NATS 1540 Study Guide - Final Guide: Valsartan, Sacubitril, Neprilysin
31 May 2020
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Mechanism of action: sacubitril is a neprilysin (endopeptidase) inhibitor: vasodilatory peptides sodium loss, Combination with an arb is necessary as inhibition of neprilysin leads to activation of the renin angiotensin aldosterone system (raas). Indication: health canada indication1: heart failure with reduced ejection fraction (hfref), nyha class ii-iii, in combination with other heart failure (hf) therapies in place of an acei or arb. Ccs hf 2014 guidelines2: mild-moderate hf, left ventricular ejection fraction (lvef) <40%, natriuretic peptides or hospitalization for hf in past 12 months, k+ <5. 2, egfr 30 ml/min and treated with appropriate doses of guideline-directed medical therapy. Paradigm inclusion: nyha class ii-iv, lvef 40, bnp 150 pg/ml (or nt-probnp 600 pg/ml) Or hospitalization for hf in the past year and. Bnp 100 pg/ml (or nt-probnp 400 pg/ml: stable dose of acei or arb (equivalent to enalapril 10 mg/d) and -blocker for 4 weeks. Paradigm exclusion: hypotension (symptomatic, systolic blood pressure.
