Chronic Chf

Question 1

Calcium channel blockers should not be used in CHF

Answer 1

Due to reflex sympathetic activation in case of nifedipine or direct cardiodepressant action in case of verapamil and diltiazem

Question 2

Agents reducing both preload and afterload include

Answer 2

ACE inhibitors, angiotensin receptor blockers (ARBs), nitroprusside and alpha blockers.

Question 3

Combination of hydralazine and isosorbide dinitrate

Answer 3

Decrease mortality

Question 4

ACE Inhibitors and Angiotensin Receptor Blockers indicated in

Answer 4

These drugs are indicated in all grade of CHF unless contra-indicated. These can decrease mortality in CHF

Question 5

How do ace i and arb dec mortality

Answer 5

These decrease the mortality via prevention and reversal of cardiac remodeling due to aldosterone

Question 6

Ex of aldosterone antagonist

Answer 6

Spironolactone and epleronone are the aldosterone antagonists.

Question 7

If tol dev in case of aldo antagonist

Answer 7

These can also be added to thiazides if tolerance develops.

Question 8

Beta and chf ?

Answer 8

Previously beta blockers were considered to be contra-indicated in CHF due to their negative inotropic action but now it has been found that if used carefully, these drugs can increase the longevity of CHF patients.

Question 9

Moa of beta blocker in. Chf

Answer 9

Beta-1 causes release of renin which stimulate RAAS and finally increase in aldosterone results. Beta blockers antagonize this pathway resulting in reversal of remodeling.

Question 10

Most common beta blocker in chf

Answer 10

Most widely used beta blocker is carvedilol

Question 11

Best indication of beta blocker in chf

Answer 11

These are best indicated in mild to moderate heart failure (NYHA class II and III) with dilated cardiomyopathy

Question 12

Contraindication of beta blocker in which failure

Answer 12

absolutely contra-indicated in decompensated heart failure

Question 13

How do we administer beta blocker

Answer 13

. These should be started at very low doses and the dose should be gradually increased to get the maximum benefit.

Question 14

Ivabradine ufnny current blocker

Answer 14

It is a funny current blocker used in angina pectoris

Question 15

Moa of ivabradin

Answer 15

It decreases myocardial oxygen demand by causing bradycardia.

Question 16

When should we use ivabradine

Answer 16

recommend it for CHF in patients with heart rate >70 bpm with ejection fraction < 35% and symptomatic despite treatment with beta blockers, ACE inhibitors and aldosterone antagonists.

Question 17

What are vasopeptidase inhibitors?

Answer 17

These are the drugs inhibiting two enzymes, ACE and NEP

Question 18

Ex of vasopeptidase inhibitor

Answer 18

Omapatrilat and sampatrilat

Question 19

Mode of admin for vasopeptidase inhibitor

Answer 19

orally for the treatment of chronic CHF.

Question 20

Limiting factor of vasopeptidase inhibitor

Answer 20

Major limiting factor of these drugs is angioedema.

Question 21

combination of valsartan and sacubitril called as

Answer 21

ARNI - ANGIOTENSIN RECEPTOR BLOCKER AND NEPRILYSIN INHIBITOR APPROVED FOR CHF

Question 22

Agents decreasing mortality in chf

Answer 22

Ace inhibitor
Arb 
Beta blocker
Aldosterone antagonist
Isosorbide dinitrate plus hydralazine combo