CHF Treatment

Question 1

Drugs used in Class 1 (Stage B) CHF

Answer 1

ACEi/ARB, Beta-blocker

Question 2

Drugs used in Class 2 (Stage C) CHF

Answer 2

Diuretic, ACEi/ARB, Beta-blocker

Question 3

Drugs used in Class3 (Stage C) CHF

Answer 3

Digoxin, Diuretic, ACEi/ARB, Beta-blocker

Question 4

Drugs used in Class 4 (Stage D) CHF

Answer 4

IV Vasodilators, Transplantion/assist devices, digoxin, diuretics, ACEi/ARB, Beta-blocker

Question 5

Beta blockers used for CHF

Answer 5

Metoprolol, Carvedilol, Bisprolol, Nebivolol (not approved by FDA yet)

Question 6

High ceiling loop diuretics

Answer 6

Furosemide, Bumetanide

Question 7

K+ sparing diuretics

Answer 7

Aldosterone antagonists: Spironolactone, eplerenone

Independent of Aldo: Triamterene, Amiloride

Question 8

Diuretic Toxicities

Answer 8

electroyle disturbances, hypokalemia, hyponatremia, hypochloremic metabolic alkalosis, azotemia dehydration, hypotension, tinnitus, hearing loss (loop only)

Question 9

Diuretic drug interactions

Answer 9

NSAIDs reduce efficacy and promote fluid retention

Question 10

Spironolactone, Eplerenone

Answer 10

K+ sparing diuretics that also help CHF because aldosterone has direct mitogenic and fibrogenic effects on myocardium and increased aldosterone may worsen LV function

Question 11

IV Vasodilators used for CHF

Answer 11

Nitrates to reduce preload and after load

Question 12

IV Inotropic agents used for CHF

Answer 12

Beta-agonists: dobutamine - contraindicated with beta blockers

Phosphodiesterase inhibitors: Milrinone - short term IV use only

Question 13

Nesiritide

Answer 13

B-type natriuretic peptide (BNP) given IV in recombinant form to promote vaso/venodilation and natriureses causing reduced preload, inhibition of renin and aldosterone release, inhibition of sodium reabsorption in proximal convoluted tubule, and selective afferent arteriolar vasodilation

Only used in Class IV CHF, when IV NO is not tolerated because BNP has longer sustained hypotension