CHF 2: medications

Family Medicine & Pharmacy Podcast

Content provided by Billy Lin, MD, Tina Lien, and BSc Pharm. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Billy Lin, MD, Tina Lien, and BSc Pharm or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.

10+ y ago 21:09

M4A•Episode home

Archived series ("Inactive feed" status)

When? This feed was archived on April 19, 2019 07:10 (5+ y ago). Last successful fetch was on February 08, 2018 18:20 (6+ y ago)

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.

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

#Podcasting Education #Higher Education #Medicine #Science #Family Medicine #Pharmacy #Community Pharmacy #Primary Care