heart failure+ adenosine+angina+mi stuff - Sheet1

Question 1

What are the main drug classes used to treat heart failure (HF)?

Answer 1

Beta blockers: Bisoprolol, Carvedilol, Metoprolol ARNI: Sacubitril/Valsartan ACE Inhibitors (ACEIs): Captopril, Enalapril, Lisinopril, Ramipril Angiotensin II Receptor Blockers (ARBs): Candesartan, Losartan, Valsartan Aldosterone Antagonists: Eplerenone, Spironolactone SGLT2 Inhibitors: Dapagliflozin, Empagliflozin Vasodilators: Hydralazine, Isosorbide dinitrate Others: Ivabradine, Digoxin

Question 2

What is Sacubitril/Valsartan (ARNI)?

Answer 2

A combination drug replacing ACEI or ARB for HF treatment.

Question 3

What are the adverse effects of ARNI (Sacubitril/Valsartan)?

Answer 3

Angioedema, hyperkalemia, hypotension, dizziness, cough, renal failure.

Question 4

When should ARNI be avoided?

Answer 4

Pregnancy, lactation, hepatic impairment, use with ACEIs, ARBs, K+-sparing diuretics, NSAIDs, or lithium.

Question 5

What is Digoxin used for?

Answer 5

Second-line treatment for HF and atrial fibrillation (A Fib).

Question 6

How does Digoxin work?

Answer 6

Positive inotropic effect → increases myocardial contraction strength. Negative chronotropic effect → slows heart rate (HR).

Question 7

What are Digoxin’s adverse effects (AEs)?

Answer 7

Cardiotoxicity/dysrhythmias, GI symptoms (early sign): anorexia, nausea, vomiting, abdominal pain. CNS symptoms: fatigue, weakness, vision changes (yellow-green halos, blurred vision).

Question 8

What is the therapeutic range for Digoxin?

Answer 8

0.5 – 2 ng/mL

Question 9

How should Digoxin be administered?

Answer 9

Same time daily, take apical pulse for 1 min before administration, hold if HR <60 bpm. Monitor potassium & digoxin levels.

Question 10

When should Digoxin not be used?

Answer 10

Absolute contraindications: Ventricular fibrillation (V Fib), ventricular tachycardia (V Tach), 2nd or 3rd-degree heart block. Use cautiously in: Hypokalemia, partial AV block, advanced HF, renal impairment.

Question 11

Which drugs interact with Digoxin?

Answer 11

Increase risk of toxicity: Thiazide/loop diuretics, ACEIs/ARBs, sympathomimetics (e.g., dopamine), quinidine, verapamil.

Question 12

What are the steps for managing Digoxin toxicity?

Answer 12

1. Stop Digoxin & K+-wasting diuretics 2. Monitor potassium (K+) levels 3. Treat dysrhythmias: Phenytoin or lidocaine 4. Treat bradycardia: Atropine 5. Remove toxic levels: Activated charcoal, cholestyramine, Digoxin immune Fab (antidote).

Question 13

What is Adenosine used for?

Answer 13

Terminates paroxysmal supraventricular tachycardia (PSVT).

Question 14

What are the adverse effects (AEs) of Adenosine?

Answer 14

Sinus bradycardia, hypotension, dyspnea, face flushing.

Question 15

What is the half-life of Adenosine?

Answer 15

10 seconds – AEs are self-limiting

Question 16

What are examples of organic nitrates used for angina?

Answer 16

Nitroglycerin (NTG), Isosorbide dinitrate (SL), Isosorbide mononitrate (PO).

Question 17

What forms does Nitroglycerin (NTG) come in?

Answer 17

Oral ER capsules, SL tablet, translingual spray, topical ointment, transdermal patch, IV.

Question 18

How does Nitroglycerin work?

Answer 18

Dilates veins → ↓ venous return (preload) → ↓ cardiac oxygen demand.

Question 19

What are the AEs of Nitroglycerin?

Answer 19

Headache, orthostatic hypotension, reflex tachycardia, tolerance.

Question 20

What precautions should be taken with Nitroglycerin?

Answer 20

Avoid phosphodiesterase type 5 inhibitors (e.g., sildenafil). Do not use in severe anemia, closed-angle glaucoma, or traumatic head injury (↑ ICP).

Question 21

What is Ranolazine used for?

Answer 21

Chronic stable angina.

Question 22

What are the AEs of Ranolazine?

Answer 22

QT prolongation, elevated BP.

Question 23

What drugs interact with Ranolazine?

Answer 23

CYP450 inhibitors, quinidine, sotalol. Increases digoxin & simvastatin levels.

Question 24

1

Answer 24

ABCs (Airway, Breathing, Circulation)

Question 25

2

Answer 25

Cardiac & O₂ monitors

Question 26

3

Answer 26

ACLS as needed

Question 27

4

Answer 27

Aspirin (ASA) 325 mg

Question 28

5

Answer 28

Assess & Blood work

Question 29

6

Answer 29

Give 3 SL NTG tablets or spray

Question 30

6A

Answer 30

Treat left heart failure (LHF) if present

Question 31

6B

Answer 31

Beta blocker

Question 32

7

Answer 32

Morphine

Question 33

8

Answer 33

Statin