W3, 9 HF Treatment (pharma)

Question 1

What is Heart failure (HF) or (CHF)?

Answer 1

It’s abserious condition in which the heart is not pumping enough blood around the body efficiently

Question 2

A complication of HF?

Answer 2

When the heart is weakened by heart failure, blood and fluid can back up into the lungs, and fluid builds up in different tissues.

Question 3

Cardiovascular Consequences of Heart Failure (slide)

Answer 3

Question 4

Objectives in treatment of CHF

Answer 4

• To reduce congestion (oedema)
• To improve cardiac contractility

Question 5

Classes of Drugs Used in Treatment of CHF (slide)

Answer 5

Question 6

Pharmacologically active compounds extracted from foxglove plants (also called Digitalis) are ..?

Answer 6

Cardiac glycosides

Question 7

What drug is the prototype cardiac glycoside?

Answer 7

Digoxin

Question 8

Digoxin route of administration & excretion?

Answer 8

Question 9

Mechanism of action of digoxin?

Answer 9

Question 10

Adverse Reactions to Digitalis Glycosides

Answer 10

Question 11

What drug is Beta-1 Adrenoceptor Agonists ?

Answer 11

Dobutamine

Question 12

moa of Dobutamine

Answer 12

Activate cardiac beta-1 receptors —> inc cAMP —> elevated intracellular Ca2+ —> positive inotropic effect —> inc CO

Question 13

What drug is Phosphodiesterase (PDE) inhibitor?

Answer 13

Amrinone

Question 14

Moa of Amrinone

Answer 14

Question 15

Diuretics (examples of drugs + MOA)

Answer 15

Question 16

What drug Relaxes vascular smooth muscle by supplying nitric oxide? Name the drug class or category & drug name.

Answer 16

Direct Vasodilators & Venodilators (Nitrovasodilators) eg: Hydralazine

Question 17

-

Answer 17

• Reduce preload by producing venodilation (reduce VR)
• Reduce afterload by arteriolar dilation (decrease PVR)

Question 18

HF leads to (activation or inhibition) of the renin-angiotensin- aldosterone system?

Answer 18

Activation

Question 19

Renin release due to ….?

Answer 19

increased sympathetic stimulation
and activation of beta-1 receptors in the kidneys

Question 20

What is ACE enzyme

Answer 20

Question 21

High levels of Ang II have detrimental effects on the cardiac muscle
شنو اهم؟

Answer 21

High levels of Ang II have detrimental effects on the cardiac muscle, causing remodeling, fibrosis and inflammatory changes.

Question 22

What drug is Angiotensin-Converting Enzyme Inhibitor?

Answer 22

Captopril

Question 23

MOA of Captopril?

Answer 23

ACEIs prevent the conversion of Angiotensin I to Angiotensin II.

Question 24

Adverse effects to ACEIs?

Answer 24

Postural hypotension, hyperkalemia
persistent dry cough (Due to accumulation of bradykinin)

Question 25

Effects of ACEI (slide)

Answer 25

Question 26

Angiotensin II Receptor Blockers (ARBs) A. 2 Drug examples? B. MOA

Answer 26

A. Losartan, valsartan B. Antagonists at Angiotensin II type 1 receptor (block effect of ang II obtained from ACE- dependent and - independent pathways

Question 27

ARBs > ACEI or ACEI > ARBs and why?

Answer 27

- ARBs have the advantage of more complete blockade of Angiotensin II action, because ACEIs inhibit only one enzyme “ responsible for production of Angiotensin II. - ARBs do not affect bradykinin levels.

Question 28

Route of administration of Losartan

Answer 28

- ARBs are orally active compounds - Losartan undergoes extensive first-pass hepatic metabolism.

Question 29

Beta Blockers MOA (slide)

Answer 29

Question 30

Types of beta blockers A. B.

Answer 30

- Beta-1 selective adrenoceptor antagonists (e.g. Metoprolol, Atenolol) - Combined Alpha-1 and Beta Blockers (e.g. Carvedilol).

Question 31

What is Metoprolol?

Answer 31

Beta 1 antagonist that reduces the mortality of patients with heart failure

Question 32

What drugs are Aldosterone Receptor Antagonists ?

Answer 32

Eplerenone, Spironolactone

Question 33

A non- selective aldosterone receptor antagonist.

Answer 33

Spironolactone

Question 34

Selectively binds to the mineralocorticoid receptor, blocking the binding of aldosterone, inhibiting sodium reabsorption.

