Drugs to control CHF state

Question 1

There are 2 types of Diuretics, what are the types?

Answer 1

K+ sparing

K+ losing

Question 2

What are the K+ sparing Diuretics?

Answer 2

Spironolactone

Eplerneone

Question 3

What are the K+ losing Diuretic classes?

Answer 3

Loops

Thiazides

Question 4

Where do K+ sparing Diuretics work?

Answer 4

Proximal to the late distal convoluted tubule

Question 5

What are 4 Loops (K+ losing Diuretics)?

Answer 5

Furosemide
Torsemide
Bumetanide
Ethacrynic acid

Question 6

What are 4 Loops (K+ losing Diuretic)?

Answer 6

Furosemide
Torsemide
Bumetanide
Ethacrynic acid

Question 7

MOA for Loops?

Answer 7

Block Na, K, 2Cl cotransporters

Question 8

What is the main thing that Diuretics can treat that is associated with CHF?

Answer 8

EDEMA – fluid removal!

Question 9

What are the electrolyte changes that can occur with Loops, like Furosemide?

Answer 9

HYPO-kalemia, natremia, chloremia, calcemia

HYPER-glycemia, uricemia

Question 10

What is a potential side effect of Furosemide?

Answer 10

Ototoxicity - vertigo, tinnitus, hearing impairment

Question 11

Compared to other loops (K+ losing diuretics), Torsemide and Bumetanide have better?

Answer 11

Oral absorption

Question 12

Loops are contraindicated in patients with a _____ allergy. Which loop can they take?

Answer 12

Sulfa allergy

– Can take ethacrynic acid

Question 13

What are 3 Thiazides (K+ losing diuretics)?

Answer 13

Hydrochlorothiazide (HCTZ)
Chlorthalidone
Metolazone

Question 14

What are 3 Thiazides (K+ losing Diuretics)?

Answer 14

Hydrochlorothiazide (HCTZ)
Chlorthalidone
Metolazone

Question 15

MOA for Thiazides (K+ losing diuretics)?

Answer 15

Blocks NaCl cotransporter

Question 16

Hydrochlorothiazide can treat HTN but is not effective in patients with a decreased ____

Answer 16

GFR

Question 17

What are the electrolyte changes seen with Thiazides?

Answer 17

Hypo-electrolytes

HYPER-calcemia, glycemia, uricemia

Question 18

In what patients are Thiazides and Loops contraindicated in?

Answer 18

Sulfa allergy

Question 19

Which Thiazide is a favorite to treat CHF symptoms?

Answer 19

Metolazone

Question 20

What are 4 Vasodilators to reduce cardiac work?

Answer 20

Isosorbide Dinitrate
Hydralizine
Nitroglycerin
Nitropursside

Question 21

What are 4 Vasodilators to reduce cardiac work?

Answer 21

Isosorbide Dinitrate
Hydralazine
Nitroglycerin
Nitroprusside

Question 22

Isosorbide Dinitrate vasodilates ____ to decrease ___

Answer 22

Veins to decrease preload

Question 23

Hydralazine vasodilates ____ to decrease ____

Answer 23

Arteries to decrease afterload

Question 24

What combination of Vasodilators works well on African Americans only?

Answer 24

Isosorbide Dinitrate + Hydralazine

Question 25

What are possible side effects of Hydralazine?

Answer 25

Drug-induced lupus | Angina, flushing, edema

Question 26

Nitroglyercin vasodilates ___

Answer 26

Veins

Question 27

This Vasodilator can treat Angina pectoris and acute decompensated HF?

Answer 27

Nitroglycerin

Question 28

What is 1 cardiac glycoside?

Answer 28

Digoxin

Question 29

Digoxin MOA and what it results in?

Answer 29

(-) Na/K ATPase | => increases contractility and suppresses AV node conduction

Question 30

Digoxin MOA results in?

Answer 30

Increased contractility and suppression of AV node conduction

Question 31

What must be normal in the patient before they are given Digoxin?

Answer 31

HR

Question 32

Digoxin it taken orally and has a long half life. What does it need to be dosed with?

Answer 32

Loading dose

Question 33

Digoxin is safe for pregnant women even though?

Answer 33

It crosses the placenta

Question 34

Describe how Digoxin toxicity arises

Answer 34

- (-) Na/K ATPase - DECREASED calcium movement out of cell - INCREASED calcium in myocte = spontaneous oscillatory release which contributes to twitchy arrhythmias

Question 35

Which drug tends to uncouple the atria from the ventricles and can cause alarming ECG features?

Answer 35

Digoxin

Question 36

What does Digoxin do to the AV node conduction, AV node refractory period, ventricular refractory period and purkinje automaticity?

Answer 36

AV node conduction = DECREASED AV node refractory period = INCREASED Ventricular refractory period = DECREASED Purkinje automaticity = INCREASED

Question 37

What vision changes can occur with Digoxin?

Answer 37

Halos, yellowish or greenish tint to objects

Question 38

Diuretics that cause HYPOkalemia in combination with what drug can result in that drug's toxicity?

Answer 38

Digoxin -- hypokalemia increases Digoxin binding | = Digoxin toxicity

Question 39

What is the order of Diuretics that should be given?

Answer 39

Loop - Add K+ sparing - Add Thiazide