Week 4: Cardiovascular-Renal Drugs: Drugs used in Heart Failure

Question 1

classification of HF:
Description: no symptoms but risk factors present
treatment: treat obesity, HTN, DM, Hyperlipidemia, etc.

Answer 1

ACC/AHA Stage: A
NYHA Class: Prefailure

Question 2

Classification of HF:
Description: Symptoms with severe exercise
treatment: ACEI/ARB, B-Blockers, Diuretic

Answer 2

ACC/AHA Stage: B
NYHA Class: I

Question 3

classification of HF:
Description: Symptoms with marked (class II) or mild (class III) exercise
treatment: add aldosterone antagonist, digoxin; CRT, ARNI, Hydralazine/nitrate

Answer 3

ACC/AHA Stage: C
NYHA Class: II/III

Question 4

Classification of HF:
Description: severe symptoms at rest
treatment: maximal medical therapy, transplant, LVAD

Answer 4

ACC/AHA Stage: D
NYHA Class: IV

Question 5

first line drugs in treating chronic HF:

Answer 5

Drugs WITHOUT major effect on the contractile machinery of the heart:
ACE inhibitors
B-Agonist
B-Blockers
Diuretics

Question 6

digoxin has two principal mechanisms of action, what are they?

Answer 6

Positive inotropic
AV Node inhibition

Question 7

Positive inotropic mechanism increases the force of contraction of the heart by reversibly inhibiting that activity of the myocardial ______.

Answer 7

Na-K ATPase pump

Question 8

in the Positive inotropic mechanism, Digoxin induces an increase in intracellular ______ that will drive an influx of _____ in the heart and cause an increase in contractility.

Answer 8

sodium, calcium

Question 9

in AV Node inhibition, digoxin has a vago-mimetic effect on what?

Answer 9

the AV Node

Question 10

In AV Node Inhibition, digoxin stimulates the ______ nervous system, which slows conduction in the AV node, therefore decreasing HR.

Answer 10

parasympathetic

Question 11

in AV Node Inhibition, the rise in _______ levels leads to prolongation of phase 4 and phase 0 of the cardiac action potential, thus increasing the AV node’s _______ period.

Answer 11

calcium, refractory period

Question 12

in AV node inhibiton, slower conduction through the AV node, due to the rise in calcium levels, decreases _______ response.

Answer 12

ventricular

Question 13

Cardiac glycosides affect all excitable tissues, including ______ and the _____

Answer 13

smooth muscle and the CNS

Question 14

the __________ is the most common site of digitalis toxicity outside of the heart

Answer 14

gastrointestinal tract

Question 15

S/S of GI toxicity due to digoxin?

Answer 15

anorexia, nausea, vomiting, and diarrhea

Question 16

hypercalcemia increases the risk of a digitalis-induced _____

Answer 16

arrhythmia

Question 17

_________ can cause hazardous effects with digoxin

Answer 17

hypokalemia

Question 18

Decreased _______, decrease risk of arrhythmias with digoxin

Answer 18

magnesium

Question 19

management of CHF:
guidelines suggest that the treatment of patients at high risk (stage _____ and stage ____) should be focused on the control of hypertension, arrhythmias, hyperlipidemia, and diabetes if present.

Answer 19

stage A and stage B

Question 20

management of CHF:
once symptoms and signs of failure are present, stage _____ has been entered, and active treatment of failure must be initiated.

Answer 20

stage C

Question 21

what is the mainstay in the management of symptomatic HF, especially if edema is present

Answer 21

sodium removal + a diuretic

Question 22

sodium loss causes a secondary loss of ______, which is particularly hazardous if the patient is to be given digitalis

Answer 22

potassium

Question 23

______ or ____ should probably be considered in all patients with moderate or severe HR since both appear to reduce both morbidity and mortality

Answer 23

spironolactone or eplerenone

Question 24

digoxin is indicated in patients with HR and atrial fibrillation. it is usually given only when _____ and _____ have failed to control symtoms

Answer 24

diuretics and ACE inhibitors