Heart Failure

Question 1

What are the recommendations regarding Na+ intake for patients in A/B heart failure vs. C/D heart failure stages?

Answer 1

A/B <1.5g per day

C/D <3g per day

Question 2

What class of drugs is indicated in patients with current or prior symptoms of HF and reduced LVEF who have evidence of fluid retention?

Answer 2

Diuretics

Question 3

What is the MOA for loop diuretics?

Answer 3

Blocks Na+-K+-Cl- cotransporter thus increasing their excretion

Question 4

Why may it be necessary to switch from oral to IV loop diuretics, use alternative forms, or initiate combination therapy in patients with HF?

Answer 4

Diuretic resistance

Question 5

What are three vasodilators used for HF?

Answer 5

Nitroglycerine
Nitroprusside
Nersirtide

Question 6

All three vasodilators for HF decrease preload. Two of them also reduce afterload, which one doesn’t?

Answer 6

Nitroglycerine

Question 7

All three vasodilators for HF are indicated for warm and wet ADHF. Which one(s) are an alternative to inotropes in cold and wet ADHF?

Answer 7

Nitroprusside and Nersirtide

Question 8

Beside hypotension, what are the side effects of nitroprusside?

Answer 8

Cyanide or thiocyanate toxicity

Question 9

What are the two inotropes for HF?

Answer 9

Dobutamine and milrinone

Question 10

Dobutamine: MOA?

Answer 10

B 1 agonist

Question 11

Dobutamine: indications?

Answer 11

ADHF: cold and wet or cold and exacerbation

Question 12

Dobutamine: side effects?

Answer 12

Proarrhythmia, tachycardia, hypokalemia, myocardial ischemia, tachyphylaxis, increased mortality

Question 13

Milrinone: MOA?

Answer 13

PDE inhibitor increases CO by decreasing preload and afterload

Question 14

Milrinone: indications?

Answer 14

ADHF: cold and wet or cold and exacerbation

Question 15

Milrinone: side effects?

Answer 15

Proarrhythmia, hypotension, tachycardia, thrombocytopenia, increased mortality with long term use

Question 16

What class of drugs should be used in all patients with a reduced EF to prevent HF and is recommended for all patients with HFrEF?

Answer 16

ACE-I

Question 17

What are ACE-I side effects?

Answer 17

Hypotension, cough, renal effects, angioedema, teratogenic, hyperkalemia, rash, taste disturbances

Question 18

What should be used in patients with HFrEF who are ACE-I intolerant?

Answer 18

ARBs

Question 19

Is it a good idea to routinely combine an ACE-I, ARB, and aldosterone antagonist?

Answer 19

No, it’s potentially harmful

Question 20

What are the indications for aldosterone antagonists?

Answer 20

HF w/ LVEF <35%

Following acute MI w/ LVEF <40% w/symptoms of HF or DM

Question 21

What are side effects of aldosterone antagonists?

Answer 21

Hyperkalemia (needs close monitoring)
Gynaecomastia
dizziness, worsening renal function

Question 22

What are the two aldosterone antagonists?

Answer 22

Eplerenone

Spironolactone

Question 23

What is the place of aldosterone antagonists in the order of therapies for HF?

Answer 23

Third-line

Question 24

What are the indications for beta blockers in regard to HF?

Answer 24

MI, reduced EF

Question 25

Which lecture notes are the worst?

Answer 25

These lecture notes (I'm doing my best here people)

Question 26

What is the outcome of adrenergic activation in patients with chronic HF?

Answer 26

Lethal

Question 27

Beta blockers shield the myocardium from the chronically toxic effects of what?

Answer 27

High norepinephrine levels (leading to improved beta stimulation and LV systolic function)

Question 28

What are contraindications for beta blockers?

Answer 28

Cardiogenic shock, bradycardia, 2nd/3rd degree heart block w/o pacemaker, reactive airway disease, hypotension, asthma

Question 29

Isosorbide dinitrate MOA?

Answer 29

Nitric oxide donor Large and small artery dilator Venous dilator

Question 30

Hydralazine MOA?

Answer 30

Antioxidant (inhibits destruction of NO) | Arteriolar dilator

Question 31

BiDil MOA?

Answer 31

Fixed dose I/H (I don't know what any of this means) | NO enhancer

Question 32

What are the side effects of hydralazine?

Answer 32

Hypotension, HA, tachycardia, lupus like syndrome

Question 33

What is Digoxin likely MOA?

Answer 33

Neurohormonal inhibition - decreased sympathetic outflow - improved baroreceptor function and increased vagal tone

Question 34

Why give digoxin to HF patients?

Answer 34

Improved symptoms, exercise tolerance, quality of life, and fewer hospitalizations, but there is no survival benefit

Question 35

Digoxin side effects?

Answer 35

HA, dizziness, halos, change in colors, anorexia, N/V, diarrhea, constipation, bradycardia, PVCs, arrhythmias

Question 36

What are the risk factors for digoxin toxicity?

Answer 36

Renal insufficiency Hypokalemia/hyperkalemia Drug interactions

Question 37

Digoxin interactions?

Answer 37

Increased serum concentrations: Amiodarone, Erythromycin, Itraconazole, Omeprazole Decreased serum concentration: altered absorption of antacids, colestipol, laxatives

Question 38

Hawthorn indications?

Answer 38

CHF, angina, arrhythmias, hyperlipidemia, Buerger's disease

Question 39

Hawthorne side effects?

Answer 39

Hypotension, palpitations, progression of HF

Question 40

St. John's wort indications?

Answer 40

Depression, anxiety, sleep disorders, HIV

Question 41

St. John's wort side effects?

Answer 41

Arrhythmia and HTN