Congestive Heart Failure

Question 1

Which 3 drugs are responsible for cardiac remodeling?

Answer 1

Ang II

Aldosterone

Norepi

Question 2

Which 3 drugs slow cardiac remodeling?

Answer 2

Spironolactone

ACE Inhibitors

ARB’s

Question 3

The majority of heart failure patients will require the loop diuretic…..

Answer 3

furosemide

Question 4

If the patient is allergic to furosemide, then give them what?

Answer 4

Ethacrynic Acid

Question 5

Which types of diuretics cause hypokalemia?

Which diuretics can help reduce the hypokalemia caused by the above?

Answer 5

Loop and Thiazides

Potasssium Sparing Diuretics (Spiro)

Question 6

Advanced heart failure patients are given ACE inhibitors and diuretics, what else can be added to help patiets survive longer?

Answer 6

Spironolactone

Question 7

What are the 3 most important basis for use ACE inhibitors in HF?

Answer 7

Reduction in arterial resistance (afterload)

Reduction in venous tension (preload)

Slows down cardiac remodeling

Question 8

ACE inhibitors work to help reduce cardiac modeling in ….systolic or diastolic HF?

Answer 8

Systolic

Question 9

Which ACE inhibitor can significantly reduce LV hypertrophy?

Answer 9

Enalapril

Question 10

What is the advantage of using an ARB as opposed to an ACE Inhintor?

Answer 10

THe ARB will not produce a cough, because it is not involved wth Bradykinin

Question 11

Which 4 Beta blockers are used to help trear CHF?

What is the specific pathology involved for its treatment?

Answer 11

Carvedilol, Metoprolol, Bisoprolol, and Atenonlol

Dilated Cardiomyopathy (Systolic Dysfunction)

Question 12

What are the 3 main categories for vasodilators?

Answer 12

Nitrates

Hydralazine

Sodium nitroprusside

Question 13

What are some inotropic drugs?

Answer 13

Digoxin (cardiac glycoside), Dobutamine (Beta agonisr),

Amrinone, and Milrinone (PDE inhibtors)

Question 14

What are the two things Digoxin do to treat CHF (systolic) ?

Answer 14

Increase contractility

Enhance Vagal tone

Question 15

Whats the benefit of Digoxin enhancing vagal tone?

Answer 15

to slow down sinus heart rate and av conduction

*to reduce the rapid vetricular rate in atrial flutter and fibrillation*

Question 16

What is the first sign of Digoxin toxicity?

Answer 16

Vision issues (abnormalities in color vision)

Question 17

What 3 physiological factors increase digoxin toxicity?

Answer 17

hypokalemia

hypercalcemia

hypomagnesemia

Question 18

Which 3 drugs can enhance digoxin toxicity?

Answer 18

quinidine, amiodarone, verapamil

Question 19

In digoxin toxicity, serious arrhythmias can occur, which 3-4 drugs can help treat it?

Answer 19

lidocaine/phenytoin (ventricular arrhythmias)

atropine (av block)

digoxin specific antibody fragments (given IV for severe OD)