HF Quiz Updated Version Flashcards
Which one of the following drugs used in HF is associated with clinically or physiologically useful inotropic effects?
A) Nesiritide
B) Lisinopril
C) Dobutamine
D) Valsartan
C
Patient JR was on the following meds PTA:
-Amiodarone 200mg q day
-Furosemide 40mg q day
-Levothyroxine 100mcg q day
-Metoprolol tartrate 25mg BID
-KCl 20 mEq q day
-Atorvastatin 40mg q day
-Warfarin 2mg q day
-Ibuprofen 400 mg PRN mild to moderate pain
- How should we optimize JR’s Medications? Comment on each of the listed medications, (No change, decrease to xx mg, increase to xx mg, discontinue) and include any other medications and doses that should be added to his regimen.
My answer:
Amiodarone 200 mg QD: no change
Furosemide 40 mg QD: increase frequency to 40 mg BID rather than QD
Levothyroxine 100 mcg QD: no change
Metoprolol tartrate 25 mg BID: change to metoprolol succinate
KCl 20 mEq QD: no change or potentially discontinue after tending labs because ACEs and ARBs can cause hyperkalemia
Atorvastatin 40 mg QD: no change
Warfarin 2 mg QD: no change
Ibuprofen 400 mg PRN for mild to moderate pain – discontinue and switch this to a non-NSAID such as acetaminophen
ADD: an ARB such as losartan (25 mg QD) or valsartan, aldosterone antagonist such as spironolactone (which can also cause hyperkalemia so the potassium supplement may not be necessary)
Fotis’ answer:
1. Add an ARB
2. Increase furosemide to 40 mg BID
3. Change metoprolol tartrate to extended release metoprolol (succinate)
4. Consider aldosterone antagonist
5. Change ibuprofen to acetaminophen
Which two classes of drugs interfere with the elimination of bradykinin?
A) ARBs and NSAIDs
B) ACE inhibitors and neprilysin inhibitors
C) Nesiritide and neprilysin inhibitors
D) Loop diuretics and ARBs
B
ACE inhibitors should be used with caution in patients with:
A) Diastolic BP > 90 mm Hg
B) Serum Na > 145 mEq/L
C) Serum K > 5/mEq/L
D) Serum creatinine > 1.2 mEq/L
C
Today’s patient is a 64 year old man with NYHA HFrEF stable while managed with enalapril and carvedilol, but now has developed angioedema.
You recommend switching from enalapril to valsartan, but he asks you about Entresto because the advertisements on TV and social media encouraged him to ask his Dr. about Entresto.
You advise him that:
A) Valsartan is more effective than Entresto
B) Patients with a history of angioedema should NOT take Entresto!
C) He should start Entresto as soon as possible and definitely within 24 hours of his last dose of enalapril
D) Entresto is contraindicated for use with carvedilol
B
In addition to an ACEI, ARB, or ARNI, all patients with HFrEF should take a beta blocker. Which statement is correct?
A) Metoprolol is more likely than carvedilol to cause hypotension
B) Beta blockers should be used cautiously if at all in patients with severe bradycardia
C) Discontinue the beta blocker if there is no significant improvement during the first week of treatment
D) All beta blockers are shown to reduce hospitalizations, and mortality
B
The most important adverse effect of loop diuretics is:
A) Hypokalemia
B) Hyponatremia
C) Renal insufficiency
D) Angioedema
A
