Lippincott Chapter 19: Heart Failure Flashcards
19.1 Which drug may exacerbate HF?
A. Acetaminophen.
B. Cetirizine.
C. Chlorthalidone.
D. Ibuprofen.
Correct answer = D. NSAIDs, such as ibuprofen, lead to
increased fluid retention and increased blood pressure. If
possible, NSAIDs should be avoided in HF patients in order
to avoid exacerbations of HF.
19.2 Which best describes the action of ACE inhibitors on
the failing heart?
A. ACE inhibitors increase vascular resistance.
B. ACE inhibitors decrease cardiac output.
C. ACE inhibitors reduce preload.
D. ACE inhibitors increase aldosterone.
Correct answer = C. ACE inhibitors decrease vascular resis-
tance, decrease preload, decrease afterload, and increase
cardiac output. In addition, ACE inhibitors blunt aldosterone
release.
19.3 What makes losartan different from other ARBs?
A. Losartan is renally eliminated.
B. Losartan has an active metabolite.
C. Losartan has the shortest half-life.
D. Losartan has a small volume of distribution.
Correct answer = B. Losartan is the only ARB that under-
goes first-pass metabolism to convert to its active metab-
olite. Most ARBs have once-daily dosing, and all (except
candesartan) have large volumes of distribution.
19.4 How do β-blockers improve cardiac function in HF?
A. By decreasing cardiac remodeling.
B. By increasing heart rate.
C. By increasing renin release.
D. By activating norepinephrine.
Correct answer = A. Although it seems counterintuitive to
decrease heart rate in HF, β-blockers improve cardiac func-
tioning by slowing heart rate, decreasing renin release, and
preventing the direct effects of norepinephrine on cardiac
muscle to decrease remodeling.
19.5 BC is a 70-year-old female who is diagnosed with
HFrEF. Her past medical history is significant for
hypertension and atrial fibrillation. She is taking
hydrochlorothiazide, lisinopril, metoprolol tartrate, and
warfarin. BC says she is feeling “good” and has no
cough, shortness of breath, or edema. Which is the
most appropriate medication change to make?
A. Discontinue hydrochlorothiazide.
B. Change lisinopril to losartan.
C. Decrease warfarin dose.
D. Change metoprolol tartrate to metoprolol succinate.
Correct answer = D. Metoprolol succinate should be used in
HF, given that there is mortality benefit shown with metopro-
lol succinate in landmark HF trials. Hydrochlorothiazide and
warfarin are appropriate based on the information given;
there is no reason to change to an ARB since the patient
has no cough or history of angioedema.
19.6 SC is a 75-year-old white male who has HF. He is seen
in clinic today, reporting shortness of breath, increased
pitting edema, and a 5-pound weight gain over the
last 2 days. His current medication regimen includes
losartan and metoprolol succinate. SC has no chest
pain and is deemed stable for outpatient treatment.
Which of the following is the best recommendation?
A. Increase the dose of metoprolol succinate.
B. Start hydrochlorothiazide.
C. Start furosemide.
D. Discontinue losartan.
Correct answer = C. As it is possible that SC is having a
HF exacerbation, increasing the dose of the β-blocker is not
indicated at this time. There is no reason to stop losartan,
based on the information we have. Loop diuretics are pre-
ferred over thiazide diuretics when patients require diuresis
immediately
19.7 How is spironolactone beneficial in HF?
A. Promotes potassium secretion.
B. Agonizes aldosterone.
C. Prevents cardiac hypertrophy.
D. Decreases blood glucose.
Correct answer = C. Spironolactone antagonizes aldoste-
rone, which in turn prevents salt/water retention, cardiac
hypertrophy, and hypokalemia. Spironolactone has endo-
crine effects on hormones but not on glucose.
19.8 Which is important to monitor in patients taking
digoxin?
A. Chloride.
B. Potassium.
C. Sodium.
D. Zinc.
Correct answer = B. Hypokalemia can lead to life-threaten-
ing arrhythmias and increases the potential of cardiac toxic-
ity with digoxin.
19.9 Which describes the mechanism of action of milrinone
in HF?
A. Decreases intracellular calcium.
B. Increases cardiac contractility.
C. Decreases cAMP.
D. Activates phosphodiesterase.
Correct answer = B. Milrinone is a phosphodiesterase inhib-
itor that leads to increased cAMP, increased intracellular
calcium, and therefore increased contractility.
19.10 What is the most common adverse effect associated
with fixed-dose hydralazine/isosorbide dinitrate?
A. Diarrhea.
B. Drug-induced lupus.
C. Headache.
D. Heartburn.
Correct answer = C. While drug-induced lupus is a possibil-
ity with hydralazine, headache is the most common adverse
effect.
