/druginfo.aspx
The post CHF 2: medications appeared first on Family Pharm Podcast.
28 episodes
Archived series ("Inactive feed" status)
When? This feed was archived on April 19, 2019 07:10 (). Last successful fetch was on February 08, 2018 18:20 ()
Why? Inactive feed status. Our servers were unable to retrieve a valid podcast feed for a sustained period.
What now? You might be able to find a more up-to-date version using the search function. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.
Manage episode 152064819 series 1047810
Tina revisits ACEI, ARB, BB, and Thiazides, which were covered previously with the hypertension episodes, and introduces a few new medications as well:
- Mineralocorticoid Receptor Antagonists: spironolactone and eplerenone
- Loop diuretic: furosemide
- Digoxin
- Vasodilators: hydralazine and isosorbite dinitrate
For a quick summary of the CCS 2013 recommendations:
ACE inhibitors:
- all asymptomatic patients with an EF < 35%
- all symptomatic HF patients and EF < 40%
ARB:
- if intolerant to ACEI
- add to ACEI if intolerant or contraindicated for BB
- add to ACEI and BB if NYHA class II-IV HF and EF ? 40% deemed at increased risk of HF events
BB:
- all HF patients with an EF ? 40%
- initiated at a low dose and titrated to the target dose or maximal tolerated dose
MRA:
- patients > 55 years with mild to moderate HF during standard HF treatments with EF ? 30% (or ? 35% if QRS duration > 130 ms) and recent (6 months) hospitalization for CV disease or
- with elevated BNP or NT-proBNP levels
- after an MI with EF ? 30% and HF or
- EF ? 30% alone in the presence of diabetes
- EF < 30% and severe chronic HF (NYHA IIIB-IV) despite optimization of other recommended treatments
Diuretics:
- for congestive symptoms
- When acute congestion is cleared, the lowest dose should be used that is compatible with stable signs and symptoms
- persistent volume overload despite optimal medical therapy and increases in loop diuretics, cautious addition of a second diuretic (a thiazide or low dose metolazone) may be considered as long as it is possible to closely monitor morning weight, renal function, and serum potassium
Digoxin:
- patients in sinus rhythm who continue to have moderate to severe symptoms, despite optimized HF therapy
- patients with chronic atrial fibrillation (AF) and poor control of ventricular rate
Isosorbide dinitrate and hydralazine:
- black Canadians with HF-REF
- non-black HF patients unable to tolerate an ACE inhibitor or ARB
Drug information from:
- Drug monographs
- CPS: http://www.e-therapeutics.ca/
- Therapeutic Choices: http://www.e-therapeutics.ca/
- Rx Files: http://www.rxfiles.ca/rxfiles/modules/druginfoindex/druginfo.aspx
The post CHF 2: medications appeared first on Family Pharm Podcast.
28 episodes
All episodes
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