CV & Renal: HF Drugs

Question 1

Which two drug classes used to treat HF have positive inotropic effects?

Answer 1

sympathomimetics

Digitalis

Question 2

Venodilators can be used to decrease _____

Answer 2

preload

Question 3

Arteriodilators can be used to decrease ______

Answer 3

afterload

Question 4

What effect do beta-blockers have on contractility?

Answer 4

decrease

Question 5

Which drug class should be used?

Cause: increased preload due to increased volume and venous tone.

Goal: Reduce preload

Answer 5

Diuretic or venodilator

Question 6

Which drug class should be used?

Cause: Increased afterload due to increased aortic impedance and arterial constriction.

Goal: Decrease afterload

Answer 6

Arteriodilator

Question 7

Which drug class should be used?

Cause: Decreased contractility due to ventricular dilation, causing reduced pumping force

Goal: Increase contractility

Answer 7

Inotropic drug

Question 8

Which drug class should be used?

Cause: Increased HR due to reflex tachy via sympathetic hyperactivity.

Goal: Reduce energy expenditure of heart

Answer 8

Beta Blocker

Question 9

Positive inotropic drugs should be considered only when?

Answer 9

last resort

Question 10

This drug class has the following characteristics:

decrease salt and water retention

Decrease venous pressure

decrease edema and cardiac size

Answer 10

Diuretics

Question 11

Which diuretics have been shown to reduce mortality rate?

Answer 11

Aldosterone Antagonists: spironolactone and eplerenone

Question 12

What are the three major pathophysiologic functions of AT II?

Answer 12

altered peripheral resistance, renal function, cardiovascular structure

Question 13

What are the three results from AT II stimulation?

Answer 13

Increased afterload (rapid pressure response)

Increased preload (slow pressor response)

Increased cardiac remodeling

Question 14

Which drugs are considered RAAS inhibitors?

Answer 14

ACEs and ARBs

Question 15

This enzyme catalyzes the conversion of AT I to AT II

Answer 15

ACE

Question 16

These drugs block AT II binding to the AT1 receptor thereby inhibiting RAAS

Answer 16

ARBs

Question 17

ACE-Is have the suffix _____

ARBs have the suffix ____

Answer 17

ACE: pril

ARB: sartan

Question 18

This drug class has the following therapeutic effects:

Tx of HF

Decrease HF mortality 28-40%

Diminish cardiac workload

Answer 18

ACE/ARBs (RAAS inhibitors)

Question 19

This drug has the following adverse effects:

Dry cough due to reduced bradykinin metabolism

Answer 19

ACE-I

Question 20

What is responsible for the decreased preload with RAAS inhibitors?

Answer 20

decreased aldosterone release

Question 21

What is responsible for the decreased afterload with RAAS inhibitors?

Answer 21

decreased AT-II induced vasoconstriction

Question 22

What drug class is a combination ARB and Neprilysin Inhibitor?

Answer 22

ARNI (entresto)

Question 23

Which drug class has the following mechanism?

Blocks binding of ATII to ATI

decreased degradation of natriuretic peptides, bradykinin

Answer 23

ARNI (entresto)

Question 24

What three effects does neprilysin inhibition of ARNIs have?

Answer 24

↓ vasoconstriction
↓ Na+ Retention
↓ Cardiac Remodeling

Question 25

Which RAAS antagonist is the best at reducing mortality?

Answer 25

ARNI (entresto)

Question 26

Three adverse effects of ARNIs...

Answer 26

hypotension hyperkalemia cough/angioedema

Question 27

Can you use an ARNI with an ACE or ARB?

Answer 27

no

Question 28

When can beta blockers be considered in heart failure?

Answer 28

early... dangerous in severe HF

Question 29

The below effects of beta blockers have what positive impact on HF? ↓ Renin Modulate effects of catecholamines Up-Regulate Beta Receptors

Answer 29

↓ Mortality

Question 30

Which three vasodilators can be used in HF?

Answer 30

sodium nitroprusside isosorbide dinitrate hydralazine

Question 31

The below effects of vasodilators have what overall benefit in HF tx? ↓ Preload via venodilation ↓ afterload via arteriolar dilation

Answer 31

↓ cardiac remodeling

Question 32

This HF drug is a selective B1 agonist with positive inotropic effects.

Answer 32

Dobutamine

Question 33

When should dobutamine be considered with HF?

Answer 33

short term tx of severe refractory HF

Question 34

Low dose dopamine has what effect?

Answer 34

D1 receptors in kidney → vasodilation

Question 35

Moderate dose dopamine has what effect?

Answer 35

B1 receptors in heart → positive inotropic effect

Question 36

High dose dopamine has what effect?

Answer 36

Alpha receptors in vessels → vasoconstriction

Question 37

Dopamine is indicated for...

Answer 37

severe, refractory HF w/ Hypotension

Question 38

The below mechanism describes which HF drug? Inhibition of membrane Na+/K+ ATPase, resulting in ↑ intracellular Ca2+

Answer 38

Digoxin

Question 39

Both SNS stimulation and Digoxin can cause ↑ contractility. In HF, there is increased SNS tone. What effect does adding digoxin have?

Answer 39

decreases SNS tone in failing heart

Question 40

When should digoxin be considered?

Answer 40

arrhythmia last resort in HF

Question 41

What is an early sign of digoxin toxicity?

Answer 41

GI sxs

Question 42

Describe the margin of safety of digoxin...

Answer 42

toxic even at therapeutic doses

Question 43

What type of toxicity is experienced in 5-25% of patients using digoxin?

Answer 43

glycoside toxicity

Question 44

What tests and serum values must be measured regularly to avoid arrhythmia?

Answer 44

EKG + Potassium and Digoxin levels

Question 45

What is the most common and most dangerous SFx of digoxin?

Answer 45

arrythmia

Question 46

Cardioversion is only indicated in which digoxin induced arrhythmia?

Answer 46

VFib

Question 47

How is mild, moderate, and severe digoxin toxicity treated?

Answer 47

Mild (GI): Discontinue Moderate (Arrhythmia): Above + PO/IV Potassium Severe (life threatening arrhythmia): Above + Digitalis Immune Fab

Question 48

The below will have what effect on digoxin? Hypokalemia ↓ SA/AV node activity Myocardial sensitization to digoxin

Answer 48

Increased toxicity

Question 49

Hypokalemia has what effect on digoxin? What can cause this?

Answer 49

↑ Digitalis Action Use w/ thiazide/loop diuretics, diarrhea

Question 50

↓ SA/AV node activity is exacerbated when digoxin is administered with...

Answer 50

beta blockers

Question 51

Myocardial sensitization to digoxin is worsened with administration of...

Answer 51

NE releasing agents

Question 52

What drug class decreases the effectiveness of digoxin?

Answer 52

CCBs

Question 53

Are CCBs indicated or contraindicated for HF?

Answer 53

contraindicated