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81 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which 3 antihypertensives do blacks not respond to as well?
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ACE
ARB Beta Blockers |
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What are compelling reasons for use a an ACE-inhibitor?
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- Systolic heart failure
- Post MI - Proteinuric chronic renal failure - maybe DM even w/o proteinuria - maybe high coronary risk w/o past MI |
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What are contraindications to using an ACE-inhibitor?
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angioedema (duh)
pregnancy (duh) renovascular disease (relative CI) |
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What are compelling reasons for use of a beta blocker?
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- past MI
- Angina - A fib (rate control) - A flutter (rate control) - essential tremor - hyperthyroidism - migraine |
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What are contraindications to using a beta blocker?
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- bronchospastic airway disease
- heart block (2nd or 3rd degree) - depression? |
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Which antihypertensive should be avoided in a patient who is hyperkalemic?
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aldo antagonists
ACE ARB |
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Which antihypertensive should be avoided in a patient w/hyponatremia?
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thiazide diuretics
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Which patients would you probably want to avoid using a diuretic in?
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hyponatremic
gout |
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Would you consider using nondihydropridine or dihydropiridine CCBs in a patient with raynauds?
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dihydopyridine CCB
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Where do thiazide diuretics act in the nephron?
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distal tubule and connecting segment
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Name 4 thiazide diuretics
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Hydrochlorothiazide
Chlorthalidone Metolazone Indapamide |
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Thiazides interact mainly with which 4 medications?
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Digoxin (via hypokalemia)
Lithium (dec excretion) DM meds (antagonizes) Gout meds (antagonizes) |
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Which antihypertensive can enhance calcium reabsorption and what are the effects of that?
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Thiazide
- may unmask underlying condition like hyperparathyroidism, CA, sarcoid - doesn't just cause hypercalcemia itself - may decrease hypercalcuria(stones) - may help w/osteoporosis |
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What are the adverse reactions most commonly associated with thiazides?
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- Volume depletion (orthostatic hypotension)
- hypokalemia - hyponatremia - hyperuricemia - hyperlipidemia - hyperglycemia - impotence - rash (sulfa drug) |
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Which antihypertensive enhances calcium excretion and may be beneficial in treating hypercalcemia from small cell lung CA?
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loop
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Which 3 medications do loop diuretics antagonize?
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dig
lithium gout meds |
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Which drugs are associated with sensorineural hearing loss?
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Loops (furosemide)
AGs (irreversible) Vancomycin Cisplatin Aspirin (low dose - one time) |
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Which potassium sparing diuretics work b inhibiting Na influx through ion channels in the luminal membrane?
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triamterene and amiloride
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Which patient's are at inc risk of hyperkalemia when taking a potassium-sparing diuretic?
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- pts w/renal disease
- pt on another drug that dec. renin (beta blocker, NSAIDS) - pt on another drug that dec angiotensin II (ACE, ARB) |
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Which hypertension med is a potential nephrotoxin that may lead to crystalluria and cast formation?
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triamterene
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Which two drugs besides triamterene can precipitate in the kidney?
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Indinavir and acyclovir
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Which drug may be added to furosemide in a CHF pt who is diabetic w/some kidney problems and can't diurese easily?
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metolazone
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Where is angiotensin I converted to angiotensin II?
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lungs
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Which is the only ACE available in IV form?
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enalapril
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WHich populations of patients are best suited for ACE inhibitors?
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HTN especially w/LVH
Systolic heart failure Chronic renal failure Post AMI -> systolic dysfunction |
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What are the CYP interactions of ACE inhibitors?
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Lisinopril has none
Enalapril is a substrate of 3A4 |
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ACE inhibitors are synergistic with which meds?
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diuretics
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Why must you be careful when using an ACE with something like an ARB or triamterene/HCTZ?
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they all lead to hyperkalemia - monitor the K
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Due to the potential side effect of decreased intrarenal perfusion pressures, which patients must you be careful/or avoid starting an ACE in?
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Bilateral RAS
HTN nephrosclerosis CHF? CRF (check creat w/in a week) Polycystic kidneys |
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How do ARBs work?
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They impair binding of angiotensin II to AT1 receptors but do not actually block the receptors
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What are the cytochrome interactions of ARBs?
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Losartan is a substrate of 2C9 and 3A4
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How do alpha blockers work?
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the reduce arterial pressure by dilating resistance and capacitance vessels
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Which antihypertensive med will likely lead to fluid retention if not given with a diuretic?
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alpha blocker (terazosin, doxazosin, prazosin)
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Which antihypertensive has higher cardiac mortality with use?
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alpha blocker
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Which med should not be taken if patient is taking an alpha blocker?
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any ED med (phosphodiesterase inhibitors)
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Which causes more reflex tachycardia, direct vasodilators or alpha blockers?
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direct vasodilators
(but alpha blockers --> postural hypotension . . .esp w/first dose!) |
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What are two random side effects of alpha blockers besides postural hypotension?
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drowsiness/fatigue
and nasal congestion |
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What does stimulation of beta-1 receptors do?
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inc HR
inc contractility inc AV nodal condution |
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How do beta blockers work?
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competetively inhibit catecholamines at beta receptors
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Name the non selective beta blockers
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propranolol
nadolol timolol |
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Which patients should not recieve a nonselective beta blocker?
