Exam 3: Drugs Used In Heart Failure

Question 0

50% of younger patients have this type of HF in which there is reduced mechanical pumping action and reduced ejection fraction

Answer 0

Systolic HF

Question 1

Most common cause of HF in US?

Answer 1

Coronary Artery Disease (CAD)

Question 2

This type of HF is characterized by stiffening and loss of adequate relaxation playing a major role in reduced filling and CO. Ejection fraction may be reduced even though SV is super reduced

Answer 2

Diastolic HF

Question 3

2 goals in treatment of HF:

Answer 3

1. Reducing symptoms & slow progression

2. Manage acute episodes of decompensated failure

Question 4

In this type of HF it is believed that it is primarily due to a problem within the excitation-contraction coupling machinery of the heart

Answer 4

Systolic HF

Question 5

In the treatment of HF, therapy directed towards non-cardiac elements are much more valuable strategies for long term management instead of the use of positive ionotropes such as digitalis. T/F?

Answer 5

True

Question 6

Only agents in current use that actually prolong patient's life with chronic HF. There are 5. Choose the one that does not belong: 
A. Diuretics
B. ACEI
C. ARB
D. Beta blockers
E. Aldosterone receptor agonists
F. Hydralazine nitrate

Answer 6

A

Question 7

Which classification of drug is most useful in acute systolic failure? And give example

Answer 7

Positive ionotropes, cardiac glycosides like digitalis

Question 8

Positive ionotropes help increase survival in chronic failure. T/F

Answer 8

False. They consistently reduce survival. The only positive ionotrope that doesn’t reduce survival is digitalis. But the use of other positive ionotropes is discouraged

Question 9

This drug is derived from the purple foxglove plant: 
A. Aspirin 
B. Warfarin
C. Digoxin
D. Dobutamine

Answer 9

C

Question 10

Bipyridines, such as Inamrione and Milrinone inhibit what? Available only parenterally and elimination half lives of 3-6 hours.
A. Inhibits PDE-1
B. Inhibits PDE-2
C. Inhibits PDE-3

Answer 10

C

Question 11

All are MOAs of bipyridines except:
A. Vasodilator effect
B. Inhibition of PDE-3 results in inc cGMP, thus inc in contractibility & vasodilation
C. Inc calcium influx during action potential
D. Stimulate sacroplasmic reticulum to release calcium

Answer 11

B. It inc camp, not cGMP

Question 12

This drug is a selective beta 1 agonist wildly used in the treatment of HF: 
A. Captopril
B. Amiodarone
C. Milrinone
D. Dobutamine

Answer 12

D

Question 13

Drugs primarily used in the treatment of chronic HF? Name them. There’s 5

Answer 13

Diuretics, ACEI, ARB, aldosterone antagonists and beta blockers

AAABD

Question 14

Important drugs used in acute HF? Name them. There are 2

Answer 14

Diuretics and vasodilators

Question 15

All are main goals of diuretics except:
A. Reduce venous pressure
B. Increase cardiac contractility
C. Reduce ventricular preload

Answer 15

B

Question 16

Spironolactone and eplerenone have an additional benefit of decreasing morbidity and mortality in pts with severe HF also taking ACEI and other standard therapy. What class do they belong to?

Answer 16

Aldosterone antagonist diuretics

Question 17

This class of drug, alone reduces long term remodeling of heart and vessels. Which is good because it reduces morbidity and mortality

Answer 17

ACEI like Captopril

Question 18

So your patient comes back to you after consult because the ACEI you put him in results in a really annoying cough. It’s incessant and he hates it. What drug can you give instead of the ACEI?

Answer 18

Give angiotensin (AT1) blocker

Question 19

Renin inhibitor used to tx HTN?

Answer 19

Aliskiren

Question 20

If you combine these two drugs they also result in reduced cardiac remodeling following damage to the heart

Answer 20

Long term use of hydrazaline and isosorbide dinitrate

Question 21

This drug activates BNP receptors to increase cGMP. Results in vasodilation and diuresis. Only given IV:
A. Nesiritide
B. Inamrinone
C. Dopamine

Answer 21

A

Question 22

This drug inhibits the Na/K ATP-ase pump resulting in reduced calcium expulsion and increased calcium stored in sacroplasmic reticulum
A. Dobutamine
B. Digoxin
C. Dopamine

Answer 22

B