Misc CHF Drug Info

Question 1

What is the mechanism of digoxin?

Answer 1

Na/K ATPase inhibitor, vagal stimulation, AV block

Question 2

What drug interactions with diltiazem?

Answer 2

Inhibits CYP–statins

Question 3

Amiodarone side effects?

Answer 3

Blue/grey skin
photosensitivity
hepatotoxicity
hypo/hyperthyroidism
pulmonary fibrosis
hypotension
bradycardia
corneal microdeposits

Question 4

Propafanone/flecainide side effects?

Answer 4

dizziness, blurred vision, HF exacerbation

Question 5

Ibutilide/dofetilide ADEs?

Answer 5

TdP

Question 6

Sotalol ADE?

Answer 6

TdP

Question 7

Dronedarone ADEs?

Answer 7

Bradycardia, diarrhea, nausea, asthenia, rash

Question 8

Dronedarone interactions?

Answer 8

Digoxin, diltiazem, verapamil

Question 9

Dronedarone CI?

Answer 9

HF patients!

Question 10

Adenosine mechanism?

Answer 10

Inhibits AV node, terminates re-entry pathway

Question 11

Procainamide ADEs?

Answer 11

Hypotension, QT prolongation, TdP

Question 12

Epinephrine class?

Answer 12

Vasopressor

Question 13

Dofetilide dose?

Answer 13

> 60: 500 mcg BID
40-60: 250 mcg BID
20-39: 125 mcg BID
<20: None

Question 14

Amiodarone dose:

Ventricular rate control?

Answer 14

100-200 mg PO daily

Question 15

Amiodarone dose:

Conversion?

Answer 15

10 g loading dose in 600-800 mg increments –>200 mg daily

Question 16

Amiodarone dose: Maintenance?

Answer 16

400-600 mg LD x 2-4 weeks

100-200 mg daily MD

Question 17

Amiodarone dose:

Ventricular tachycardia?

Answer 17

150 mg IV x 10 minutes

1mg/min IV x 6h + 0.5 mg/min x 18 hours

Question 18

Amiodarone dose:

Ventricular tachycardia prevention?

Answer 18

400 mg daily PO

Question 19

Amiodarone dose:

V fib?

Answer 19

300 mg IV

then 150 mg IV

Question 20

Drug classes that cause TdP (Wendt)?

Answer 20

Antiarrhythmics
Antibiotics
Cancer
Opiate
Antidepressants
Antipsychotics
CCBs
antiemetics
Gastric pro-motility
Antihistamines
Diuretics

Question 21

Digoxin mechanism of action?

Answer 21

Lowers Na gradient
Less Ca ejected
More Ca in SR (more Ca released during AP)
STRONGER contractility

Question 22

Mechanism of Action: Beta agonists in CHF?

Answer 22

Beta receptor –> Gs –> Increased cAMP–> PKA activiation –> Increased calcium (activates Ca channels) –> Increased contractility

Question 23

Mechanism of action: PDE3 inhibitors in CHF?

Answer 23

Blocks PDE –> less cAMP degradation –> more cAMP in the cell –> Increased Calcium –> increased contractility

Question 24

What are vasopressors used for in CHF?

Answer 24

Hyponatremia

Question 25

What does decreased CO cause?

Answer 25

decreased renal blood flow (which activates RAAS) | Increased carotid sinus firing (which activates sympathetic discharge)

Question 26

What are cardiovascular causes of ADHF?

Answer 26

``` MI valvular disease uncontrolled HTN PE Arrhythmias Worsening HF ```

Question 27

What is the cut-off PCWP for wet?

Answer 27

>18

Question 28

What is the cut off CI for cold?

Answer 28

<2.0

Question 29

How is CI calculated?

Answer 29

CO/BSA

Question 30

T/F: Inotropes affect preload

Answer 30

FALSE

Question 31

What should be monitored w/ADHF?

Answer 31

``` Weight (qAM) HR/BP Ins/outs S/S of edema Electrolytes (qd) Renal function (BUN/SCr) (qd) ```

Question 32

How do you dose loop diuretics in ADHF?

Answer 32

Give Bolus of normal diuretic therapy for a day--half of the dose if furosemide

Question 33

How can you overcome diuretic resistance?

Answer 33

``` Add thiazide Increase frequency of dose Limit sodium/water intake IV infusion ultrafiltration ```

Question 34

How to monitor loops?

Answer 34

Urine output, s/s congestion regularly

Question 35

Vasopressor ADE?

Answer 35

Osmotic demyelination

Question 36

What is the MOA of adenosine in VSM?

Answer 36

Binds to A2 receptor --> Gs --> activation of AC --> increased cAMP --> Relaxation

Question 37

What is the MOA of adenosine in heart?

Answer 37

Binds to A1 receptor --> Gi --> inhibition of AC ---> decreased cAMP --> Decreased activation of HCN/CCB --> decreased contractility/HR