Heart Failure

Question 1

Renin-angiotensin converting enzyme inhibitors examples

Answer 1

enalapril, lisinopril, quinapril

Question 2

Renin-angiotension converting enzyme inhibitors are also known as

Answer 2

ACE inhibitors

Question 3

ACE inhibitors can be given to patients with

Answer 3

heart failure, left ventricular dysfunction with serum creatinine concentration below 220umol/L, serum potassium concentration less than 5.5mol/L without postural hypotension or a history of angioedema.

Question 4

What are the side effects of ACE inhibitors?

Answer 4

Angioedema, dry cough, loss of taste, orthostatic hypotension

Question 5

Who is contraindicated with ACE inhibitors

Answer 5

Patients with renal artery stenosis or in condition of hyperkalemia (serum potassium concentration of 5.5 mmol or greater)

Question 6

Angiotension 2 type1-receptor antagonists are also know as

Answer 6

ARBs

Question 7

ARBs you should know

Answer 7

losartan and candesartan

Question 8

What do ARBs due to the heart

Answer 8

block the effect of angiotension 2 on angiotension 2 type1 receptors, and produce similar beneficial haemodynamic effects as those of ACE inhibitors in patients with congestive heart failure.

Question 9

When should ARBs be used?

Answer 9

If someone is intolerant to ACE inhibitors (usually because of loss of taste or cough)

Question 10

Neutral endopeptidase inhibitor combined with ARB do __ to the heart?

Answer 10

They can reduce the risk of cardiovascular death and hospitalization in patients with heart failure that have reduced ejection fraction. The two drugs combined lower cardiovascular mortality and slow the progression of heart failure

Question 11

Neutral endopeptidase inhibitor combined with ARB side effects:

Answer 11

hypotension and hyperkalemia. Cough and elevated serum creatinine levels as well

Question 12

Neutral endopeptidase inhibitor combined with ARB contraindications:

Answer 12

increases the risk of serious angioedema. Should be avoided in pts with hyperkalemia

Question 13

Nitrovasodilators you should know

Answer 13

sodium nitroprusside, hydralazine, nitroglycerin

Question 14

Side effects of nitrovasodilators

Answer 14

liver metabolism of sodium nitroprusside results in the production of cyanide which can accumulate in the body of patients with renal insufficiency. Can result in nausea, confusion and convulsions

Question 15

Hydralazine and nitrate combination therapy has been used as a first line of treatment in place of _____

Answer 15

ACE inhibitors

Question 16

True or False: Hydralazine and nitrate reduce both preload and afterload

Answer 16

True

Question 17

Side effects of Hydralazine and nitrate combination use:

Answer 17

lupus erythematosus and extensive hypotension

Question 18

What cardiac glycoside should you know?

Answer 18

digoxin

Question 19

How does digoxin decrease heart rate?

Answer 19

1) Improved cardiac function leading to a decrease in sympathetic tone.
2) Indirect slowing of the sinus rate by vagomimetic actions
3) A direct depressant action of the AV nodal conductivity.
The use of these compounds can produce enhanced automaticity, decrease cardiac conduction velocity and increase AV nodal refractory period

Question 20

Side effects of cardiac glycosides

Answer 20

cardiac arrhythmias. Nausea, vomiting, diarrhea, anorexia

Question 21

Beta Blockers you should know

Answer 21

Metoprolol, Carvedilol

Question 22

Carvedilol can treat patients with mild to moderate or mild to severe heart failure

Answer 22

Mild to moderate

Question 23

How does carvedilol have a beneficial effect on a failing heart

Answer 23

1) it will reduce the impact of increased sympathetic nerve stimulation to the heart reducing the workload and oxygen demand
2) Reduces arterial resistance and thus afterload
3) Reduces the effect of sympathetic nerve activation thus reducing the release of renin which should ultimately result in reduced volume overload

Question 24

Side effects of Carvedilol

Answer 24

bradycardia, worsening heart failure, dizziness or light-headedness due to vasodilation and decrease in blood pressure

Question 25

Side effects of diuretics

Answer 25

electrolyte imbalance resulting in hypokalemia

Question 26

What current does Ivabradine block?

Answer 26

I f current, the funny currents in the cardiac pacemaker cells

Question 27

Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2) do three things?

Answer 27

produce osmotic diuresis, reduce blood pressure, and cause vascular stiffness

Question 28

Can SGLT2 inhibitors reduce preload, afterload, or both?

Answer 28

Both

Question 29

Contraindication of SGLT2 Inhibitors

Answer 29

estimated GFR of less than 30 mL/min/1.53 m2 (dapaglifozin) and 20 mL/min/1.73 m2 (empagliflozin)

Question 30

Common side effects od SGLT2 inhibitors

Answer 30

yeast infection, back pain and mild skin reactions for dapagliflozin
yeast infection, weakness, lightheadedness for empagliflozin