Patient Population: ACE-I
Everyone
Patient Population: ARB
People who cannot use ACE-I: patients who cough or who have Angiodema
Patient Population: B-Blockers
Everyone
Patient Population: Loop Diuretics
Signs and symptoms of fluid retention
Patient Population: Aldosterone Antagonist
NYHM II-IV - Symptoms
Before: ACE + BB + Diuretics
Patient Population: Diogoxin
Decreases hospitalization
Hydralazine /ISO
- African Americans ( Class III-IV) on ACE-I + BB + Diuretic
Mortality Data: ACE-I
Yes
Mortality Data: ARB
Yes
Mortality Data: Beta-Blockers
Yes
Mortality Data: Loop Diuretics
NO**
Mortality Data: Aldosterone Antagonist
Yes
Mortality Data: Digoxin
NO**
Mortality Data: Hydralazine
YES, mainly for African Americans
Monitoring/Comments: ACE-I
Cough, Scr, K+, Angiodema
Monitoring/Comments: ARB
Angiodemia with ARB, sCr, K+
Monitoring/Comments: Beta-Blockers
HR (BP), Patients must be stable in regard to fluids. so if Beta blockers are out of line but Fluids are not stable, address the fluids.–see case 6 in Heart Failure
Monitoring/Comments: Loop diuretics
Volume(?), electrolytes (K+). Renal function.
20mg PO = 20 mg IV ( IV is double the PO dose)
Monitoring/Comments: Aldosterone Antagonist
sCr > 2.5
K+ > 5
If Gyneomastia, change to Eplerone (Inspra)
Monitoring/Comments: Digoxin
Decrease K+: Can cause toxicity ScR,
Digoxin Levels must reach. 0.5 - 1 level (heart failure)
Check Digoxin Levels: Check 5-7 days, on the 5th or 7th day take the PO dose, then check 8 hours for digoxin levels which must be 0.5- 1.
Monitoring/Comments: Hydralazine / ISO
H: BP, HR, SLE (Lupus)
I: BP and HA (head ace)