Dr. Kacker Block 2 Pharm

Question 1

What do you prescribe for heart dilation and why?

Answer 1

Nitrates, to bring the heart back to normal

Question 2

What drugs do you give for lung symptoms in a patient with heart dilatation?

Answer 2

Furosemide

Question 3

What tx do you give if the patient is an extremist?

Answer 3

Ventilatory support and intubation

Question 4

What drug do you give to relieve symptoms for heart dilatation?

Answer 4

Loop diuretics

Question 5

What are the drug classes given for Dilated Cardiomyopathy HF?

Answer 5

Human B-type naturetic peptide
ARBS, ACEi, Beta blockers, Aldosterone antagonist (reduce remolding)

Question 6

What drugs are given to decrease mortality of CHF?

Answer 6

ACEi/ARBs, Beta Blockers and Spironolactone,
Digoxin decreases symptoms but does not lower mortality

Question 7

What drug is given in cases of dilated cardiomyopathy secondary to myocarditis?

Answer 7

Corticosteroids

Question 8

What drug do you give if there is an emergency lowering of BP?

Answer 8

Esmolol

Question 9

What increases after given a positive inotropy?

Answer 9

Contractility, EF, SV and CO

Question 9

What increases after given a positive inotropy?

Answer 9

Contractility, EF, SV and CO

Question 10

What effects does Ace Inhibitors (prils) have on CHF (dilated cardiomyopathy)?

Answer 10

Decrease afterload and preload, Decrease aldosterone, Renal protective, Reduce remodeling, control BP and proteinuria, cardio protective, anti-proliferative, anti-hypertensive

Question 11

What two drugs will both manage Hyperkalemia?

Answer 11

ACEi (prils) and Diuretics

Question 12

What is the patient selection with ACEi (prils) ?

Answer 12

Pt’s with Left Ventricular dysfunction and CHF systolic dysfunction All 4 classes

Question 13

What are the main adverse effects with ACEi (prils)?

Answer 13

Cough, hypotension, hyperkalemia, and renal dysfunction. Also, swelling of the lips, tongue, edema and mushy lips

Question 14

What are the contraindications of ACEi (prils)?

Answer 14

Renal artery stenosis (due to the reabsorption of proteins and potassium), pregnancy and previous angioedema from kinin (bradykinin). Previous history of an allergic reaction avoids using ACEi

Question 15

What effect do ACEi (prils) have on Bradykinin and Angiotensin 2?

Answer 15

ACEi (prils) will increase bradykinin and decrease Angiotensin 2.

Question 16

What effect does ARBs (sartans) have on Bradykinin and Angiotensin 2?

Answer 16

No effect on Bradykinin and increase Angiotensin 2

Question 16

What effect does ARBs (sartans) have on Bradykinin and Angiotensin 2?

Answer 16

No effect on Bradykinin and increase Angiotensin 2

Question 17

When ACEi are given, what would increase?

Answer 17

Bradykinin, Angiotensin 1, Renin, Potassium and increase of Vasoconstriction

Question 18

When given an ARBs (sartan) what would increase?

Answer 18

Renin, Angiotensin 1 and 2

Question 19

What is the best beta blocker to use for HF and why?

Answer 19

Carvedilol, more beneficial. Has 3 properties, beta blocker, alpha blocker, antioxidant. Works faster because the other beta blockers will decrease renin release.

Question 20

Why use a beta blocker in patient with CHF systolic dysfunction?

Answer 20

great reduction in mortality rates by reducing remodeling and less progression, improve quality of life and antiarrhythmic

Question 21

What role does beta blockers have on patients with CHF?

Answer 21

Anti-hypertensive, Anti Angina, Anti arrythmia, REDUCE AFTERLOAD, cardioprotective

Question 22

What role does beta blockers have on patients with CHF?

Answer 22

Anti-hypertensive, Anti Angina, Anti arrythmia, REDUCE AFTERLOAD, cardioprotective

Question 23

What are Spironolactone and Eplerenone?

Answer 23

Aldosterone Antagonist

Question 24

What are Spironolactone and Eplerenone?

Answer 24

Aldosterone Antagonist

Question 25

What are Spironolactone and Eplerenone?

Answer 25

Aldosterone Antagonist

Question 25

What are Spironolactone and Eplerenone?

Answer 25

Aldosterone Antagonist

Question 26

Why use Spironolactone?

Answer 26

Will help in patients with a EF less than 40%. In females, it will help with acne and hirsutism

Question 27

Why use Eplerenone?

Answer 27

It is more superior than spiralnectone In Males, there is no gynecomastia and erectile dysfunction

Question 28

Why use Digoxin?

