15: Drugs for CHF

Question 1

what do most ACEis end in ?

Answer 1

-pril

Question 2

what do most ARBs end in?

Answer 2

-sartan

Question 3

what tissue makes BNP?

Answer 3

ventricles

Question 4

whihc is more potent, BNP or ANP?

Answer 4

ANP

Question 5

what two hormones does ANP decrease?

Answer 5

renin, aldosterone

Question 6

locally produced ___ contributes to cardiac fibrosis after MI

Answer 6

aldosterone

Question 7

four major reasons to give diuretics

Answer 7

1. essential HTN
2. edema in CHF
3. edema in liver failure
4. edema in kidney failure

Question 8

a decrease in what causes digitalis toxicity?

Answer 8

hypokalemia

Question 9

major ECG effect of hyperkalemia vs hypokalemia

Answer 9

1. hyperK: bradycardia

2. hypoK: tall U waves

Question 10

which diuretics are considered “high ceiling”; have the greatest amount of diuresis?

Answer 10

loop diuretics

Question 11

what part of the nephron tubule do loop diuretics work in?

Answer 11

thick ascending limb

Question 12

first drug ever intended for one racial group (African Americans)

Answer 12

isosorbide dinitrate

Question 13

two cellular causes of digoxin cardiac toxicity

Answer 13

1. myocytes become overloaded with Ca -> spontaneous oscillatory releases from SR -> delayed afterdepols and aftercontractions
2. free radicals

Question 14

normal ECG changes with digoxin vs toxic levels of digoxin

Answer 14

1. normal: ST depression, PR prolongation

2. toxic: AV dissociation, ectopic ventricular beats

Question 15

four things to treat digoxin OD

Answer 15

1. KCl
2. lidocaine
3. phenytoin
4. anti-digitalis Abs

Question 16

which cardiac drug can sometimes need a loading dose

Answer 16

digoxin

Question 17

cardiorenal syndrome

Answer 17

a spectrum of disorders involving heart + kidney where dysfunction in one organ causes dysfunction in the other

Question 18

why is it important to relieve congestion in ADHF?

Answer 18

so ventricular fiber length can return to optimal range

Question 19

three classes of drugs to avoid when treating ADHF + why

Answer 19

1. class I anti-arrhtyhmics: some are negative inotropes
2. CCBs: suppress cardiac contractility
3. NSAIDs: impair Na and H2O excretion