CARDIO

 CYP SUBSTRATES
o ALL CCB
o Eplerenone
o Digoxin
o Ivabradine
o Carv, Prop, Metoprolol 2D6
 CYP INHIBITORS
o Carv, Propranolol Pgp Inhibitors
o NON-DHP CCB’s (verapamil, diltiazem) 3A4 Inhibitors
o Amiodarone 3A4 Inhibitor

 (- chrono ) Additive dec HR w/ : Non-dhp ccb, BB, Digoxin, Clonidine, Amiodarone, Ivabradine

 Diuretics & ACE/ARB inc Lithium

 Methyldopa X MAOi’s
 Methyldopa + COOMBS hemolytic anemia
 LOOPs & Methyldopa & Hydralazine & BiDil LUPUS
 Olmesartan [Benicar] sprue-like enteropathy
 BiDIl X PDE5i’s [erectile dysnfxn] & riociguat (Adempas) [guanylate cyclase stimulator for PAH]

 Pregnant hcg+ “hydral, methyl, labet, nifedipine ER = Adalat CC or Procardia XL”

 Black  CCB HCTZ BiDil
 Angioedema
 SULFA X LOOP except Edecrin
X Thiazides

 A.FIB  Amiodarone Digoxin BB Non-DHP CCB v&D ::::dec Digoxin 50% w/ Amiodarone
 RA  ACE or CCB
 COPD  ARB + CCB diuretic B1B if CAD or CHF
 CHF  ACE/ARB + B1B + ARA can add CCB or Thiazide
 CAD/Heart Attack  ACE/ARB + B1B can add CCB X BB with ISA: Ace, Pen, Pin
 HIV X not CCB bc CYP-450
 Depression X not CCB’s bc orthostatic hypotension with SSRIs
 Diabetes w/ Urine albumin >300  ACE/ARB even without HTN!
 CKD CrCL <60 or urine albumin >300  ACE/ARB

o K > 5.5 X ARA

o Scr > 2.5 X ARA

o CrCL <30 X Thiazides, ARA’s ✔LOOP, Metolazone

HTN
AHA/ACC Goal = <130/80
ADA recommends <140/90 if low ASCVD risk

1st Line: ACE ARB HCTZ CCB

1 drug = Stage 1 - 130s or 80s + clinical ASCVD or ASCVD > 10%

2 drugs = Stage 2 - 140s or 90s

Urgency / Emergency - > 180 / 120 + end organ damage
dec BP NMT 25% in 1 hour

IV:
ARBs OTC:
Enalaprilat
fish oil,
Methyldopa
Hydralazine coenzyme Q10,

Verap L-arginine,
Dilt
garlic
Nicard
Clevid

Chlorothiazide (Diuril)

BB’s : “MAPLES” Metoprolol Tartrate PO  IV

2.5  1

Phentolamine Regitine Alpha Antag

Fenoldopam Corlopam Dopamine Agonist/vasodilator

HCTZ 50 Amlodipine 10
Chlorothiazide [ Diuril ] 2,000 Nifedipine 90
Chlorthalidone 25 Clevidipine start 5/hr max 15/hr

Amiloride 20
Triamterene [ Dyrenium ] 300 A M E N B Bis A
100
Eplerenone [ Inspra ] 100 tar: 450
Spironolactone 100 succ: 400
succ CHF: 200

P
640 XL is
120

Carvedilol BID IR  CR
3.125 10
6.25 20
12.5 40
25 80

Clonidine WEEKLY Patch dosed daily TTS-1 = 0.1 mg/day

st
Combos 1 Line Stage 2 HTN:
ACE
ARB

+ CCB Lotrel Exforge “ExAM Value”

Prestalia Twynsta
verapamil Tarka Azor = olmesartan

+ HCTZ Prinzide / Zestoretic Hyzaar L

Lotensin-HCT Avalide I
Accuretic
Capozide
Vaseretic
Uniretic
 +chlorthalidone Edarbyclor

Other Combos:

BB + HCTZ BB + ARB Kspare + HCTZ CCB + DRI 3 drug

chlorthalidoneTenoretic Byvalson (neb + val) Aldactazide Tekamlo - Amturnide
Ziac Dyazide/ Maxzide Tribenzor (olm)
Corzide
Inderide
Dutoprol (met succ)

Neprisylin Blocker + ARB

Entresto sacubitril/Valsartan

CHF
ACC/AHA NYHA
A = at risk ****Clinical Diagnosis
B = no symptoms 1 = no symptom
****Clinical Diagnosis 2 = slight symptoms but comfortable @rest
C = prior or current symptoms 3 = minimal exertion causes symptoms but comfy @rest
D =advanced 4 = worst and bad even resting

Systolic HFrEF : LVEF <40% BAD DRUGS FOR CHF

ECHO
BNP NO NEGATIVE INOTROPES!!!!
Rales, gallop Class 1 antiarrthymic
Non-DHP CCBs V&D

OTC: Diabetes:
Omega-3 Fatty Acids dec mortality - DPP4 –gliptin [Alo Nessina] [Sita Januvia]
Hawthorne, coQ10
- Thiazolidinediones [pio actos] [ rosi Avandia]
- Metformin
For Mortality:
1. ACE/ARB/Entresto NSAIDS
2. BB
3. ARA Itraconazole antifungal
4. BiDil
5. Dapagliflozin [Farxiga] SGLT2i Immunune: TNFi etanercept, rituximab interferons
Anthrocyclines: Doxirubicin & Daunorubicin
Entresto (sacubitril/Valsartan) - neprilysin inhibitor inc natriuretic peptides 100 BID
200 BID
ACE/ARB  start low titrate to target dose to reduce symptoms not BP

LTBQ- CREFP * ACEi 36 hour washout b4 Entresto

L T B Q C R E F P
5 1 5 BID 6.25 TID 2.5 2.5 BID10 2
40 4 40 ÷ 50 TID 10 40 ÷ 40 16 : CHFmax
40 20 : HTN

CATOLIVE *ARB

C A T O L I V E
32 150 320 ÷ : CHFmax
80 80 40 300 800 : HTN

BB’s  start low titrate to target dose every 2 weeks

Biso (Zebeta) Meto Succ (Toprol XL) Carvedilol

1.25 25 3.125 BID or 10
10 200 < 85kg : 25 BID 80
> 85kg : 50 BID

ARA  Spirono Epleren

25 BID 50

Black or Angioedema  BiDil ( Hydralazine + isosorbide dinitrate ) 2 tabs TID

 Hydralazine 300
 Isosorbide dinitrate 120

ADD ONS Reduce Hospitalization and symptoms:

Digoxin - Renal & inhibit Na/K ATPase Pump & inc CO ( +ino) & dec HR ( - chrono)
 Cyp 3A4 SUBSTRATE  w/ inhibitors like Amiodarone, dec 50%
 PO  IV decrease 20%
 Therapeutic Level:
o Lower CHF: 0.5-0.9
o A.fib : 0.8-2
 Dose: 0.125-0.25
 ANTIDOTE = DigiFab
 Toxicity due to:
o LOW K <3.5
o LOW Mag
o HIGH Ca
o HIGH Scr
o HYPOthyroid HIGH TSH

Ivabradine (Corlanor) - dec HR ( - chrono) bradycardia and QT-prolong 7.5 BID

 Cyp 3A4 SUBSTRATE
 NEED:
o NSR
o EF <35 %
o HR > 70
o On max dose of BB -OR- contraindication to BB

LOOPS  use lowest dose possible

B T F E * store Furosemide IV @ ROOM TEMP

PO 1 20 40 50
IV 20

CHF MAX 10 200 600 400