1-8 and 9

Question 1

True or False: TNF-a, CRP, CK-MB, Trop T/I, and BNP are all biomarkers for cardiac injury

Answer 1

True

Question 2

How is initial cardiac dysfunction exhibited in HF/CHF?

Answer 2

Decrease in cardiac output

Question 3

In HF/CHF, there is ultimately decreased perfusion of vessels and tissues, leading to ___deprivation and increased oxygen demand for the ____muscle (due to decreased coronary perfusion)

Answer 3

O2; heart

Question 4

True or False: Activation of the RAAS System and Sympathetic Nervous System is an adaptive mechanism in HF/CHF

Answer 4

True

Question 5

Eventually the compensatory mechanisms fail in CHF/HF, accompanied by ___ dysfunction

Answer 5

baroreceptor

Question 6

In HF/CHF, increased RAAs activity results in what three effects?

Answer 6

1) Edema
2) Vascular dysfunction
3) Cardiac tissue damage

Question 7

HF is accompanied by increased ____ and decrease ____

Answer 7

resistance; SV

Question 8

Healthy heart muscles have HIGH adaptability to changing ____by regulating their own ___, as stated by Frank Starling

Answer 8

EDV; SV
(note: failing hearts do not follow this rule and this adaptive mechanism is lost)

Question 9

What are the two types of CHF?

Answer 9

1) HF with reduced EF - Systolic Heart Failure
2) HF with preserved EF - Diastolic HF

Question 10

In Heart Failure with Reduced Ejection Fraction (Systolic HF), there is impaired __ function and LCEF is ___ than 40%

Answer 10

systolic ; less than 40%

Question 11

Which type of heart failure is associated with preserved ejection fraction and systolic function?

Answer 11

Disatolic Heart Failure (HF with preserved ejection fraction)

Question 12

LVEF is greater than 50% in what type of HF?

Answer 12

Diastolic HF (HF w preserved EF)

Question 13

What type of heart failure is associated with weakened pump and blood that backs up, overloading the heart

Answer 13

Systolic Heart Failure

Question 14

Which type of heart failure is associated with thickened or stiff walls, as well as abnormal relaxation and inability to allow enough blood to fill heart prior to squeezizng?

Answer 14

Diastolic HF

Question 15

Most common cause of acute decompensated HF?

Answer 15

LV or Diastolic Dysfunction

Question 16

What is the compensation in acute decompensated HF? Why does it ultimately fail?

Answer 16

Compensation = increase in sympathetic activation, which results in increase in ventricular filling pressure

-Leads to leakage of fluids into lung alveoli and intersitium (congestion)

Question 17

True or False: Acute decompensated HF is associated with rapid fluid accumulation in the lungs

Answer 17

True

Question 18

What are two positive intotropic agents?

Answer 18

Digoxin, Lanoxin

Question 19

___ inhibit the phosphorylated alpha subunit of the plasma membranes residing Na/K ATPase channel

Answer 19

Digoxin (and other positive introtropic agents)

Question 20

How does Digoxin affect Na efflux via Na/K ATPase?

Answer 20

Decreases sodium efflux, increase cytosolic sodium

Question 21

When digoxin acts, it increases cytosolic sodium, which REDUCES the requirement of Na entry through ___. As a result there is ___ retention in all cells, leading to increase in cytosolic ___, along with release of Ca2+ stores by ___, leading to myocyte contraction.

Answer 21

NCX; ca2+;ca2+;SERCA2

Question 22

Chronic use of cardiac glycosides, like Digoxin, can result in ____ drug action. Why?

Answer 22

decreased drug action
- increased extracellular K promotes dephosphorylation of Na/K ATPase alpha subunit

Question 23

Digoxin only has the ability to act on the ______ alpha subunit

Answer 23

phosphorylated state

Question 24

How is digoxin typically excreted?

Answer 24

Renal route

Question 25

What is the safe dose for digoxin maintenance therapy?

Answer 25

< 1 ng/mL

Question 26

True or False: Digoxin has DDI with verapamil and spironolactone

Answer 26

True

Question 27

True or False: Dopamine is an inotrope with vascular effects that acts on D1 and D2 receptors

Answer 27

True

Question 28

How does dopamine behave at very low doses?

Answer 28

-Induces cAMP -Vasorelaxation

Question 29

In sympathetic neurons, dopamine acts via ___ receptors, inhibit __ release

Answer 29

D2; NE

Question 30

How does dopamine behave at moderate doses (2-5 ug/kg/min)>

Answer 30

-Directly stimulates cardiac B1 receptors -Increase cardiac contractility -Increases sympathetic neuronal NE release

Question 31

How does dopamine behave at higher doses?

Answer 31

-Stimulates alpha adrenergic receptors in arteries and veins -Vasoconstriction

Question 32

Clinical indications for high dose of dopamine infusion?

Answer 32

Circulatory collapse

Question 33

Where is PDE-5 commonly found?

Answer 33

Lung

Question 34

How can revatio/viagra be used in HF?

