Drugs Used in Heart Failure II

Question 1

ethacrynic acid

Answer 1

loop diuretic

-no sulfa

Question 2

nesiritide

Answer 2

natriuretic peptide

Question 3

isosorbide dinitrate

Answer 3

venodilator

Question 4

hydralazine

Answer 4

arteriolar dilator

Question 5

nitroprusside

Answer 5

arteriolar and venodilator

Question 6

vit B deficiency

Answer 6

decreased myocardium contractility

Question 7

drug therapies for HF

Answer 7

volume overload (congestion)

and myocardial dysfunction

Question 8

diuretics and inotropes

Answer 8

not proven to decrease mortality

Question 9

reduce mortality

Answer 9

ACE
ARB
beta blockers
aldosterone receptor blocker

Question 10

systolic failure

Answer 10

reduced CO and contractility
reduced EF

respond to positive inotropes**

Question 11

diastolic failure

Answer 11

hypertrophy and stiffened myocardium

CO reduced

EF normal

Question 12

HF clinical

Answer 12

tachycardia, decreased exercise tolerance, SOB, edema, cardiomegaly

Question 13

Tx for HF and atrial fib

Answer 13

digoxin

Question 14

digoxin mechanism

Answer 14

inhibit Na/K ATPase

improve contractility
AND prolong refractory of AV node

Ca accumulates in myocardium**

Question 15

therapeutic digoxin

Answer 15

early prolonged AP
-followed by AP shortening

increased PS, decreased S
-inhibited by atropine

Question 16

toxic digoxin

Answer 16

shortened AP - with depolarizing afterpotentials

-premature ectopic beats

AV junctional rhythm, premature ventricular depolarization, bigeminal rhythm, second degree AV block

can deteriorate to fibrillation

also toxic GI affects

Question 17

hyperkalemia

Answer 17

reduce toxic effects of digoxin

Question 18

hypokalemia

Answer 18

increase toxic effects of digoxin

Question 19

hypercalcemia and hypomagnesemia

Answer 19

increase risk of digoxin induced arrhythmia

Question 20

inamrinone

Answer 20

bipyridine

Question 21

milrinone

Answer 21

bipyridine

Question 22

bipyridine

Answer 22

short term support of circulation of HF

Question 23

bipyridine MOA**

Answer 23

inhibit phosphodiesterase isozyme 3 (PDE3)
-increased cAMP

cardiac - stimulated contraction and fast relaxation

vasculature - balances a and v dilation

both mediated by cAMP increases

Question 24

dobutamine

Answer 24

beta1 agonist

positive inotropic

used short term**

Question 25

dopamine

Answer 25

D1 agonist

Question 26

intermediate dopamine doses

Answer 26

beta stimulation

Question 27

high dose dopamine doses

Answer 27

constriction of a and v - alpha-adrenergic

Question 28

diuretics

Answer 28

loop, thiazide, K-sparing, aldosterone antagonist only aldosterone antagonists reduce mortality**

Question 29

SIADH

Answer 29

give vasopressin

Question 30

conivaptan

Answer 30

ADH antagonist

Question 31

tolvaptan

Answer 31

selective antagonist of V2 ADH receptors

Question 32

angioedema, cough, hyperkalemia

Answer 32

with ACE inhibitors

Question 33

ARBs

Answer 33

selectively block AT1 - resulting in beneficial effect of ANGII action at AT2

Question 34

isosorbide dinitrate

Answer 34

venodilator | -decreased preload

Question 35

hydralazine

Answer 35

arteriolar dilator | -decreased afterload

Question 36

nitroprusside

Answer 36

arteriolar and venodilator | -decreased preload and afterload

Question 37

nesiritide

Answer 37

given IV -form of BNP smooth m relaxation

Question 38

reduce mortality

Answer 38

bisoprolol carvedilol metoprolol nebivolol

Question 39

beta blockers and CHF

Answer 39

therapy initiated at low doses

Question 40

thiazide and loop diuretics

Answer 40

secondary loss of potassium - hazardous with digoxin | -

Question 41

ACE - and ARBs

Answer 41

first choice in HF with no edema

Question 42

in african americans who cannot tolerate standard HF therapy

Answer 42

hydralazine and isosorbide dinitrate

Question 43

digoxin

Answer 43

no effect on mortality

Question 44

improve mortality

Answer 44

``` ACE ARBs beta blockers aldosterone antagonists hydralazine + nitrate ``` for chronic HF -along with diuretics and digoxin

Question 45

Tx for acute HF

Answer 45

diuretics, IV vasodilators, beta agonists, bipyridines

Question 46

diuretic

Answer 46

get rid of congestive symptoms

Question 47

inotropic agent

Answer 47

get rid of low output symptoms

Question 48

spironolactone and eplerenone

Answer 48

reduce mortality