Cardiovascular- Heart Failure

Question 1

What kinds of drugs are used in HF to decrease pathologic sympathetic stimulation?

Answer 1

Beta Blockers

Question 2

What kinds of drugs are used in HF to decrease the load on failing hearts?

Answer 2

Diuretics

Question 3

What kinds of drugs are used in HF to address issues involving the RAA axis?

Answer 3

ACEI

Question 4

Systolic HF treatment involves what meds?

Answer 4

Diuretics, ACI, digoxin & nonspecific vasodilators

Question 5

Diastolic HF treatment involves what meds?

Answer 5

Diuretics, vasodilators, inotropic drugs, BB, hydralazine/nitrates

Question 6

ACC/AHA 2005 guidelines say that Stages A and B are

Answer 6

at risk for heart failure

Question 7

ACC/AHA 2005 guidelines say that Stages C and D are

Answer 7

in heart failure

Question 8

What is the frontline treatment of systolic heart failure?

Answer 8

Diuretic + ACEI

Question 9

What is added to treat systolic heart failure after diuretic + ACEI(or ARB)?

Answer 9

Beta Blocker

Question 10

If persistent signs and symptoms remain in a patient with systolic heart failure who is on a diuretic, ACEI, and BB what is the next line of treatment?

Answer 10

Aldosterone antagonist or ARB

Question 11

If persistent signs and symptoms remain in a patient with systolic heart failure who is on a diuretic, ACEI, BB, and an aldosterone antagonist with a QRS

Answer 11

Digoxin

Question 12

What stage is a patient at high risk for heart failure but without structural heart disease or symptoms of HF?

Answer 12

Stage A

Question 13

What stage is a patient with structural heart disease but w/out symptoms?

Answer 13

Stage B

Question 14

What Stage is a patient with structural heart disease with prior or current symptoms

Answer 14

Stage C

Question 15

What stage is a patient with refractory heart failure?

Answer 15

Stage D

Question 16

What classifications does the NYHA use?

Answer 16

Class 1-4
I= is the best
2= dyspnea w/minimal activity
3= dyspnea at lower workloads
4= dyspnea at rest

Question 17

At what stage should you begin to think about heart transplants?

Answer 17

Stage D

Question 18

How would you treat a Stage A patient?

Answer 18

Treat HTN- ACEI
Treat lipids
Control metabolic syndrome
Encourage lifestyle modifications

Question 19

How would you treat a Stage B patient?

Answer 19

ACEI/ARB in appropriate pts

BB in appropriate pts

Question 20

How would you treat a Stage C patient?

Answer 20

Routine Use of:
Diuretics for fluid retention
ACEI
BB

In selected patients:
Aldosterone antag
ARB
Digoxin
Hydralazine/nitrates

Devices:
Biventricular pacing
Implantable defibrillators

Question 21

What would you prescribe to a patient with HF and fluid retention?

Answer 21

Furosemide 40 mg

One tablet twice daily

Question 22

What would be your therapy for a patient with Stage A HF and HTN?

Answer 22

Lisinopril 40mg

One tablet daily

Question 23

Dose an ARB for use in HF

Answer 23

Valsartan 80mg

One tablet twice daily

Question 24

What would you give to a HF patient who is post MI?

Answer 24

Carvedilol 25 mg

One tablet twice daily

Question 25

What drugs reverse cardiac remodeling?

Answer 25

Beta blockers

Question 26

What ejection fraction is indicative of heart failure?

Answer 26

<40%

Question 27

Dose an aldosterone antagonist you would give to your patient in who is Stage C

Answer 27

Eplerenone 50mg | One tablet daily

Question 28

What vasodilator would you give to a refractory patient in Stage D

Answer 28

BiDil | One tablet 3x a day

Question 29

How does Digoxin work?

Answer 29

Increased force of contraction and decreased rate of contraction

Question 30

When is digoxin indicated?

Answer 30

Patients with LVEF <40% | who continue to have NYHA class, II, III, and IV despite optimal therapy

Question 31

What drugs have been shown to increase dig levels?

Answer 31

Antacids Metoclopramide (Reglan) St. John's wort

Question 32

What drugs decrease dig levels?

Answer 32

Amiodarone Alprazolam (Xanax) Verapamil Spironolactone (Aldactone)

Question 33

Dose a cardiac glycoside

Answer 33

Digoxin 125mcg | 1 tablet daily

Question 34

How do inotropes work?

Answer 34

Stimulate B1 receptors of heart, comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects

Question 35

Dose an inotrope

Answer 35

Dobutamine infusion 5 mcg/kg/minute | titrate to effect

Question 36

How do B-type Natriuretic Peptides work?

Answer 36

Increase intracellular cGMP resulting in smooth muscle relaxation and arterial & venous dilation