Answer 34

-Used to treat right ventricular systolic failure (due to: pulmonary artery hypertension)

Question 35

___ is approved for short term in advanced CHF and can improve ventricular contractility and CO?

Answer 35

Inamrinone (PD3 Inhibitor)

Question 36

True or False: Inamrinone is effective as a short term inotropic

Answer 36

True

Question 37

AE for PDE3 Inhibitors (Inamrinone)?

Answer 37

Thrombocytopenia

Question 38

What drug class do Inamirone and Sildenafil belong to?

Answer 38

PDE Inhibitors (includes PDE3 and 5 Inhibitors)

Question 39

How does inhibiting PDE enzymes in HF affect cAMP levels?

Answer 39

-Raise or upregulate cellular cAMP

Question 40

True or False: PDE results in a negative intropice effect in cardiac tissue, along with increases resistance in both arteries and veins

Answer 40

False

Question 41

Clinical Benefits of PDE Inhibitors in HF? (hint: preload/afterload)

Answer 41

Reduces preload and afterload

Question 42

___is a non-specific beta agonist that can stimulate b1 receptors in cardiac tissue, resulting in increased contractility

Answer 42

Dobutamine

Question 43

Dobutamine acts on ___ receptors on VSM, which results in ____ and ___ in vessel resistance

Answer 43

beta 2; vasodilation/decrease in vessels resistance

Question 44

True or False: Dobutamine could be used to decrease inotropic effect and cause vasodilation

Answer 44

False - while Dobutamine can be used to cause vasodilation, it will INCREASE inotropic effect

Question 45

Tolerance may develop follow 1 week of treatment with ____ due to increased PDE activity. Under those conditions ___ inhibitor addition will yield better pharmacological results.

Answer 45

Dobutamine; PDE3

Question 46

What is the major role of diuretics in HF?

Answer 46

Decrease pre-load Decrease edema

Question 47

___: agents known to decrease ventricular filling pressure due to ability to decrease ECF volume

Answer 47

Diuretics

Question 48

True or False: Diuretics typically decrease pre-load without significantly changing CO

Answer 48

True

Question 49

What class of drugs are preferred for maintaining euvolemic state for patients suffering from hypervolemia?

Answer 49

Diuretics

Question 50

What type of doses are initially required for diuretics, when used in CHF?

Answer 50

High doses

Question 51

Since diuretics can cause hypokalemia, ___ are preferred in HF

Answer 51

K+ sparing diuretics

Question 52

True or False: Bumetamide is a Loop Diuretic

Answer 52

True

Question 53

What class of drugs are used to treat HYPERVOLEMIC patients with edema

Answer 53

Loop Diuretics

Question 54

Why are Loop Diuretics also known as high ceiling diuretics?

Answer 54

They can expel max. Na/Cl/water

Question 55

True or False: Thiazides result in loss of Na and K

Answer 55

True

Question 56

True or False: Thiazides are only recommended for combinatorial therapy in CHF

Answer 56

True

Question 57

Which drug class causes volume depletion and minimal K/Mg loss?

Answer 57

K Sparing Diuretics

Question 58

True or False: MR Antagonists protect against cardiac/renal fibrosis, ischemia, and help prevent endothelial and vascular smooth muscle contraction, as well as damage/loss of elasticity

Answer 58

True

Question 59

True or False: CHF patients have almost ___ more aldosterone in their circulation

Answer 59

20%

Question 60

MR Antagonists, such as spironolactone, can be given in CHF. However, what is the AE associated?

Answer 60

Gynecomastia - If this happens, substitute for Eplerenone

Question 61

MR Antagonists can be used to treat CHF. However, about 2% of people develop ____. How can it be treated?

Answer 61

Hyperkalemia -IV calcium OR glucose/insulin combination (IV) -eventually switch to loop diuretics

Question 62

Why does Diuretic Resistance occur in CHF treatment?

Answer 62

1) Non-adherence to na/fluid restriction 2) Non-compliance w med dose 3) Compensatory increase in sodium reabsorption following na loss from body by RAAS activation (mostly seen in Loop Diuretics)

Question 63

____ and ___ are channel activating proteases (CAP1) present in tubular lumen that cleave GAMMA subunit of ENaC and activates it, resulting in enhanced reabsorption of __

Answer 63

Na (Used if resistance to K sparing diuretics)

Question 64

The endogenous prostaglandins enhance __ via RAAS

Answer 64

renal perfusion

Question 65

Inhibition of prostaglandins (aspirin, NSAID) can decrease ____ and attenuate diuretic efficacy (there will be LESSER amount of filtrate in lumen)

Answer 65

renal perfusion

Question 66

Hydralazine is also known as

Answer 66

Bidil

Question 67

Bidil/Hydralizine is a ___

Answer 67

arterial dilator

Question 68

Organic Nitrate primarily acts as a __dilator, thus reducing both ___ and ____

Answer 68

pre and afterload

Question 69

What are two visodilators used in CHF?

Answer 69

1) Isosorbide Dinitrate 2) Hydralazine

Question 70

____, a vasodilator used in CHF, gets converted to NO using ER residing CYP450 system

Answer 70

Isosorbide Dinitrate

Question 71

____, an arterial dilator, decreases release of calcium from intracellular pools by inhibiting IP3 pathway and decreasing vascular contraction

Answer 71

Hydralazine