(2) CV & Renal: Heart Failure (1.1-1.2)

Question 1

what plant is digoxin derived from?

Answer 1

foxglove plant

Question 2

MOA: cardiac glycosides

Answer 2

Inhibit Na⁺/K⁺ ATPase

(⇒ ↓ Ca²⁺ efflux due to inhibition of Na⁺/Ca²⁺ exchanger)

Question 3

Indications (2) : Digoxin

Answer 3

(1) Heart failure
(2) Atrial arrhythmias
* (Inhibition of neuronal Na+, K+ ATPase ⇒ Depolarization of ANS efferents ⇒ ↑ PNS on nodes (↓ HR) and ↑ SNS on ventricles (↑ Contractility) )*

Question 4

name 5 signs of digoxin poisoning

Answer 4

(1) Hyperkalemia
(2) ⇒ Arrhythmias
(3) Bradycardia
(4) Nausea/Vomiting

(5) Xanthopsia (objects appear yellow)

Question 5

what effect does digoxin have on EKG?

Answer 5

“scooped” concave ST segments

Question 6

how does digoxin reduce heart rate?

Answer 6

↑ PNS on SA/AV

Question 7

What electrolyte abnormality exacerbates Digoxin toxicity?

Answer 7

Hypokalemia

Question 8

How is Digoxin eliminated from the body?

Answer 8

Renal clearance

(Note: Digoxin has a huge Vd as its concentration is buffered by the ubiquitous Na+,K+-ATPase)

Question 9

Treatment: Digoxin toxicity

Answer 9

anti-Digoxin Fabs

(Mg2+ also helpful)

Question 10

MOA: Milrinone

Answer 10

Inhibits phosphodiesterase

Question 11

MOA: Nesiritide

Answer 11

Analog of BNP

(⇒ Diuresis and arteriolar/venous dilation)

Question 12

Contraindication - Cardiac Origin: Digoxin

Answer 12

Heart block

Question 13

Suffix: ARBs

Answer 13

“-sartan”

Question 14

MOA: Aliskiren

Answer 14

Direct renin inhibitor

Question 15

What effect does Angiotensin II have on renal electrolyte handling?

Answer 15

↑ Na⁺/HCO3^- in PCT

Question 16

Suffix: ACE inhibitors

Answer 16

“-pril”

Question 17

Name 4 physiologic effects of ACE inhibitors/ARBs

Answer 17

(1) Dilate efferent arteriole
(2) ⇒ ↓ GFR
(3) ↓ Aldosterone release
(4) ⇒ ↓ Na+/HCO3- reabsorption in PCT

Question 18

Name 2 solute abnormalities caused by ACE inhibitors

Answer 18

(1) ↑ Creatinine
(2) Hyperkalemia

Question 19

What is a common initial side effect for heart failure patients started on ACE inhibitors?

Answer 19

Fainting

(Sudden drop in AngII ⇒ Vasodilation ⇒ Syncope)

Question 20

Indications (4) : ACE inhibitors

Answer 20

(1) Heart failure
(2) Myocardial infarction
(3) Hypertension
(4) Diabetic nephropathy

Question 21

Do ACE inhibitors ↓ mortality in heart failure?

Answer 21

Yes

(By inhibiting AngII mediated remodeling)

Question 22

When are diabetic patients placed on ACE inhibitors?

Answer 22

Albuminuria with BP >130/80

Question 23

What is the most distinctive side effect of ACE inhibitors?

Answer 23

Dry cough

(Due to increased bradykinin)

Question 24

What genetic disease is an absolute contraindication to ACE inhibitors?

Answer 24

Hereditary angioedema

Question 25

Which antihypertensive is a teratogen?

Answer 25

ACE inhibitors

Question 26

What drugs are an absolute contraindication to ACE inhibitors?

Answer 26

NSAIDs