Exam 2 Practice Questions Flashcards
Low cardiac output results in the activation of compensatory neurohormonal pathways. Activation of the SNS results in which of the following effects?
A. Peripheral vasodilation
B. Fluid retention
C. Decreased cardiac contractility
D. Increased heart rate
E. Diuresis
D. Increased heart rate
A (should be vasoconstriction)
B (not specifically SNS)
C (SNS increased contractility)
*Think fight or flight response
Which one of the following medications may exacerbate HFrEF?
A. Metformin
B. Amlodipine
C. Atorvastatin
D. Ibuprofen
D. Ibuprofen
**all NSAIDs
Which of the following physical exam findings are consistent with symptomatic heart failure (Select all that apply)?
A. Asterixis
B. Dyspnea
C. Jugular Vein Distension
D. Peripheral Edema
E. Rales
B, C, D, E
Which of the following are common causes of heart failure (Select all that apply)?
A. Bipolar disorder
B. Asthma
C. Myocardial infarction
D. Hypertension
E. Gout
C, D
Which one of the following doses would be considered “equivalent” to 1 mg PO bumetanide?
A. Furosemide PO 80 mg
B. Furosemide IV 20 mg
C. Torsemide PO 10 mg
D. Bumetanide IV 0.5 mg
A. Furosemide PO 80 mg
*note: bumetanide bioavailability is the same in both po and IV
*IV F 40mg = IV B 1mg
*Have to multiply F IV dose by 2 for PO dosing
Sacubitril/Valsartan is contraindicated in patients with HFrEF and with which one of the following?
A. Hypokalemia
B. Angioedema with ramipril
C. Concomitant therapy with furosemide
D. Heart rate < 65bpm
B. Angioedema with ramipril
A 64-year-old African American man with a history of HFrEF continues to have fatigue and dyspnea on exertion. His other labs are within normal limits. His LVEF by echocardiography is 30%. His serum digoxin concentration collected 18 hours after the previous dose is 0.8 ng/mL. His blood pressure is 130/85 mm Hg and heart rate is 60 bpm. His cardiovascular drug regimen is unchanged over the previous 3 months and includes:
Enalapril 10 mg twice daily, Carvedilol 25 mg twice daily, Furosemide 40 mg twice daily, Digoxin 0.125 mg daily, Spironolactone 25 mg daily, ASA 81 mg
daily, Atorvastatin 40 mg at bedtime
Which is the most appropriate change to his therapy?
A. Add amlodipine
B. Increase the digoxin dose to 0.25 mg/day
C. Add Ivabradine
D. Change enalapril to sacubitril/valsartan
D. Change enalapril to sacubitril/valsartan
*Determine eligibility:
Systolic BP < 100
K < 5.2
*Need to determine SrCr
GV was brought to the emergency department for difficulty breathing and notable swelling of the face, lips, and tongue. His medical history is significant for diabetes and heart failure with reduced ejection fraction. He currently takes rosuvastatin, metformin, spironolactone, carvedilol, fosinopril, bumetanide, and digoxin. Which medication should be discontinued?
A. Bumetanide
B. Digoxin
C. Fosinopril
D. Spironolactone
E. Carvedilol
C. Fosinopril
(angioedema)
*ARB becomes the substitute
Which beta-adrenergic blocking agent reduces morality in systolic heart failure?
A. Bisoprolol
B. Metoprolol tartrate
C. Atenolol
D. Nebivolol
E. Labetalol
A. Bisoprolol
ST is a 38-year-old female with heart failure secondary to radiation exposure. She is well controlled on her current treatment regimen. Today she is being seen in the clinic due to missed periods.
Her medications are: ramipril 10mg daily, bisoprolol 5 mg daily, torsemide 20 mg daily, and levothyroxine 25 mcg daily.
Human chorionic gonadotropin is +
Which of the following recommendations should be made to the prescriber regarding ST’s current medication regimen?
A. Discontinue bisoprolol
B. Increase the torsemide dose
C. Discontinue ramipril
D. Discontinue levothyroxine
E. Start valsartan
C. Discontinue ramipril
*patient is pregnant, ACEi is contraindicated in pregnancy
A patient with systolic heart failure brings a new prescription for Entresto 49/51 mg BID to the pharmacy. He was instructed to stop quinapril 20 mg BID but wants to know when to start the new medication.
The patient should wait at least how long after stopping quinapril before taking the first Entresto dose?
A. 12 hours
B. 18 hours
C. 24 hours
D. 36 hours
E. 48 hours
D. 36 hours
KG has been diagnosed with heart failure and is beginning carvedilol immediate-release. He is 5 ft, 7 in and weighs 78 kg. Assuming he tolerates the dose titrations, what is the target dose of carvedilol immediate-release for KG?
A. 12.5 mg BID
B. 25 mg BID
C. 50 mg BID
D. 75 mg BID
E. 100 mg BID
B 25 mg BID
EG is a 67-year-old white female with NYHA functional class III systolic heart failure. The cardiologist wants to begin spironolactone.
Which finding would prohibit the use of this medication?
A. CrCl= 60 mL/min
B. Sulfa allergy
C. History of angioedema
D. K=5.6 mEq/L
E. Hemoglobin= 10.2 mg/dL
D. K= 5.6 mEq/L
*do not start, wait and check again
A would be <30
B is for thiazides, and loops
Eplerenone is a suitable alternative for patients experiencing which side effect of spironolactone?
A. Hyperkalemia
B. Hypotension
C. Gynecomastia
D. Hypertriglyceridemia
E. Renal Dysfunction
C. Gynecomastia
*Note: A,B,D are associated with both agents
KL is a 54-year-old Caucasian female with HFrEF and hypertension who returns to your heaty failure clinic for routine follow up.
Her current medication regimen includes:
metoprolol succinate 200 mg daily, sacubitril/valsartan 97 mg/103 mg BID, and torsemide 20 mg daily.
She is without complaints and states that she is comfortable at rest but does have SOB after walking up two flights of stairs.
Labs: SCr: 1.2 mg/dL, K: 5.2 mEq/L
Which of the following medications would be most appropriate to start for additional mortality reduction?
A. Dapagliflozin
B. Ivabradine
C. Hydralazine/ Isosorbide Dinitrate
D. Spironolactone
E. Digoxin
A. Dapagliflozin
B does not reduce mortality
D K is too high
E does not reduce mortality
