Case #1:

A 55 YOM has PMH significant for HFrEF (EF 35%) for 2 years, Stage C/III who is having shortness of breath with ordinary activities that you notice as he walks up to your pharmacy counter. Using the local RHIO you notice his BMP is within normal limits (including potassium and serum creatinine), and you perform a MTM encounter to improve his morbidity and mortality with HF.

▪ Meds:

▪ Lisinopril 20 mg PO daily

▪ Metoprolol succinate 50 mg PO daily

▪ Aspirin 81 mg PO daily

▪ Rosuvastatin 20 mg PO daily

What would you do?

▪ Zoom Polling Question

a) Add Sacubitril/Valsartan 24/26 mg PO daily

b) Add spironolactone 25 mg PO daily

c) Increase metoprolol succinate to 100 mg PO daily

d) Change metoprolol succinate to carvedilol 25 mg PO BID

Case #2:

▪ A 50 yoF with history of T2DM, HFrEF, HTN.

▪ Her BP in the pharmacy today is 110/70 mmHg; last A1c was 9.0%; BMI is 33 kg/m2

▪ She is not experiencing any symptoms of shortness of breath, edema, or fatigue at rest or with activity

▪ Medications:

▪ Atorvastatin 40mg daily

▪ Aspirin 81mg

▪ Carvedilol 25mg twice daily

▪ Entresto 49/51mg twice daily

▪ Furosemide 20mg daily

▪ Metformin 500mg twice daily

▪ Spironolactone 25mg daily Which of the following changes would you recommend to optimize this patient's regimen? (Select al that apply)

a) Increase sacubitril/valsartan to 97/103mg twice daily

b) Start dapagliflozin 10mg daily

c) Start liraglutide 0.6mg daily for 1 week, then increase to 1.2mg daily

d) Increase metformin to 1000mg twice daily

e) Stop furosemide 20mg daily

Case #3:

A patient with a history of heart failure with preserved ejection fraction undergoes routine ECHO in the setting of ongoing dyspnea on exertion. Her ECHO reveals EF 60% with moderate pulmonary hypertension. She then undergoes right heart catheterization for diagnosis and categorization of pulmonary hypertension.

▪ Her initial readings are:

▪ MPAP = 29 mmHg

▪ PAWP = 21 mmHg.

▪ PVR = 1.9 Wood units.

▪ She is given a dose of furosemide 80mg IV and after 30 minutes her readings are:

▪ mPAP = 21mmHg

▪ PAWP = 14 mmHg

▪ PVR = 1.9 Wood units

Which of the following disease state specific medication regimens is appropriate for her?

a) Tadalafil 40mg daily

b) Macitentan 10mg daily

c) Tadalafil 40mg + Macitentan 10mg daily

d) Treprostinil 10 ng/kg/min IV

e) None of the above

Case #4

▪ A 44 YOM with a history of HTN, dyslipidemia, and MI is having trouble getting his blood pressure goal of 130/80. His BMP is notable for a potassium of 4.9 and a SCr of 1.1 (CrCl 98mL/min). What recommendations do you have?

Meds:

• Hydrochlorothiazide 25 mg PO daily

• Amlodipine 5 mg PO daily

• Metoprolol succinate 25 mg PO daily

• Atorvastatin 40 mg PO daily

• Aspirin 81 mg PO daily

a) Increase hydrochlorothiazide to 50 mg PO daily

b) Change hydrochlorothiazide to chlorthalidone 25 mg PO daily.

c) Change metoprolol to carvedilol 12.5 mg PO BID

d) Add spironolactone 12.5 mg PO daily

Case #4 (part 2):

▪ You see from the RHIO that his lipid panel is:

▪ LDL 155

▪ HDL 33

▪ Trig 177

What do you recommend for changes to his medication therapy?

a) Increase atorvastatin to 80 mg PO daily

b) Change atorvastatin to rosuvastatin 40 mg PO daily

c) Add ezetimibe 10 mg PO daily

d) Add insurance-covered PCSK-9 inhibitor therapy