Cardiac Week 10

Question 1

Classes of Anti Anginal Agents

Answer 1

Organic nitrates
beta blockers
calcium channel blockers
Ranolazine (Ranexa)

Question 2

Nitrates MOA

Answer 2

cause vasodilation through direct action on vascular smooth muscle
* Primarily affects VEINS
* Decreases cardiac oxygen demand
* Decreases preload

Question 3

Heart Failure Mechanisms

Answer 3

• Inability of the heart to pump blood in amount adequate to meet
  oxygen need of tissues
• Primary defect is with contractility- leading to decreased CO
• HFrEF (Heart Failure with reduced ejection fraction)
• Chronic HTN
• Post-MI

Question 4

HF Treatment

Answer 4

Question 5

Heart Failure Compensation

Answer 5

Question 6

Digoxin (Lanoxin)

Answer 6

CLASS
* Cardiac glycoside
* 2nd-line treatment for HF
* MOA
* Inhibits Na+, K+, -ATPase, promoting calcium accumulation in myosites
* Increasing myocardial contractility
* Increases cardiac output
* Decreasing sympathetic tone (and heart rate)
* Increasing urine production
* Decreasing renin release
* Narrow Therapeutic Index: 0.8- 2ng/dL

Question 7

Name adverse effects for Digoxin

Answer 7

Dysrhythmias- baseline ECG, electrolytes/renal function labs
* Bradycardia
* GI (n/v/d, anorexia)
* Weakness
* Drowsiness/confusion
* Hypokalemia = digoxin toxicity (patient should monitor for signs/sx of low K+)

Question 8

Patient instructions for Lanoxin

Answer 8

Take @ same time each day
* Measure HR daily (HOLD and call office if <50-60)
* Report signs and sx of worsening heart failure
* Do NOT switch brands
* Do not take with antacids or milk
* Eat high-K+ diet UNLESS taking ACE-Is or K+ sparing diuretic

Question 9

Sacubitril / Valsartan (Entresto)

Answer 9

• CLASS
• Angiotensin receptor neprilysin inhibitor (ANRI)
• MOA
• Increases natriuretic peptides while suppressing the negative effects of RAAS
• Use/Indication
• HF stages II-IV (in place of ACE-I or ARB)
• AE (same as ARB class)
• Hyperkalemia, angioedema, hypotension