Congestive Heart Failure

Question 1

ACEIs

Answer 1

Captopril
Enalapril
Lisinipril

Question 2

ARBs

Answer 2

Losartan
Valsartan

Question 3

Positive Inotropes

Answer 3

Digoxin
Doubtamine

Question 4

B-Blockers

Answer 4

Carvedilol
Metaprolol

Question 5

Diuretic

Answer 5

Spironolactone
Eplerenone

Question 6

ACEI and ARBs are…

Answer 6

DOC in HF

Question 7

Heart failure

Answer 7

Decrease in cardiac contractility which results in decrease CO

Question 8

Pharmacotherapy aimed at

Answer 8

Increase contractility of the heart (increase CO)
Decrease preload
Decrease afterload
Decrease remodeling of cardiac muscle

Question 9

Angiotensin Antagonists
- MOA

Answer 9

Decreased preload and afterload

Question 10

Angiotensin Antagonists
- Reduces

Answer 10

Cardiac remodeling and improve left ventricular function
Morbidity and mortality in CHF

Question 11

ACEIs
- Captopril, enalapril, lisinopril

Answer 11

Used as first-line therapy in patients with HF
Slow the progress of ventricular dilation by decreasing preload and afterload

Question 12

ARBs
- losartan, valsartan, telmisartan

Answer 12

Block AT1 recetpors
Produce beneficial clinical effects similar to ACEIs
ARBs do not interfere with bradykinin degradation (DO NOT INDUCE DRY COUGH)

Question 13

ARBs
- Block AT1 receptors

Answer 13

Effective against hypertension and CHF

Question 14

Diuretics

Answer 14

Spironolactone
Loop diuretics
Thiazide diuretics

Question 15

Diuretics
- Spironolactone

Answer 15

Used to decrease remodeling (decrease aldosterone-induced remodeling)

Question 16

Diuretics
- Loop diuretics

Answer 16

Furosemide
Carefully monitor K+ levels

Question 17

Diuretics
- Thiazide diuretics

Answer 17

Hydrochlorothiazide
Monitor K+ levels

Question 18

Metoprolol and Carvedilol

Answer 18

Decrease HR and renin release
Decrease remodeling (by decreasing catecholamine-induced mitogensis)
Improve left ventricular function and exercise time, and reduce mortality and morbidity post-CHF

Question 19

Positive Inotropic Drugs
- Digoxin

Answer 19

Increase contractility of heart (increase CO)

Question 20

Digoxin
- MOA

Answer 20

Inhibition of cardiac Na+-K+ ATPase, increasing calcium activity within the cardiac myocyte

Question 21

Digoxin
- Results in:

Answer 21

Increased intracellular Na+
Affects Na+/Ca2+ exchange
Increase intracellular Ca++
Increase Ca2+ released from sarcoplasmic reticulum
Increase actin-myosin interaction
Increase contractile force

Question 22

Digoxin indirect effect

Answer 22

Inhibition of cardiac Na+-K+ ATPase

Question 23

Inhibition of cardiac Na+-K+ ATPase
- Results in

Answer 23

Increase vagal activity (therapeutic doses)–> slows HR and AV nodal conduction-treats atrial flutter/fibrillation and supraventricular tachycardia

Question 24

Positive Inotropic Drugs
- Pharmacokinetics

Answer 24

Narrow therapeutic index
Long t1/2: 30-40 hours
Renal clearance (digoxin)

Question 25

Positive Inotropic Drugs
- Uses

Answer 25

CHF
Supraventricular tachycardias

Question 26

Side effects of Digoxin

Answer 26

Anorexia
Nausea
Vomiting
ECG changes (AV block)
Bradycardia
Disorientation
Visual effects (halos)
Increase (toxic) doses–> increase sympathetic activity (ventricular arrhythmias)

Question 27

Management of Digoxin toxicity

Answer 27

Use antidote
Supportive therapy

Question 28

Management of Digoxin toxicity
- Antidote

Answer 28

Digoxin antibodies (Fab fragments) known as Dgibind, DigiFab