Answer 34

Eplerenone

Question 35

MOA of Spironolactone?

Answer 35

- Reduces Na+ reabsorption - Prevents salt retention, myocardial hypertrophy and hypokalemia.

Question 36

Which aldosterone receptor antagonist has Less hormonal side effects?

Answer 36

Eplerenone

Question 37

Adverse effects of Eplerenone include

Answer 37

hyperkalemia

Question 38

How do Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) act?

Answer 38

consists of angiotensin receptor blocker valsartan and neprilysin inhibitor (blocks both RAAS & augment natriuretic peptides) -drug name =n LCZ696 ,, not on drug list -

Question 39

What drug is Currently indicated in USA for treatment of hypertension, and for first-line treatment of heart failure secondary to myocardial infarction?

Answer 39

Eplerenone

Question 40

What drugs Decrease and block the effect of some symptoms caused by release of catecholamines?

Answer 40

Beta blockers

Question 41

Contraindicated in pregnancy.

Answer 41

ARBs & ACEI

Question 42

Can cause hyperkalemia, gynecomastia & testicular atrophy.

Answer 42

Spironolactone

Question 43

Long term therapy with this drug can benefit patients who had a recent myocardial infarction (protects heart)

Answer 43

ACEIs

Question 44

toxicity of this drug can be worsened by hypokalemia

Answer 44

Digoxin

Question 45

What drug Activate cardiac beta-1 receptors ?

Answer 45

Dobutamine

Question 46

Mcq: What should be monitored when administering digoxin? A. Potassium B. Calcium C. Sodium D. Chloride

Answer 46

A. Potassium

Question 47

Mcq: What drug should be carefully monitored as it has a narrow therapeutic index?

Answer 47

Digoxin

Question 48

Mcq: What is the mechanism of action of amrinone?

Answer 48

Phosphodiesterase inhibitor

Question 49

Mcq: Which of the following is a selective angiotensin II antagonist?

Answer 49

Losartan

Question 50

Mcq: Which drug has less hormonal effects because it’s band specifically to aldosterone receptor? A. Eplerenone B. Spironolactone

Answer 50

A. Eplerenone

Question 51

Mcq: What is the mechanism of action of digoxin?

Answer 51

A. increase intracellular calcium

Question 52

mcq: which drug causes dry cough?

Answer 52

A. Captopril (ACEI)

Question 53

Mcq: Which of the following inhibits Na/K ATPase and is used for the management of congestive heart failure? A. Hydralazine B. Digoxin

Answer 53

B. Digoxin

Question 54

Mcq: Indicated to prevent the deterioration of the left ventricular function after myocardial infraction A. Angiotensin converting enzyme inhibitor B. Nitrate C. Secondary prevention

Answer 54

A. Angiotensin converting enzyme inhibitor

Question 55

Mcq: Selectively binds to mineralocorticoid receptors

Answer 55

A. Eplerenone

Question 56

Mcq: which one describe the mechanism of dobutamine? A. activation of aldosterone receptor B. inhibition of ACE C. activation of B1 receptor D. release of nitric oxide

Answer 56

C. activation of B1 receptor

Question 57

Mcq: What is the effect of co-administering digoxin and thiazide diuretics? A. Increases the toxicity of digoxin B. Reduces the absorption of digoxin C. Reduce vagal activity of digoxin

Answer 57

A. Increases the toxicity of digoxin

Question 58

Mcq: A patient has a cardiovascular disease and he is being treated for it, after a while he Develops bilateral angioedema. Which of the following drugs is likely to cause this presentation? A. Diuretics B. Digoxin C. Angiotensin converting enzyme inhibitors D. Hydralazine Answer: C

Answer 58

ACEI

Question 59

Mcq: A patient with heart failure you gave him a drug & he comes to you with irritated throat and cough A. ACEI B. BB C. Diuretic D. Digoxin

Answer 59

A. ACEI

Question 60

Mcq: Which of the following is true regarding RAAS in HF? A. Using angiotensin 2 receptor blocker decreases aldosterone B. Aldosterone causes diuresis C. It must be blocked in HF with reduced EF

Answer 60

C. It must be blocked in HF with reduced EF

Question 61

Mcq: Patient being treated for HF comes with enlarged swollen breast, what is the cause of this side effect? A. Digoxin B. ARB C. Aldosterone blocker D. BB

Answer 61

C. Aldosterone blocker

Question 62

Drug List for Treatment of CHF

Answer 62