Congestive heart Failure -kumar

Question 1

What occurs when cardiac output is inadequate to provide the oxygen needed by the body?

Answer 1

Heart failure

Heart failure can lead to various symptoms and complications due to insufficient blood flow and oxygen delivery.

Question 2

What are the two major types of heart failure?

Answer 2

• Systolic failure (HFrEF)
• Diastolic failure (HFpEF)

Systolic failure is characterized by reduced contractility and ejection fraction, while diastolic failure involves stiffening and inadequate relaxation.

Question 3

What is a common symptom of heart failure?

Answer 3

• Tachycardia
• Shortness of breath
• Cardiomegaly
• Decreased exercise tolerance

These symptoms reflect the body’s compensatory mechanisms and the heart’s inability to meet its demands.

Question 4

What is the mechanism of action of loop diuretics?

Answer 4

Inhibit Na+-K+-2Cl- symporter in the ascending loop of Henle

This action increases Na+ and water delivery to the distal tubule, leading to diuresis.

Question 5

Name three examples of loop diuretics.

Answer 5

• Furosemide
• Bumetanide
• Torsemide

These medications are commonly used to manage fluid overload in heart failure.

Question 6

What is diuretic resistance?

Answer 6

A compensatory increase in renal tubular reabsorption of Na+

This can occur when patients become less responsive to diuretics over time.

Question 7

Fill in the blank: Loop diuretics do not improve the _______ rate in patients.

Answer 7

mortality

While effective for symptom management, loop diuretics have not been shown to reduce mortality in heart failure.

Question 8

What are the common adverse drug reactions (ADRs) associated with furosemide?

Answer 8

• Nausea
• Vomiting
• Dizziness
• Hypokalemia
• Ototoxicity

These ADRs can lead to significant complications, especially in elderly patients.

Question 9

What is the primary use of aldosterone antagonists?

Answer 9

Treatment of hypertension and congestive heart failure

Aldosterone antagonists help manage fluid retention and blood pressure.

Question 10

What is the mechanism of action of eplerenone?

Answer 10

Blocks the binding of aldosterone to mineralocorticoid receptors

This action inhibits one arm of the Renin-Angiotensin-Aldosterone System (RAAS).

Question 11

What are the contraindications for eplerenone?

Answer 11

• Hyperkalemia
• Creatinine clearance < 50 mL/min
• Serum creatinine > 1.8 M, 2.0 F

These contraindications help prevent dangerous levels of potassium in the blood.

Question 12

Fill in the blank: Sodium Nitroprusside acts as a _______ by relaxing both resistance and capacitance vessels.

Answer 12

vasodilator

It is used in acute situations to rapidly reduce preload and improve cardiac function.

Question 13

What is a major risk associated with prolonged administration of sodium nitroprusside?

Answer 13

Cyanide toxicity

This occurs due to the release of cyanide during the biotransformation of nitroprusside.

Question 14

How does hydralazine function as a treatment for heart failure?

Answer 14

Directly acts as a vasodilator to decrease systemic vascular resistance

This allows the heart to pump more efficiently, improving symptoms of heart failure.

Question 15

True or False: ACE inhibitors are superior to hydralazine in reducing mortality in CHF.

Answer 15

True

ACE inhibitors have been shown to provide better outcomes in terms of survival for CHF patients.

Question 16

What are the advantages of inhibitors over hydralazine in CHF?

Answer 16

Inhibitors are superior in reducing mortality in CHF

ADRs of inhibitors include withdrawal effect and lupus-like syndrome.

Question 17

What is the mechanism of action (MOA) of hydralazine?

Answer 17

Hydralazine binds with endothelium receptors in the arterioles, causing NO release and relaxation of vascular smooth muscle.

Question 18

In what combinations is hydralazine often used?

Answer 18

Hydralazine is more often used in combination with isosorbide dinitrate.

Question 19

List the major uses of Minoxidil.

Answer 19

• Antihypertensive
• Alopecia treatment to promote hair growth

Question 20

What is the MOA of Minoxidil for hair growth?

Answer 20

Enhanced microcirculation around hair follicles and direct stimulation of follicles.

Question 21

What are the effects of beta-blockers in CHF?

Answer 21

• Reduces sympathetic tachycardic reflex
• Improves left ventricular morphology
• Decreases cardiomyocyte apoptosis

Question 22

What is the initial effect of beta-blockers on systolic function in CHF?