Answer 28

It is a cardiac glycoside, will improve contractility and CO, INCREASE CALCIUM by inhibiting the Na+/K+ ATPAse

Question 29

What drug will also increase calcium?

Answer 29

Dobutamine, beta 1 agonist

Question 30

What are the side effects of Dixogin?

Answer 30

GI and vision issues, yellow and greenish hues called chromotopsia, cardiac vagal arrest (for overdose) in the long run, automaticity, delayed after depolarization of premature contractility called bigamy, ventricular fib for the long run

Question 31

What symptoms does Diuretics have on the lungs?

Answer 31

Decrease preload and improve ventricular efficiency by reducing circulating volume. Reduction of peripheral edema and pulmonary congestion

Question 32

What are the Adverse Effects with Diuretics?

Answer 32

Hypokalemia and hypomagnesemia

Question 33

What drug should not be given with Diuretics?

Answer 33

antibiotic aminoglycosides because of the auto toxicity

Question 34

What drug class are Amiodarone and Dofetilide?

Answer 34

Antiarrhythmics

Question 35

What effects does Vasodilators cause?

Answer 35

Reduce afterload and preload

Question 36

What is the MOA for Vasodilators?

Answer 36

Nitric Oxide release to activate guanylate cyclase to cGMP to cause vasodilator

Question 37

What is the clinical use of Vasodilators?

Answer 37

Treatment of pulmonary edema secondary to CHF Heart failure in Afro-Americans patients Patients intolerant of ACEI or ARA. As soon as you decrease afterload you will increase CO

Question 38

What are Isosorbide dinitrate and hydralazine?

Answer 38

Isosorbide dinitrate is a Venodilator Hydralazine is an Arterial dilator

Question 39

What are the Adverse Effects of Nitrates?

Answer 39

They cause Methemoglobinemia

Question 40

What are the clinical uses of Human B type Natriuretic Peptide?

Answer 40

acutely decompensated heart failure by their vasodilatory and diuretic effects. 

Question 41

What is Milrinone?

Answer 41

PDE inhibitor  cAMP increase  increase Ca++ inotropic and vasodilation Only given for acute.

Question 42

Why should you NEVER use Milrinone for chronic management of CHF?

Answer 42

strong severe reflex tachycardia and arrythmia

Question 43

What are the clinical uses for Milrinone?

Answer 43

Reserved for patients who need hemodynamic-directed treatment during ACUTE DECOMPENSATION, For those who are refractory to maximal standard therapy, As palliation for end-stage heart failure, or as a bridge to transplantation for appropriate candidates.

Question 44

In what patients should you restrict giving Anti coagulants/ Anti platelets (Heparin and Enoxaparin) to?

Answer 44

In atrial fibrillation With artificial valves With known mural thrombus

Question 45

What patients should have the left ventricular device or for cardiomyopathy surgery?

Answer 45

Patients with disease refractory to medical therapy.

Question 46

How do you treat patient with Hypertrophic Cardiomyopathy?

Answer 46

Beta blockers, verapamil (CCB) and diuretics

Question 47

What are the Adverse Effects with Hypertrophic Cardiomyopathy Medication?

Answer 47

non sustained ventricular tachycardia, abnormal blood pressure

Question 48

What is the treatment for (HOCM) Hypertrophic Cardiomyopathy?

Answer 48

Metoprolol

Question 49

What is the treatment for Aortic Regurgitation?

Answer 49

hydralazine and nifedipine to reduce afterload, surgery

Question 50

What is the treatment for Mitral Stenosis?

Answer 50

Percutaneous mitral balloon valvotomy. Beta Blockers and CCB, diuretics

Question 51

What is the treatment for patients with Rheumatic Fever?

Answer 51

Penicillin G benzathine (im), Penicillin V(oral) Statin- can significantly slows progression

Question 52

What is the treatment with Atrial Fibrillation?

Answer 52

beta-blocker or calcium channel blocker therapy.Metoprolol (Lopressor, Toprol XL), Diltiazem Anticoagulation is indicated: Heparin, Warfarin (Coumadin) 3 weeks prior cardioversion

Question 53

What is the treatment for Mitral Regurgitation?

Answer 53

Surgery, the physician should consider cardioversion in refractory or unstable patients.

Question 54

What is the treatment of Mitral Regurgitation?

Answer 54

Nitrate, nitroprusside (vasodilator). The goal is to reduce afterload treatment of pulmonary edema should include oxygen, diuretics(furosemide), nitrates, nitroprusside and early intubation if respiratory failure results. Treatment of myocardial infarction : Thrombolytics. Rapid atrial fibrillation secondary to chronic mitral regurgitation should be controlled with digoxin or diltiazem.