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asthma
COPD Raynauds |
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Name the beta-1 selective beta blockers
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metoprolol
atenolol betaxolol bisoprolol |
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What does it mean if a beta blocker has intrinsic sympathomimetic activity?
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partial agonist - so they produce slight activation of the receptor as they prevent access of catecholamines to the receptor (dec BP with less bradycardia)
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Which beta blockers have ISA?
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pindolol
acebutolol penbutolol |
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Whatis the only situation you should a beta blocker with ISA be considered?
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pt must have bradycardia to consider use
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Which beta blockers have some alpha blocking action (and what does this mean)?
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Carvedilol
Labetalol *alpha blocking = vasodilation |
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Can beta blockers be used in systolic or diastolic dysfunction?
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both (but must consider other factors)
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What is the difference between lipophilic beta blockers and non-lipophilic beta blockers?
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lipophilic agents are largely metabolized by the liver (2D6)
non-lipophilic agents are eliminated unchanged in the urine |
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Which beta blockers are lipophilic?
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propanolol
metoprolol |
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Which beta blockers are non-liphophilic?
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atenolol
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Which beta blocker is a sustracte of 2D6 and 2C9
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carvedilol
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IF pt is on SSRI, or other drugs w/narrow therapeutic windows what is your beta blocker of choice?
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atenolol
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How do beta blockers mask/delay recovery from hypoglycemia?
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blocks epinephrine acting on beta receptors which would normally stimulate glycogenolysis and gluconeogenesis protecting against development of hypoglycemia; epinephrine is also responsible for early warning signs of hypoglycemia (sweating, anxiety, etc)
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How do CCBs work?
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inhbit L-type Ca channels -> no intracellular Ca influx
-> no Ca to bind to troponin or calmodulin (vascular smooth muscle) --> complex cannot allow actin and myosin to interact/contract |
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What is the difference between dihydropyridine and non-dihydropyridine CCBs?
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dihydros mostly vasodilate vascular smooth muscle (-> dec SVR) but do not affect contractility/conduction like the non-dihydros do
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Which drug is a short acting dihydropyridine CCB?
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nifedipine
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Which drugs are longer-acting dihydropyridines?
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amlodipine
felodipine isradipine nicardipine nisoldipine |
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Which drug is a long-acting dihydropyridine?
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amlodipine (most consistent CCB)
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What are the dihydros used for? the non-dihydros?
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Dihydro- for HTN
nondihydro - for cardiac problems |
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Name the non-dihydro CCBs.
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verapamil
diltiazem |
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Which CCBs are substrates of 3A4?
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amlodipine
verapamil diltiazem felodipine nifedipine |
both the non-dihydros and the long-acting dihydro |
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What are the 3A4 inducers?
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Rifampin
Phenytoin Carbamazepine St John's Wort |
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What are the 3A4 inhibitors?
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CCBs (nondihydros)
Keto/Itraconazole Cimetedine Ritonavir Grapefruit Juice Macrolides (except azithro) |
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What are the 2D6 substrates?
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Beta Blockers (not atenolol)
TCAs Antiarrythmics SSRIs (will deactivate enzyme also!) Opiods |
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If patient is deficient in 2D6 what is the problem with beta blockers (metoprolol and carvedilol)? what about TCAs?
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metoprolol dose will build up --> toxicity
TCAs --> anticholinergic effects |
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What are the side effects of CCBs?
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HA, dizziness, flushing, peripheral edema
*reflex tachycardia, gingival hyperplasia **less likely w/long-acting agents |
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What drugs causes gingival hyperplasia?
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verapamil (all CCBs but mostly this one)
Phenytoin |
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What is the most common side effect of verapamil?
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constipation
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Which CCB can cause a lupus like reaction? What other hypertension med can cause a lupus like reaction?
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diltiazem
hydralazine |
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How do central alpha-adrenergic agonists work?
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decrease sympathetic outflow from vasopressor centers in the brainstem leading to a decrease in systemic vascular resistance.
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Name two cental alpha-adrenergic agents
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clonidine
methyldopa |
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Abrupt withdrawal of this drug may lead to HTN crisis.
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Clonidine
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This anti-hypertensive drug may cause a positive coombs test.
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methyldopa
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Name two direct vasodilators
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Hydralazine
Minoxidil |
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Which direct vasodilator may lead to peripheral neuropathy?
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hydralazine
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Which patients are at most risk of developing a lupus like reaction from taking hydralazine? What is hydralazine?
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Slow acetylators (50% of Caucasians and AA)
a direct vasodilator |
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Which hypertension drug must be given with a beta blocker because of reflex tachycardia and with a loop because of fluid retention?
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minoxidil
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hirsuitism |
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Which three beta blockers have been shown to reduce mortality in pts with systolic heart failure?
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bisoprolol
carvedilol S-R metroprolol succinate |
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Which two ARBs are approved for use in heart failure?
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candesartan
valsartan |
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What therapy might you try in a patient with CHF who is taking a BB and an ACE and is still symptomatic?
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combination of a nitrate and hydralazine
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In which HF class have aldosterone antagonist been studied/recommended?
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NYHA class III and IV
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