Answer 22

Initially decreases, but recovers over 2-4 months.

Question 23

Which drugs are classified as beta-blockers for CHF?

Answer 23

• Atenolol
• Metoprolol
• Carvedilol
• Bisoprolol

Question 24

What is recommended for patients with CHF and an ejection fraction < 35%?

Answer 24

Beta-blockers are recommended to counteract circulating catecholamines.

Question 25

What are the side effects of Carvedilol?

Answer 25

* CNS: malaise, dizziness, fatigue * CV: A-V block, bradycardia * GI: nausea, vomiting, diarrhea

Question 26

What are the drug interactions associated with Carvedilol?

Answer 26

* Increased levels with calcium channel blockers * Enhanced hypoglycemia with insulin * 70% reduction in levels with Rifampin

Question 27

What are the goals of inotropic therapy in CHF?

Answer 27

* Normalize cardiac output * Relieve pulmonary congestion * Reduce ventricular dimension * Optimize blood pressure * Improve exercise tolerance

Question 28

What are the mechanisms of action for Digoxin?

Answer 28

Inhibits Na+/K+-ATPase, increases intracellular sodium, leading to increased intracellular calcium.

Question 29

What are the administration forms of Digoxin?

Answer 29

* Tablets: 0.125, 0.25, 0.5 mg * Elixir: 0.05, 0.1, 0.2 mg * IV injection: 0.05, 0.1, 0.25 mg

Question 30

What are the signs of digitalis toxicity?

Answer 30

* CNS: fatigue, confusion, psychosis * Cardiac: severe arrhythmias * Visual: yellow-green halos

Question 31

True or False: Digoxin has a narrow therapeutic index.

Answer 31

True

Question 32

What should be monitored to assess Digoxin toxicity?

Answer 32

G.I effects (diarrhea) and electrolyte levels.

Question 33

What is the MOA of Milrinone?

Answer 33

Inhibits phosphodiesterase III, increasing cAMP and calcium availability.

Question 34

What is the indication for Sacubitril/Valsartan (Entresto)?

Answer 34

Indicated to reduce the risk of cardiovascular death and hospitalization in chronic heart failure with reduced ejection fraction.

Question 35

What type of medication is Ivabradine?

Answer 35

A heart rate-lowering medicine.

Question 36

What is the mechanism of action of Ivabradine?

Answer 36

Selectively inhibits the 'funny' channel pacemaker current (If).

Question 37

What drug was approved by the FDA in April 2015 for the treatment of chronic heart failure?

Answer 37

Ivabradine ## Footnote Ivabradine is indicated for patients with an ejection fraction of ≤35% in sinus rhythm.

Question 38

What are the criteria for patients to receive Ivabradine?

Answer 38

Patients must have: * Ejection fraction of ≤35% * Sinus rhythm * Resting heart rate ≥70 beats per minute * Not on beta-blockers due to contraindications or already receiving maximum beta-blocker dose ## Footnote These criteria ensure the proper use of Ivabradine in heart failure management.

Question 39

What mechanism does Ivabradine use to lower heart rate?

Answer 39

It selectively inhibits the 'funny' channel pacemaker current (If) in the sinoatrial node ## Footnote This action results in a dose-dependent reduction in heart rate.

Question 40

What is the role of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in the action of Ivabradine?

Answer 40

Ivabradine acts on HCN channels to inhibit the pacemaker current (If) ## Footnote This inhibition leads to a lower heart rate and improved blood flow to the myocardium.

Question 41

How does Ivabradine compare to non-dihydropyridine calcium channel blockers and beta blockers?

Answer 41

Ivabradine is a 'pure' heart rate-lowering drug with a more favorable side effect profile ## Footnote Non-dihydropyridine calcium channel blockers and beta blockers may cause adverse events due to negative ionotropic effects.

Question 42

What is the effect of Ivabradine on myocardial oxygen demand?

Answer 42

Ivabradine lowers the pacemaker firing rate, consequently lowering heart rate and myocardial oxygen demand ## Footnote This mechanism helps improve oxygen supply and mitigate ischemia.

Question 43

What benefits does Ivabradine provide to patients with chronic heart failure?

Answer 43

It allows for: * Improved oxygen supply * Mitigation of ischemia * Higher exercise capacity * Reduction in angina episodes ## Footnote These benefits enhance the quality of life for patients with chronic heart failure.