Heart Failure

Question 1

Cardinal manifestations of heart failure

Answer 1

Dyspnea
Fatigue
Fluid retention

Question 2

Treatment is directed at two somewhat different goals

Answer 2

Reducing symptoms and slowing progression as much as possible during relatively stable periods
Managing acute episodes of decompensated failure

Question 3

Drugs use for chronic heart failure

Answer 3

Diuretics
Aldosterone receptor antagonists
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Beta blockers
Cardiac glycosides
Vasodilators

Question 4

Drugs for heart failure

Answer 4

diuretics
vasodilators
beta agonists
bipyridines
natriuretic peptide

Question 5

General therapeutic principles

Answer 5

Reduction of the congestive state
Controlled blood pressure
Maintenance of atrial contraction and prevention of tachycardia
Treatment and prevention of myocardial ischemia
Detection and treatment of sleep apnea

Question 6

Genus name for the family of plants that provide most of the medically used cardiac glycosides

Answer 6

DIGOXIN

Question 7

T/F All of the cardiac glycosides/cardenolides combine steroid nucleus linked to a lactone ring at the 17 position and a series of sugars at carbon 3 of the nucleus

Answer 7

T

Question 8

T/F Digitalis Lack an easily ionizable group

Answer 8

T

Question 9

Prototype of digitalis

Answer 9

digoxin

Question 10

T/F 65-80% absorbed after oral administration

Answer 10

T

Question 11

T/F Digitalis are extensively metabolized and widely distributed to tissues

Answer 11

False: Digitalis are not extensively metabolized and all acardiac glycosiddes are widely distributed to tissues

Question 12

half lide of digitalis in normal renal fundtion

Answer 12

36-40 hours

Question 13

T/F Cardiac glycosides inhibit Na/K ATPase

Answer 13

T

Question 14

T/F Inhibitory action of digitalis is responsible for therapeutic effect (positive inotropy) only

Answer 14

false: Inhibitory action is responsible for both therapeutic effect and toxicity

Question 15

T/F cardiac gycosides increase contraction of the cardiac sacromere

Answer 15

T

Question 16

T/F digitalis increses the free calcium concentration

Answer 16

T

Question 17

2 steps when there is an increase in the free calcium concentration by digitalis

Answer 17

1st: Na/K ATPase inhibition
2nd: Reduction of calcium expulsion from the cells by sodium-calcium exchanger

Question 18

The most common cardiac manifestations of Digitalis toxicity include

Answer 18

Atrioventricular junctional rhythm
Premature ventricular depolarizations
Bigeminal rhythm
second-degree atrioventricular blockade

Question 19

T/F Digitalis can cause virtually ANY arrythmia.

Answer 19

T

Question 20

Most common site of digitalis toxicity outside the heart

Answer 20

GI tract

Question 21

GI tract manifestation of digitalis toxicity

Answer 21

anorexia
nausea
vomit
diarrhea

Question 22

CNS manifestation of digitalis toxicity

Answer 22

Disorientation and hallucinations (especially in the elderly), visual disturbances, aberrations of color perception

Question 23

T/F Gynecomastia is a common effect reported in men

Answer 23

F: Gynecomastia is a rare effect reported in men

Question 24

Interaction of potassium and digitalis

Answer 24

First, they inhibit each other’s binding to Na⁺/K⁺-ATPase

Second, abnormal cardiac automaticity is inhibited by hyperkalemia

Question 25

A positive inotropic drug for heart failure that increases contractility by inhibiting Na/K ATPase and is an invetigational steroid derviative

Answer 25

Istaroxime

Question 26

Positive inotropic drugs used in heart failure

Answer 26

PHOSPODIESTERASE INHIBITORS
BETA ADRENOCEPTOR AGONISTS
DIURETICS
ACE INHIBITORS, ARBS, AND RELATED AGENTS
VASODILATORS
BETA- ADRENOCEPTOR BLOCKERS