Heart Failure

Question 1

The pharmacology definition defines HFrEF or HFpEF?

Answer 1

HFrEF

Question 2

Is HFrEF systolic or diastolic?

Is HFpEF systolic or diastolic?

Answer 2

HFrEF = systolic
HFpEF = diastolic

Question 3

What is the role of venodilator drugs in pts with HF?

Answer 3

↓ preload

block ↑ RAS activity and ↑ venous return

Question 4

What is the role of arteriodilator drugs in pts with HF?

Answer 4

↓ afterload

block ↑ peripheral resistance (that occurs due to arterial constriction

Question 5

What is the role of beta blockers in pts with HF?

Answer 5

↓ contractility
↓ cardiac work by slowing HR
(↓ energy expenditure)

Question 6

What is the role of inotropic drugs in pts with HF?

Answer 6

↑ contractility

Question 7

What is the main cardiac contractility determinant?

Answer 7

Sensitivity of contractile proteins to Ca2+ and availability of Ca2+

(also some effects of Na+)

Question 8

Failed compensatory mechanisms become what in HF pts?

Answer 8

Signs and sxs

Question 9

What cardiac factor is increased in HF pts due to increased blood volume and increased venous tone?

Answer 9

Preload

Question 10

What cardiac factor is increased in HF pts due to increased aortic impedence and increased arterial constriction?

Answer 10

Afterload

Question 11

What cardiac factor is decreased in HF pts due to ventricular dilation which reduces pumping force?

Answer 11

Contractility

Question 12

What cardiac factor is increased in HF pts due to reflex tachycardia caused by sympathetic hyperactivity?

Answer 12

HR

Question 13

What drugs have been shown to reduce mortality rate in HF pts?

Answer 13

Spironolactone and eplerenone

Question 14

What drugs are included in the class of ACE inhibitors for HF pts?

Answer 14

Enalapril

RAS inhibitor

Question 15

What drugs are included in the class of Angiotensin II Receptor Blockers (ARBs) for HF pts?

Answer 15

Losartan

RAS inhibitor

Question 16

What drugs are included in the class of ARNIs for HF pts?

Answer 16

Sacubitril (Neprilysin inhibitor)/ Valsartan (ARB)

aka Entresto

Question 17

What drugs are included in the class of Beta Blockers for HF pts?

Answer 17

Metoprolol, Carvedilol

Combined 𝛼-β blockers

Question 18

What drugs are included in the class of Vasodilators for HF pts?

Answer 18

Sodium nitroprusside, isosorbide dinitrate, hydralazine

Question 19

What drugs are included in the class of Sympathomimetics for HF pts?

Answer 19

Dobutamine (B1), Dopamine

Question 20

What drugs are included in the class of Digitalis for HF pts?

Answer 20

Digoxin

Question 21

ATII alters peripheral resistance resulting in rapid pressor response which ultimately increases what?

Answer 21

Afterload

Question 22

ATII alters renal function resulting in slow pressor response which ultimately increases what?

Answer 22

Preload

Question 23

ATII alters CV structure resulting in vascular and cardiac hypertrophy and remodeling which ultimately increases what?

Answer 23

Remodeling

Question 24

What is the MOA of ARBs?

Answer 24

Block ATII from binding to the ATI receptor

Question 25

What is the current DOC for HF?

Answer 25

ACE inhibitors

Question 26

What is the adverse effect of ACE inhibitors

Answer 26

Dry cough

Question 27

Sacubitril (Neprilysin inhibitor)/ Valsartan (ARB) | (aka Entresto - ARNI) is better at reducing mortality in HF pts compared to what drug alone?

Answer 27

Enalapril

Question 28

What is the greatest effect of Neprilysin inhibition?

Answer 28

Decrease cardiac remodeling

Question 29

The following are adverse effects for what HF drug? Hypotension Hyperkalemia (esp with K+ sparing diuretic) Cough and angioedema

Answer 29

Sacubitril/ Valsartan (Entresto)

Question 30

What are the c/i's of Sacubitril/ Valsartan (Entresto)?

Answer 30

Pregnancy | Concurrent use with ACE inhibitor (angioedema)

Question 31

Carvedilol and Metoprolol ↓ renin secretion, HR, and remodeling, in addition to what other thing?

Answer 31

Mortality

Question 32

Why are beta blockers only effective in the early stages of HF?

Answer 32

Dangerous in severe, end-stage HF due to negative inotropic effect

Question 33

Which HF drug is a selective beta-1 agonist (inotropic effect), is used in short-term treatment of severe refractory HF and is given IV?

Answer 33

Dobutamine

Question 34

Besides Dobutamine, what other HF drug can be used for short-term treatment of severe refractory HF that can also increase BP if needed?

Answer 34

Dopamine

Question 35

What drug is a cardiac glycoside isolated from plants?

Answer 35

Digitalis (Digoxin)

Question 36

The MOA of Digoxin involves inhibition of what pump to lead to cardiac effects such as ↑ IC Na+, Ca2+, actin-myosin interaction, contractility, and ↓ expulsion of IC Ca2+?

Answer 36

Inhibition of Na/K ATPase pump

Question 37

If a HF pt has all benchmarks met with other meds but is still feeling sluggish, what drug can be added?

Answer 37

Digoxin

Question 38

What is the primary indication for Digoxin besides HF?

Answer 38

Arrhythmias

Question 39

What is the effect of Digoxin on HR?

Answer 39

Reduced/ slowed | ↑ myocardial contractility leads to sympathetic tone ↓

Question 40

What HF drug is orally bioavailable and is primarily excreted by the kidneys?

Answer 40

Digoxin

Question 41

What are adverse effects of Digoxin? (4)

Answer 41

All glycosides are toxic Narrow margin of safety CNS SE's Cardiac

Question 42

What are the first signs of toxicity with Digoxin?

Answer 42

GI (disappear after discontinuation)

Question 43

What SE of Digoxin is the most common cause of death?

Answer 43

Ventricular fibrillation

Question 44

What drug has common and dangerous cardiac adverse effects including sinus bradycardia, ectopic ventricular beats, AV block, and bigeminy?

Answer 44

Digoxin

Question 45

If minor intoxication occurs with Digoxin (exhibited as GI effects), what should you do?

Answer 45

D/c or ↓ dose

Question 46

If moderate intoxication occurs with Digoxin (exhibited as arrhythmias), what should you do?

Answer 46

Oral/ IV K+ and d/c or ↓ dose

Question 47

If severe intoxication occurs with Digoxin (exhibited as overdose/ life threatening arrhythmias), what should you do?

Answer 47

Immunotherapy with Digitalis Immune Fab + Oral/ IV K+ and d/c or ↓ dose

Question 48

What shouldn't be used in the treatment of Digoxin intoxication?

Answer 48

Cardioversion (unless ventricular fibrillation)

Question 49

What leads to increased Digoxin toxicity? (3)

Answer 49

Hypokalemia Further ↓ of SA/ AV node activity Myocardial sensitization to Digoxin

Question 50

What leads to decreased Digoxin effectiveness?

Answer 50

CCBs causing ↓ contractility

Question 51

What beneficial lifestyle effect does Digoxin have?

Answer 51

↑ exercise tolerance