Heart Failure

Question 1

What causes sudden death in heart heart failure?

Answer 1

Arrhythmias

Question 2

What are the main determinants of cardiac workload?

Answer 2

Preload

Afterload

Contractility

HR

Question 3

What kinds of drugs decrease preload?

Answer 3

Venodilators

Question 4

What kind of drugs reduce afterload?

Answer 4

Arteriodilators

Question 5

What effect do B-blockers have on contractility

Answer 5

Decrease conractility

Question 6

How do B blockers reduce cardiac work?

Answer 6

Slowing HR

Question 7

When your heart is failing, what happens to preload

Answer 7

Increases due to increased blood volume and increased venous tone

Question 8

What 2 classes of drugs will reduce preload in HF

Answer 8

Diuretic

Venodilators

Question 9

What effect does HF have on afterload

Answer 9

Increased afterload due to increased aortic impedance and increased arterial constriction

Question 10

What class of drugs will reduce afterload in HF

Answer 10

Arteriodilator

Question 11

What effect does HF have on HR

Answer 11

HR is increased due to reflex tachycardia caused by sympathetic hyperactivity

Question 12

How do B-blockers help in HF

Answer 12

They reduce energy expenditure by slowing the HR

Does not help in end stage HF

Question 13

What is the MOA of digoxin?

Answer 13

Inhibits the Na+,K+ ATPase pump on the cell membrane. Leads to:

⬆️Intracellular Na+

⬇️Expulsion of intracellular Ca++

⬆️Intracellular Ca++ leads to increased Ca++ stores

⬆️Actin-myosin interaction by intracellular Ca++

⬆️Contractility (positive inotropy)

Question 14

What is the #1 drug to increase inotropy

Answer 14

Digitalis

Question 15

What effect does Digoxin have on normal healthy hearts

Answer 15

Decreases HR

Question 16

Who can use Digoxin as an antiarrhythmic?

Answer 16

Patients NOT in heart failure!

Question 17

How does Digoxin slow HR in normal hearts?

Answer 17

Vagal stimulation due to:

Sensitization of arterial baroreceptors

Stimulation of central vagal nuclei

Increased SA node sensitivity to ACh

Question 18

How does Digoxin slow HR in FAILING hearts?

Answer 18

In HF, sympathetic tone will already be high, but Digitalis will reduce sympathetic tone by increasing myocardial contractility

Question 19

Does Digitalis increase Cardiac output for everyone?

Answer 19

No, only in failing hearts.

Because peripheral vasoconstriction will increase in normal people

Question 20

What is one of the earliest sign of digitalis toxicity?

Answer 20

GI side effects***

Will disappear after discontinuation

Question 21

Is the margin of safety wide or narrow in digoxin

Answer 21

Narrow, you can have toxicity even at therapeutic doses

Question 22

Is Digoxin a glycoside?

Answer 22

Yes, and all glycosides are toxic

Question 23

What is the most dangerous adverse effect of digoxin?

Answer 23

Cardiac arrhythmias!!!**

Includes: BIGEMINY**, sinus bradycardia, AV block, ectopic ventricular beats

Question 24

How do you treat a ~moderate~ digoxin intoxication

Answer 24

Stop drug and give potassium

Question 25

How do you treat SEVERE digoxin intoxication (life-threatening arrhythmias)

Answer 25

Stop drug, give potassium, and give Digitalis Immune Fab (Digibind)************** Do NOT cardiovert digitalis-induced arrhythmias unless Vfib

Question 26

If digitalis has caused an arrhythmia, can you cardoivert them?

Answer 26

No Not unless it is Vfib

Question 27

What drugs will increase the toxicity of digoxin?

Answer 27

Thiazide and Loop diuretics!!**** Quinidine- displaces digoxin from tissue binding sites

Question 28

Why do thiazides and loop diuretics increase the toxicity of digoxin?

Answer 28

They cause hypokalemia!!!******* Hypomagnesemia** and Diarrhea could also increase toxicity since they reduce K+

Question 29

What effect will hypomagnesemia have on digoxin toxicity

Answer 29

Increased

Question 30

What drug class will decrease the effectiveness of digoxin

Answer 30

Calcium channel blockers lol they will literally DECREASE contractility and are CONTRAINDICATED in HF

Question 31

What kind of drug is Milrinone

Answer 31

An “inodilator” Increase inotropy AND causes vasodilation

Question 32

What is the MOA of milrinone

Answer 32

Inhibits cAMP phosphodiesterase Leads to increased cAMP, increased Ca influx and a significant vasodilating effect

Question 33

what is the the route of administration of milrinone

Answer 33

IV only

Question 34

What do we use Milrinone for?

Answer 34

Palliative treatment for acute HF or severe exacerbation of chronic HF (IV only, SHORT TERM use)

Question 35

How long can a patient be on milrinone?

Answer 35

SHORT TERM Long term will kill them via an arrhythmia

Question 36

What is the adverse effect of milrinone

Answer 36

Arrhythmia

Question 37

What drug would be pointless to give at the same time you gave dobutamine or dopamine

Answer 37

B Blocker

Question 38

What is the MOA of dobutamine and dopamine

Answer 38

B1 agonists- causes an inotropic effect

Question 39

What are the 2 benefits of spironlactone and eplerenone

Answer 39

Reduce mortality rate Correct hypokalemia caused by loop/thiazide

Question 40

How do ACEs and ARBs treat Heart failure

Answer 40

Diminish cardiac workload by: Reduce edema and preload (inhibit aldosterone) Decrease afterload via Vasodilation (inhibit Angiotensin II)

Question 41

Why do ACEs cause a cough

Answer 41

They reduce the bradykinin metabolism

Question 42

Are ACEs/ARBs OK in pregnancy?

Answer 42

NO Category X in 2nd and 3rd trimester!

Question 43

What does Sacubitril/Valsartan (Entresto) do?

Answer 43

Valsartan: ARB Sacubitril: neprilysin inhibitor (results in more vasodilation)

Question 44

Which is better at reducing mortality in HF: Sacubitril/Valsartan (Entresto) or Enalapril alone

Answer 44

Entresto

Question 45

What effect do B-blockers have on life expectancy in HR

Answer 45

Increase life expectancy ONLY in early stages of HF Dangerous in endstage due to negative inotropic effect

Question 46

What drug is the “sweetheart” of cardiologists and why

Answer 46

Carvedilol. It is a nonspecific B blocker AND an a1 blocker so it will decrease peripheral resistance in addition to the B blocker effects

Question 47

What effect does Sodium nitroprusside (Nitropress) have

Answer 47

Dilates VEINS more than arteries. (Same thing as nitro)

Question 48

What does Isosorbide dinitrate and Nitroglycerin do?

Answer 48

Dilates veins more than arteries | Reduces preload more than afterload

Question 49

What does Hydralazine do?

Answer 49

Peripheral vasodilation via the production of NO