heart failure: chapter 25

Question 1

what are 4 symptoms of left sided heart failure. what is a way to remember these symptoms

Answer 1

pulmonary edema, cough, sob, dyspnea

LEFT=LUNG

Question 2

what are 3 symptoms of right sided heart failure

Answer 2

pedal edema, jugular vein distension, hepatic congestion

Question 3

what are the 4 classes of heart failure

Answer 3

1. no limit to normal physical activity
2. physical activity leads to fatigue and sob
3. limitation in normal physical activity
4. symptoms at rest or with any activity

Question 4

what do positive inotropic drugs do

Answer 4

increase the force of myocardial contraction

Question 5

what are the 2 classes of positive inotropic drugs

Answer 5

phosphodiesterase inhibitors, cardiac glycosides

Question 6

what do positive chronotropic drugs do

Answer 6

increase heart rate

Question 7

what do positive dromotropic drugs do

Answer 7

accelerate conduction

Question 8

what do loop diuretics do

Answer 8

reduce symptoms of heart failure secondary to fluid overload

Question 9

when would digoxin be used for heart failure

Answer 9

when all other drugs have been tried

Question 10

mechanism of action of ace inhibitors

Answer 10

prevent sodium and water reabsorption by inhibiting aldosterone secretion

Question 11

what are the 3 effects of ace inhibitors on the body

Answer 11

cause diuresis, decrease blood volume and blood return to the heart, decrease preload and work of the heart

Question 12

what is a key ace inhibitor

Answer 12

lisinopril

Question 13

3 adverse effects of linsopril

Answer 13

hyperkalemia, dry cough, decrease in kidney function

Question 14

2 effects of angiotensin II receptor blockers on the body

Answer 14

vasodilation, decrease systemic vascular resistance

Question 15

between lisinopril and valsartan, which drug is less likely to cause cough and hyperkalemia

Answer 15

valsartan

Question 16

what is a key ARB

Answer 16

valsartan

Question 17

mechanism of action of beta blockers

Answer 17

prevent catecholamine actions on the heart

Question 18

what are 4 effects of beta blockers on the body

Answer 18

reduced hr, delayed av node conduction, reduced myocardial contractility, decreased myocardial automaticity

Question 19

what is a key beta blocker

Answer 19

metoprolol

Question 20

when would aldosterone antagonists be used

Answer 20

in the case of severe heart failure

Question 21

mechanism of action of aldosterone antagonists and how does this have an effect on the body

Answer 21

block the release of aldosterone which decreases the retention of sodium and water

Question 22

what is a key aldosterone antagonist

Answer 22

spironolactone

Question 23

what drug class is dobutamine

Answer 23

b1 selective vasoactive adrenergic drug

Question 24

mechanism of action of dobutamine and how does this have an effect on the body

Answer 24

stimulate b1 receptors which increases contractility leading to increased cardiac output

Question 25

mechanism of action of phosphodiesterase inhibitors (2)

Answer 25

increase cAMP, inhibit phosphodiesterase

Question 26

how does the increase in cAMP have an effect on the body (2)

Answer 26

positive inotropic response, vasodilation which reduces the force of contractions

Question 27

how does the inhibition of phosphodiesterase have an effect on the body

Answer 27

increases availability of calcium for myocardial muscle contraction. heart muscle is able to relax more than normal because it is more responsive

Question 28

indication for phosphodiesterase inhibitors

Answer 28

acute heart failure

Question 29

contraindication for phosphodiesterase inhibitors

Answer 29

heart failure due to diastolic dysfunction

Question 30

2 adverse effects of phosphodiesterase inhibitors

Answer 30

ventricular dysrhythmia, hypokalemia

Question 31

what is the main sign of phosphodiesterase inhibitor toxicity

Answer 31

hypotension

Question 32

what is the treatment for phosphodiesterase inhibitor overdose

Answer 32

reduce the dose or temporarily discontinue

Question 33

what is a key phosphodiesterase inhibitor

Answer 33

milrinone

Question 34

what are 3 adverse effects of milrinone

Answer 34

dysrhythmia, hypokalemia, elevated liver enzymes

Question 35

what are 2 drugs that milrinone interacts with

Answer 35

diuretics and digoxin

Question 36

what drug classes are first line for treating heart failure

Answer 36

ace inhibitors and diuretics

Question 37

what is a negative chronotropic effect

Answer 37

decreased heart rate

Question 38

what is a negative dromotropic effect

Answer 38

decrease automaticity of the sa node, decreased av node conduction, prolonged atrial and ventricular refractory periods

Question 39

what are 5 effects that cardiac glycosides have on the body

Answer 39

- increased stroke volume - decreased heart size during diastole - decreased bp - increased coronary circulation - promote perfusion - improve symptom control

Question 40

what is the mechanism of action of cardiac glycosides

Answer 40

positive inotropic effect, negative chronotropic effect, negative dromotropic effect

Question 41

2 indications for cardiac glycosides

Answer 41

systolic heart failure, atrial fibrilation

Question 42

what is the normal level for cardiac glycosides

Answer 42

0.8-2ng/mL

Question 43

what 3 things can increase the risk of cardiac glycoside toxicity

Answer 43

low potassium, low magnesium, decreased kidney function

Question 44

what are 4 signs of cardiac glycoside toxicity

Answer 44

bradycardia, dizziness, confusion, visual disturbances in the form of blurred or yellow vision

Question 45

what can be used in the case of cardiac glycoside toxicity

Answer 45

digoxin immune fab therapy

Question 46

what is digoxin immune fab therapy

Answer 46

an antibody is used to inactivate free digoxin

Question 47

what are 3 situations where digoxin immune fab therapy would be used

Answer 47

hyperkalemia, life threatening cardiac dysrhythmia, life threatening overdose

Question 48

5 interactions of digoxin

Answer 48

bran, ginseng, hawthorn, licorice, st. johns wart

Question 49

what are 6 conditions that can increase the risk of digoxin toxicity

Answer 49

pacemaker, hypokalemia, hypercalcemia, dysrhythmia, kidney dysfunction, ventricular fibrillation

Question 50

what should you assess in terms of pulse before administration of a heart failure drug

Answer 50

hr at the apical and radial for 1min