Cardiac Heart Failure

Question 1

Dec in renal bf are sensed by

Answer 1

JGC of the afferent arterioles

Question 2

Heart remodelling from RAAS activation by myocardial and vascular fibrosis and baroreceptor fxn

Answer 2

Aldosterone

Question 3

Compensatory responses in HF (2)

Answer 3

1 sympathetic activation

2 RAAS

Question 4

cardenolide structure

Answer 4

steroid nucleus + lactone ring + sugar

Question 5

cardenolides come from

Answer 5

digitalis fox glove

Question 6

Digitalis Bioavailability and Half life

Elimination

Answer 6

60-75% bio
36-40h

Elimination: 60% renal 40% hepatic metab

Question 7

Digoxin MOA

Answer 7

Inhibition of Na pump (Na/K ATPase) -> inc Intracell Na -> alters Na-Ca exchange (dec Ca excretion) -> inc intracytoplasmic Ca (inc contraction) by SERCA

Question 8

Inc CO
Inc ventricular ejection
Inc renal perfusion
Dec EDS
Dec sympa tone

Answer 8

Digoxin

Question 9

Digoxin during early response shows electrical changes (4)

Answer 9

1 inc PR interval
2 flat T wave
3 slowed ventricular rate
4 shortened QT interval, T wave inversion, ST depression late

Early brief prolongation of AP then shortening of plateau bec of K conductance!

Question 10

Digoxin toxic response

Answer 10

1 inc automaticity (arrhythmia)

2 delayed afterdepolarization (Ca overload)

Question 11

Digoxin indication

Answer 11

CHF with systolic dysfxn
Atrial fibrillation
Improves functional status only

Question 12

Digitalis SE (4)

Answer 12

CNS , GI stimulation
Color perception aberration
Gynecomastia
Electrolyte (hypokalemia, hypomagnesemia, HYPERcalcemia)

Arrhythmia, arrest

Question 13

Digitalis tox tx (3)

Answer 13

1 correct K and magnesium deficiency 
2 antiarrhythmics (lidocaine, phenytoin, propanol) if not refractory to K
severe acute overdose (artificial pacemaker)
3 Digoxin antibodies

Question 14

Digoxin Minimum Effective Concentration

Answer 14

1 ng/mL

Question 15

bipyridine that inhibits PDE3 leading to inc cAMP, inc intracellular contractility

Also promotes vasodilation

Cannot be used in chronic Hf bec of inc mortality

Answer 15

Milrinone
Theophylline
Aminophylline

Question 16

Bipyridine SE (3)

Answer 16

N &amp v, arrhythmia
Thrombocytopenia
Liver enzyme

Question 17

First line for both systolic and diastolic dysfxn

Answer 17

Diuretics

Question 18

Immediately reduces pulmo congestion and severe edema

Answer 18

Furosemide

Question 19

Diuretic For mild chronic HF

Answer 19

HCTZ

Question 20

Diuretic that dec mortality in CHF

Answer 20

Aldosterone antagonist
Spironolactone
Eplerenone

Question 21

First line drugs that dec morbidity and mortality in CHF

Dec aldosterone sec, salt water ret, vasoconstriction

Answer 21

ACEI

Question 22

Drugs for ACUTE HF with marked depression of systolic dysfunction

Also for cardiogenic or hypovolemic shock

Answer 22

Beta1 Adrenoreceptor agonist

Dobutamine
Dopamine

Do not give to chronic bec of tolerance, lack of oral efficacy, significant arrhythmogenic effects

Question 23

Selective B1 agonist that inc CO and dec ventricular filling pressure

Given intermittently

SE: tachy, angina and arrhythmia, inc O2 consumption

Answer 23

Dobutamine

If need to inc BP give Dopamine

Question 24

Dec preload by vasodilation
Dec afterload by arteriolar dilation
Reduces remodelling

Answer 24

Vasodilators

Question 25

For acute severe failure with congestion | Dec preload and afterload

Answer 25

Nitroprusside NTG

Question 26

Promotes vasodilation and natriuresis for acute failure (renal toxicity)

Answer 26

Nesiritide

Question 27

Dec mortality in African-American with CHF

Answer 27

Hydralazine and ISDN

Question 28

Nesiritide MOA

Answer 28

BNP inc CGMP -> dec venous tone, dec arteriolar tone

Question 29

Nesiritide SE

Answer 29

Hypotension | Renal toxicity

Question 30

Degrades BNP and ANP

Answer 30

Sucabitril LCZ696 | ARB + Neprilysin inhibitor

Question 31

``` ACE MOA Dec afterload by Dec preload by Dec angiotenstin and sympathetic Dec remodelling by ```

Answer 31

Dec peripheral resistance arteriolar dilation Dec salt and water retention Dec NE release Dec aldosterone activation

Question 32

Steroid derivative inc contractility by inhibiting NaK ATPase pump Facilitates sequestration of Ca by SR Less arrhythmogenic

Answer 32

Istaroxime

Question 33

Sensitizes troponin to Ca Inhibits phosphodiesterase Vasodilator

Answer 33

Levosirerdan

Question 34

Activates myosin and prolongs systole without inc in O2

Answer 34

Omecamtir mecarbil