Exam 2 - Treatment for HF and CHD (lecture)

Question 1

Which HF drug improves contractility?

Answer 1

digoxin

Question 2

Would you give digoxin for systolic or diastolic heart failure?

Answer 2

systolic

Question 3

which HF drugs slow deterioration and prevent remodeling?

Answer 3

ACE-I

BB

spironolactone

Question 4

Which HF drugs improve diastolic function?

Answer 4

antihypertensives

(to decrease LVH)

Question 5

Which HF drug do you give to blacks to prevent remodeling?

Answer 5

Hydralazine

Question 6

What are some non-pharm tx for HF?

Answer 6

remove precipitating factors

bed rest (+ anticoags)

elastic stockings

low salt diet

Question 7

Which HF drugs relieve symptoms and reduce preload?

Answer 7

loop diuretics

Question 8

Which HF drugs are not loop diuretics, but have a diuretic effect?

Answer 8

ACE-I, ARBs

Question 9

Which drugs decrease mortality in HF?

Answer 9

ACE-I

BBs

Hydralazine

vasodilators

Question 10

Do ACE-Is reduce afterload, preload, or both?

Answer 10

both

Question 11

Do ACE-Is dilate veins or arteries?

Answer 11

both :)

Question 12

Can you give beta blockers in a HF patient who is unstable?

Answer 12

no!

Question 13

What HF drugs decrease SVR, increase CO, and relieve symptoms?

Answer 13

vasodilators

Question 14

How do you treat acute angina?

Answer 14

NTG sublingual

Question 15

Does NTG vasodilate or venodilate?

Answer 15

venodilates

Question 16

Does NTG decrease preload or afterload?

Answer 16

preload

Question 17

How often can you repeat a dose of NTG?

Answer 17

every 3-5 minutes if symptoms haven’t left

Question 18

What is prophylaxis for acute angina?

Answer 18

NTG sub-lingual

5 min before activity

Question 19

What drugs prevent acute angina (5)?

Answer 19

BBs

Long acting nitrates (isoborbide)

CCBs

Ranolazine

Anti-platelets

Question 20

Which 2 beta blockers are best to give for acute angina prevention?

Answer 20

metoprolol

atenolol

Question 21

what do BBs do to the heart?

Answer 21

dec HR, contractility, BP

improves exercise tolerance

Question 22

With what dz should you avoid BBs?

Answer 22

lung disease

Question 23

do CCBs dilate arteries or veins?

Answer 23

arteries (peripheral)

Question 24

do CCBs decrease preload or afterload?

Answer 24

afterload

Question 25

Do CCBs decrease mortality after an MI?

Answer 25

NO

Question 26

Which CCB type goes well in adjunct with **BBs?**

Answer 26

dihydropuridines

Question 27

Which CCB type goes well in adjunct with **nitrates?**

Answer 27

nondihydropyridines

Question 28

Which type of CCB should you avoid in HF?

Answer 28

nondihydropyridines

Question 29

Which nondihydropyridine CCB should you especially avoid with a beta blocker? What can happen?

Answer 29

veramapil heart block

Question 30

When would you give ranolazine in acute angina?

Answer 30

When a pt is nonresponsive to other treatment

Question 31

What is the MOA of ranolazine?

Answer 31

decrease sodium --\> decreases Ca --\> decreases contraction and O2 need

Question 32

What will ranolazine cause to happen on EKG, which is totally fine?

Answer 32

Prolonged QT interval

Question 33

What agent is used in ALL patients with CHD?

Answer 33

ASA

Question 34

What can you give as an ASA alternative?

Answer 34

Clopidogrel

Question 35

Which angina patients are candidates for surgery (4)?

Answer 35

they have symptoms despite treatment they have 3 vessel CAD they have disease in L main artery they have ischemia/acute MI

Question 36

Which type of revascularization surgery is indicated for 1-2 vessel disease and involves placing a stent?

Answer 36

Percutaneous Coronary Intervention | (a type of angioplasty)

Question 37

which type of revascularization surgery involves replacing the diseased vessel(s) with part of the saphenous vein or **internal mammary artery?**

Answer 37

coronary artery bypass grafting (CABG)

Question 38

How do you treat Prinzmetal's angina?

Answer 38

nitrates CCBs

Question 39

How do you treat unstable angina (non-STEMI)?

Answer 39

**Hospitalize,** bed rest, O2 fully anticoag and antiplatelet (**LMWH + ASA**) **nitrates, BB, CCB** all used to decrease 02 need

Question 40

What should you give to your STEMI patients within 1-3 hours of symptom onset (if they qualify)?

Answer 40

thrombolytics (tPA)

Question 41

How do you manage an acute STEMI?

Answer 41

**Hospitalize + ASA** morphine IV nitro IV

Question 43

What management will you send your STEMI patient home with?

Answer 43

LMWH + ASA BB

Question 44

If an elderly person has a STEMI, what treatment is preferred?

Answer 44

surgery (percutaneous transluminal coronary angioplasty)

Question 45

What drugs might you also rx with large infarcts?

Answer 45

ACE-I and ARBs

Question 46

What drug should you NOT give with infarction?

Answer 46

nsaids!