Cardio Pharm - Heart Failure

Question 1

Which medication classes are used in heart failure

Answer 1

anti-hypertensives

diuretics

nitrates

antidiuretics

anticoagulants

anti-arrhythmics

Question 2

antihypertensives

Answer 2

ace inhibitors

beta blockers

HTN is primary cause of HF so this is a good place to start

Question 3

goals of heart failure treatment

Answer 3

1. control blood pressure
2. reduce left ventricular after load
3. improving cardiac function
4. decreasing progression of pathological remodeling

Question 4

ace inhibitors

drug example

Answer 4

Lisinopril/Zestril

Question 5

ACE inhibitors indications

Answer 5

first line agent in heart failure 2nd to HTN

all patients are put on this

Question 6

ACE inhibitors

MOA

Answer 6

competitive inhibitor of ACE

prevents conversion of angiotensin I to angiotensin II causing increase of plasma renin activity and reduction in aldosterone

Question 7

ACE inhibitor

SE

Answer 7

hypotension

reduction in GFR

hyperkalemia

cough

angioedema

Question 8

ACE inhibitor CI

Answer 8

patients with idiopathic or hereditary angioedema

Question 9

Beta blockers

drug example

Answer 9

metoprolol

Lopressor

Question 10

beta blockers

indications

Answer 10

initiated after ACE inhibitor

patients with current or prior HF

Question 11

beta blockers

MOA

Answer 11

stop heart from working so hard

reduces the detrimental effects of adrenergic catecholamine stimulation

including elevated heart rate

Question 12

beta blockers SE

Answer 12

bradycardia

hypotension

bronchospasm

Question 13

beta blockers

CI

Answer 13

sinus bradycardia

2 or 3 heart block

asthma

Question 14

ex diuretics

Answer 14

furosemide (Lasix)

spironolactone (Aldactone)

fluid control, symptom relief

Question 15

major manifestations of volume overload in HF

Answer 15

pulmonary congestion

peripheral edema

elevated jugular venous pressure

Question 16

furosemide class
brand

Answer 16

loop diuretic

Lasix

Question 17

furosemide

indication

Answer 17

management of edema associated with heart failure and acute pulmonary edema

symptomatic relief of heart failure of pulmonary edema

Question 18

Lasix MOA

Answer 18

inhibits reabsorption of sodium and chloride in ascending loop of Henle and distal renal tubule

Question 19

furosemide

SE

Answer 19

hypotension

can lead to profound diuresis (K loss)

fluid and electrolyte deplete

Question 20

Lasix CI

Answer 20

electrolyte depletion

hypovolemia

hypotension

Question 21

spironolactone

brand, class

Answer 21

Aldactone

Aldosterone antagonist diuretic

Question 22

Aldactone

indication

Answer 22

reduce morbidity and mortality in patients with HF

Question 23

spironolactone

MOA

Answer 23

competes with aldosterone for receptor sites in distal renal tubules

increasing NaCl and water excretion while conserving K and H ion

Question 24

aldactone SE

Answer 24

renal failure

Question 25

spironolactone CI

Answer 25

anuria

acute renal insufficiency

significant impairing of renal excretory function

hyperkalemia

Question 26

nitrate indications

Answer 26

acute decompensated heart failure

Question 27

nitrate MOA

Answer 27

vasodilator effect on peripheral vein and arteries

more prominent effect on veins

reduces cardiac oxygen demand by decreasing preload

dilates coronary arteries

Question 28

nitrate SE

Answer 28

hypotension

bradycardia or tachycardia

syncope

headache

dizziness

nausea

vomiting

diaphoresis

dyspnea

Question 29

Nitrate

CI

Answer 29

hypotension

marked bradycardia, tachycardia

right ventricular infection

concurrent use with PDE-5

Question 30

indications for anticoagulants

Answer 30

abnormal flow

low cardiac output

atrial fibrillation

Question 31

drug examples of anticoagulants

Answer 31

warfarin (Coumadin)

enoxaparin (Lovenox)

Question 32

anti-arrhythmic drug used

Answer 32

Digoxin (Lanoxin)

Question 33

Digoxin indication

Answer 33

heart failure

Question 34

Lanoxin MOA

Answer 34

inhibition of Na/K ATPase pump in myocardial cells

this promotes Ca influx (via sodium calcium exchange) leading to increased contractility

Question 35

side effect of Digoxin/Lanoxin

Answer 35

arrhythmias

Question 36

CI for digoxin

Answer 36

arrhythmias

digoxin toxicity
(esp. those with low body weight, advanced age, renal impairment, hypokalemia, hypercalcemia, hypomagnesemia)