CHF Packet - Pharm

Question 1

True or false: in CHF, there is an increase in s/p tone and in in circulating NE.

Answer 1

True. This is what make it possible that these receptors are merely downgraded.

Question 2

Right side or left sides heart failure more common?

Answer 2

Left. Heart fails to move blood into periphery and fails to perfuse the tissue adequately. This leads to reduced renal BF.

Question 3

Which sided heart failure leads to pulmonary edema? To peripheral edema?

Answer 3

Left sided. Right.

Question 4

Can beta blockers be used to treat CHF?

Answer 4

Yes!

Question 5

For which sided heart failure is it okay to use CCB?

Answer 5

Right sided.

Question 6

Which loop diuretic should not be used in HTN? Essentially it is too powerful. But great for CHF.

Answer 6

Furosemide

Question 7

Which commonly taken drug is know to reduce the efficacy of diuretics?

Answer 7

NSAIDS

Question 8

Ototoxicity and hearing loss are common side effects for which drugs that treat CHF?

Answer 8

Diuretics

Question 9

Explain the relationship between bradykinin and ACEi.

Answer 9

ACEi prevent the metabolism of bradykinin causing a cough. Note: ARB do not inhibit bradykinin breakdown so, no cough!

Question 10

What is a viable alternative for patients who do not tolerate ACEi/antagonists?

Answer 10

Hydralazine/nitrate

Question 11

CCBs are really bad to treat CHF, why?

Answer 11

B/c of their negative inotropic effects

Question 12

When is a ccb good for CHF pts?

Answer 12

When there is right sided hypertrophy. The ccb will relax it and reduce cardiac size. So agin, only use ccb to treat Right sided heart failure.

Question 13

Agents that increase myocardial contractility are called positive inotropic agents. What is the most commonly used one to treat CHF?

Answer 13

Digoxin. A cardiac glycoside.

Question 14

What is an example of a non glycoside inotrope?

Answer 14

Dobutamine. Must be monitored b/c tachycardia can occur. Only use in ER, IV

Question 15

Phosphodiesterase inhibitors are also inotropic agents. What exactly do they do? (physiologically)

Answer 15

Increase cardiac cAMP levels which increases myocardial contractility.

Question 16

What is one of the more common phosphodiesterase inhibitors? (Used for CHF)

Answer 16

Milrinone. This is also mainly used in an inhouse setting.

Question 17

How is it that Beta blockers actually do help in CHF?

Answer 17

They may slow the progression of myocardial dysfunction by preventing catecholamine induced beta receptor down regulation.

Question 18

What is the essential part of digitalis?

Answer 18

The unsaturated lactose ring at position 17. Also the OH at 14 is necessary.

Question 19

True or false: cardiac glycosides have low therapeutic index but well known toxicity.

Answer 19

True

Question 20

Does digitalis increase heart rate?

Answer 20

No, only the force of the contraction.

Question 21

Are the inotropic effects of digitalis blocked by beta blockers or cat depleters?

Answer 21

No

Question 22

For systolic dysfunction what is the DOC?

Answer 22

Digitalis

Question 23

For diastolic dysfunction what is the DOC?

Answer 23

Ccb - NO DIGITALIS

Question 24

What is the key effect digitalis has on pts with CHF regarding each of the following: 1. heart size 2. contractile force and c/o 3. HR 4. venomotor tone 4. PR

Answer 24

reduces heart size; increases contractile force and c/o; reduces both HR and venomotor tone; decrease peripheral resistance

Question 25

Most drug drug interactions tend to decrease blood digoxin levels. A few standouts that tend to INCREASE levels include?

Answer 25

Quinidine, verapamil, amiodarone, erythromycin, diltiazem, nifedipine, cyclosporine,

Question 26

What is the first sign of toxicity from dig?

Answer 26

PVC. Vtach can then follow. And av nodal block.

Question 27

What is the agent that is the complete opposite in action of dig?

Answer 27

Dilantin (phenytoin). This can be used for dig OD.

Question 28

What is used to treat dig induced arrhythmias?

Answer 28

Lidocaine.

Question 29

What is known as purified fab fragments?

Answer 29

Digibond. The antibodies.

Question 30

what does digitalis do for a CHF patient in terms of his SA and AV nodes? (think in terms of Ach and NE)

Answer 30

sensitizes SA and AV nodes to Ach and desensitizes them to NE.