Ch 48: Drugs for Heart Failure

Question 1

Of those patients who have heart failure, __% are likely to die within 1 year, and __% within 5 years.

Answer 1

20%; 50%

p. 517

Question 2

As a rule of heart failure, cardiac remodeling ________ development of symptoms.

Answer 2

precedes

p. 517

Question 3

What 3 symptoms of HF demonstrate inadequate tissue perfusion?

Answer 3

fatigue, shortness of breath, exercise intolerance

p. 517

Question 4

What 3 symptoms of HF demonstrate volume overload?

Answer 4

[central] venous distention, peripheral edema, pulmonary edema

(p. 517)

Question 5

Cardiac dilation results from a combination of…

Answer 5

…increased venous pressure, and reduced contractile force.

p. 518

Question 6

As arterial BP falls as a result of HF, the baroreceptor reflex kicks in. What are the 4 compensatory events which occur as a result?

Answer 6

Increased HR
Increased contractility
Increased venous tone
Increased arteriolar tone

(p. 518)

Question 7

In a patient hospitalized for HF, the lower the BNP level…

Answer 7

…the greater the chances of long-term survival.

p. 519

Question 8

For routine therapy, heart failure is treated with 3 types of drugs:

Answer 8

1) diuretics
2) agents that inhibit the RAAS
3) beta blockers

(p. 519)

Question 9

When selecting a diuretic for a patient with HF, caution should be used. Because ACE inhibitors and ARBs carry a risk of hyperkalemia, these drugs should not be combined with a…

Answer 9

…potassium-sparing diuretic.

p. 520

Question 10

Spironolactone prolongs survival in HF patients primarily by blocking ___________ _________, not by causing ________.

Answer 10

aldosterone receptors
diuresis

(p. 520)

Question 11

In the absence of specific contraindications, all patients with HF should receive…

Answer 11

…an ACE inhibitor.

p. 520

Question 12

How do ACE inhibitors help to treat HF?
They block production of ____________, decrease release of ___________, and suppress degradation of ______. As a result they improve hemodynamics and favorably alter _______ __________.

Answer 12

angiotensin II
aldosterone
kinins
cardiac remodeling

(p. 520)

Question 13

Why are the ARBs’ effects on cardiac remodeling less favorable than those of ACE inhibitors?

Answer 13

Because ARBs do not increase levels of kinins.

p. 521

Question 14

Current guidelines recommend adding an aldosterone antagonist to standard HF therapy, but only in patients with persistent symptoms despite treatment with an ___ _________ and ____ _______.

Answer 14

ACE inhibitor and a beta blocker

p. 521

Question 15

The mechanism underlying the benefit behind beta blocker use in heart failure is uncertain. What are some likely possibilities?

Answer 15

protecting the heart from excessive sympathetic stimulation and protecting against dysrhythmias

(p. 522)

Question 16

What 2 sympathomimetic drugs are used to treat heart failure?

Answer 16

dopamine and dobutamine

p. 522

Question 17

What kind of drug is milrinone?

Answer 17

a phosphodiesterase inhibitor

p. 523

Question 18

What is the danger of using inotropes too aggressively?

Answer 18

Inotropes can induce dysrhythmias and cause myocardial ischemia from increased metabolic demand.

(p. 523)

Question 19

What is BiDil and why is it special?

Answer 19

It is a fixed dose combination of hydralazine and isosorbide dinitrate. It is used to treat HF in African Americans, making it the first medication approved for a specific ethnic group.

(p. 523)

Question 20

Digoxin increases myocardial contractility by inhibiting…

Inhibition of this enzyme…

Answer 20

…the enzyme known as Na-K-ATPase.
…promotes calcium accumulation within myocytes. The calcium augments contractile force.

(p. 524)

Question 21

During treatment with digoxin, if potassium levels are high, it causes…
A potassium level that is too low can cause…

Answer 21

…a reduction in the therapeutic response.
…toxicity.

(p. 525)

Question 22

Although digoxin can produce substantial improvement in HF symptoms, [research shows that]…

Answer 22

…it does not prolong life.

p. 525

Question 23

By inhibiting the Na-K-ATPase in vagal afferent fibers, digoxin…

Answer 23

…decreases sympathetic outflow from the CNS by increasing the sensitivity of cardiac baroreceptors.

(p. 525)

Question 24

What is the optimal therapeutic range for digoxin levels?

Answer 24

0. 5 - 0.8 ng/mL

p. 526

Question 25

Digoxin is eliminated primarily by…

Answer 25

…renal excretion.

p. 528

Question 26

All patients with Stage C HF should receive…

Answer 26

…an ACE inhibitor.

p. 529

Question 27

For patients who cannot tolerate ACE inhibitors or ARBs…

Answer 27

…substitution of isosorbide dinitrate (ISDN)/ hydralazine is considered reasonable.

(p. 529)