The Fantastic 4
What is the newest pillar of GDMT?
SGLT2i or ARNI
Before administering a beta blocker, this should be assessed
Heart rate and blood pressure
A dry, persistent cough is a common side effect of this RAAS medication class
ACE inhibitors
What was SGLT2i made for originally?
T2DM
What are Diuretics used for?
Treatment of fluid overload
These 4 pillars (medication classes) of GDMT used for HFrEF change the course of heart failure by reducing mortality and disease progression
ARNI/ACE/ARB
Beta Blocker
MRA
SGLT2i
Beta blockers should generally be started only after this clinical condition has been achieved
Stable, euvolemic
What two medications in the RAAS class should not be combined?
Ace inhibitor and ARNI
Name an SGLT2i?
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
Canagliflozin (Invokana)
How do we assess response to diuresis while a patient is hospitalized?
Daily weights, strict I/Os, physical assessment, VS, and lab monitoring
What guidelines support Guideline-Directed Medical Therapy (GDMT) and are used to manage heart failure at UNMH
2022 American Heart Association (AHA), American College of Cardiology (ACC), Heart Failure Society of America (HFSA) clinical practice guidelines
A patient has cool, blue extremities and is hypotensive. What would the nurse anticipate will happen with their scheduled dose of metoprolol succinate?
Hold it!
______ is preferred for HFrEF
ARNI or Entresto (sacubatil/valsartan)
What types of HF is SGLT2i recommended for?
HFrEF, HFimpEF, HFmrEF and HFpEF
MRAs are _______ sparing diuretics.
potassium
This sub-class of medication replaces ARBs and ACE-I; it has been shown to reduce cardiovascular death and hospitalizations
ARNI (Sacubitril/Valsartan)
Entresto
A patient has cool extremities, hypotension, and a weak pulse. This life-threatening condition may be worsened by administering a beta blocker
Cardiogenic shock
When switching from an ACE-I to an ARNI, this amount of time must pass to reduce the risk of angioedema
36-hour washout period
Name two contraindications for SGLT2i?
Type 1 DM
Yeast Infections
UTI
NPO status
eGFR<30
What electrolyte imbalance is most associated with loop diuretics?
Hypokalemia
Name at least two regulatory bodies that govern the care of the patient with heart failure and promote the use of guideline-directed medical therapy
JC Joint Commission
AHA American Heart Association Get With the Guidelines (GWTG)
ACC American College of Cardiology
This pillar includes Metoprolol Succinate & Carvedilol but not Atenolol or Metoprolol Tartrate
Evidence-based beta blocker
This combination of medications is recommended as an alternative for those who cannot take ACE/ARBs/ARNI and in addition to GDMT for African American patients
Hydralazine and Isosorbide Dinitrate
SGLT2i are a Class ___ recommendation
Class 1
A patient receiving aggressive diuresis becomes dizzy and has a significant drop in blood pressure. The nurse should assess for this complication.
Volume depletion (over-diuresis)