Heart Failure Treatment

Question 1

What 4 drug classes have been proven to decrease mortality in CHF pt

Answer 1

1. ACE inhibitors (-pril)
2. ARBs (-sartans)
3. Aldosterone antagonists (spronolactone)
4. Certain β blockers

Question 2

which 3 β blockers decrease mortality in CHF

Answer 2

1. metoprolol
2. carvedilol
3. bisoprolol

Question 3

What three drug classes only help with symptomatic relief in CHF

Answer 3

1. Diuretics (loop and thiazide)
2. Digoxin
3. Vasodilators (nitrates and hydralazine)

*remember = nitrates are venodilators ( ↓ preload) and hydralazine is a arterial dilator ( ↓ afterload)

Question 4

what is a classic sign of digoxin toxicity? what other two issues can it have

Answer 4

1. blurry yellow vision*
2. Cholinergic effects (vomiting, diarrhea)
3. Bradycardia

• has very low TI so tox happens

Question 5

what metabolic abn can predispose to digoxin tox

Answer 5

hypokalemia

Question 6

treatment of digoxin tox

Answer 6

1. correct hypokalemia
2. Mg+ to help with bradyarrythmia
3. anti-digoxin Ab frag if very severe

Question 7

2 indications for digoxin use

Answer 7

1. chronic heart failure
2. a-fib ( ↓ cond. through AV node)

• NOT a first line tx

Question 8

which diuretics are the go-to for pulmonary edema

Answer 8

Loop diuretics⇒ these are “heavy duty”, so used for mod. to severe HF; thiazides are not as potent, but useful for mild cases

Question 9

Tx for acute HF–> decompensating pt who is SOB and sometimes even foaming at the mouth b/c of pulmonary edema (“NO LIP”)

Answer 9

1. Nitrates
2. O2 (if hypoxemic)
3. Loop Diuretics
4. Inotropic drugs
5. Position ⇒ get their legs down; decrease preload

• if asked on STEP, prob always say Loop for these situations, if no other options of above

Question 10

What is inotropic agent given often times in acute heart failure tx

Answer 10

Dobutamine ( β1 > β2) agonist

Question 11

why are beta blockers useful, even they would decrease HR and contactility potentially–> seems like a bad idea in HF where you already have shitty output

Answer 11

Reduce renin release due to β1 stimulation of kidney also