Week 12: Heart Failure (13 questions)

Question 1

COMPENSATED/STABLE Heart Failure (controlled)?

ACUTE/DECOMPENSATED Heart Failure (heart failure exacerbation)?

Answer 1

Medications are used here to prevent further damage to the heart

Heart is not pumping enough blood to the rest of the body

Question 2

INOTROPIC (need to understand)

Answer 2

Contractility
Cardiac Muscle

increase the FORCE of myocardial contraction (STRENGTH)
- decrease the force

Question 3

CHRONOTROPIC (need to understand)

Answer 3

Heart rate
SA Node

+ increase the RATE of the heartbeat
- decrease the RATE of the heartbeat

Question 4

Digoxin
(Competes with potassium)

Used for?
Must have normal what lab?
Positive?
Negative?

I DIG CDS

Answer 4

Heart failure
AFIB

Must have normal potassium levels

-Positive INOTROPIC
-Negative CHRONOTROPIC and DROMOTROPIC

I DIG CD’s

Question 5

Digoxin

Toxicity effects?
tint?

Answer 5

heart related
GI related
CNS related

Yellow tint, halos, blurred vision

Question 6

What can cause digoxin toxicity?

antidote?

Answer 6

HYPOKALEMIA

Digibind ®- Digoxin specific Antibody Fab fragments

Question 7

ARNI:

Sacubitril-Valsartan

Used for?
contains?

Answer 7

Heart Failure

This contains two drugs in one

Valsartan: ARB
Sacubitril: new drug- Neprilysn Inhibitor

Question 8

ARNI: Sacubitril-Valsartan

Adverse effects? 3

Answer 8

HYPERKALEMIA

CHRONIC DRY COUGH

ANGIOEDEMA

Question 9

ARNI: Sacubitril-Valsartan (arb)

More Adverse effects

Boxed warning?
other affect?

Answer 9

Don’t take it preganant!!!

Orthostatic hypotension (dizziness/fall risk

Question 10

ARNI: Sacubitril-Valsartan
Drug interactions?

Answer 10

Lithium
COX inhibitors / NSAID

Question 11

Common Factors That Precipitate Acute Decompensated HF?

Answer 11

Recent addition of negative inotropic drugs

Initiation of drugs that increase salt retention

Excessive alcohol or illicit drug use

Question 12

Positive Inotropic Agents:

Dopamine (Vasopressor/Inotropic Agent)

Used for?

IV dopamine:
Low?
Moderate?
High?

Answer 12

Hemodynamic Support
Inotropic Support for Heart Failure

Low: oxygenate kidneys = increase urine output

Moderate: increase Cardiac Output

High: improved blood pressure

Question 13

Phosphodiesterase Inhibitor:

Milrinone PDE3

PDE3?
PDE4?
PDE5?

milrinone used for?

Answer 13

PDE3- CHF

PDE4- COPD- Theophylline

PDE5- PENIS- Erectile Dysfunction- NO NITRATES!

-Severe, decompensated HF (late stages)
-Bridge to await a heart transplant
-Palliative therapy

Question 14

Phosphodiesterase 3 Inhibitor/INODILATOR:

milrinone PD3

Due to positive inotropic effect?
Due to vasodilatory effect?
Cant use if?

Answer 14

Can overstress the heart and lead to dysrhythmias (ventricular)

Due to vasodilatory effect, can lead to Hypotension

Can’t use if MI or dysrhythmias