Heart Failure Drugs

Question 1

long term, this drug decreases myocardial fibrosis

Answer 1

spironolactone

eplerenone

Question 2

a prodrug, rapidly metabolized to active compound that reduces Na reabsorption

Answer 2

spironolactone

eplerenone

Question 3

spironolactone may cause hyperkalemia when combined with what drugs?

Answer 3

ace inhibitors

digoxin

Question 4

decreases mortality in CHF even at low doses that do not diurese

Answer 4

spironolactone

eplerenone

Question 5

side effect = gynecomastia

Answer 5

spironolactone

eplerenone

Question 6

decreases preload and afterload

Answer 6

captopril

enalapril

Question 7

side effect: angioedema, cough

Answer 7

captopril

enalapril

Question 8

which of these is a prodrug: captopril or enalapril

Answer 8

enalapril

Question 9

protects against severe cardiac remodeling

Answer 9

ACEIs and ARBS

Question 10

toxic to fetus

Answer 10

ACEIs and ARBS

Question 11

bilateral renal artery stenosis is a contraindication

Answer 11

ACEIs and ARBS

Question 12

degrades ANP, BNP, CNP

Answer 12

Neprilysin

Question 13

enhances ARBs by blocking neprilysin and AT1 receptor

Answer 13

ARNI

Sacubitril/Valsartan

Question 14

adverse effects: hypotension, angioedema, cough

Answer 14

Sacubitril/valsartan

Question 15

Drugs that interact with ARNIs, causing angioedema

Answer 15

ACE inhibitors

Question 16

beta-1 selective blocker

Answer 16

metoprolol

Question 17

decreases after load, preload, heart rate, contractility, conduction velocity

Answer 17

beta blockers

Question 18

beta-nonspecific > alpha-1 blocker

Answer 18

carvedilol

Question 19

abrupt discontinuation of this drug may cause severe angina/MI

Answer 19

carbedilol

Question 20

use with caution in asthmatics

Answer 20

carvedilol

Question 21

contraindicated in decompensated CHF

Answer 21

beta blockers

Question 22

contraindicated in sick sinus syndrome and 2nd and 3rd degree AV block

Answer 22

beta blockers

ivabradine

Question 23

block adrenergic stimulated adverse remodeling of myocardium

Answer 23

beta blockers???

Question 24

if beta blockers combined with Ca channel blockers

Answer 24

severe hypotension

Question 25

hyperpolarization-activated cyclic nucleotide gated channel blocker (the If channel on SA node)

Answer 25

ivabradine

Question 26

adverse effects of ivabradine

Answer 26

Afib bradyarrythmias visual disturbances

Question 27

metabolized by CYPs

Answer 27

ivabradine

Question 28

for what patient might you try ivabradine?

Answer 28

someone with stable, symptomatic CHF, EF <35%, HR>70, maxed out on beta-blockers

Question 29

unclear mechanism that dilates arterioles and decreases afterload

Answer 29

hydralazine

Question 30

improves morbidity and mortality in African Americans with CHF

Answer 30

BiDil (isosorbide denigrate + hydralazine)

Question 31

prodrug releases NO, causing vasodilation | veins (decrease preload) >>> arteries (decrease after load)

Answer 31

isosorbide dinitrate

Question 32

need dose free period (14 h/d) to prevent tolerance

Answer 32

isosorbide dinitrate

Question 33

causes severe hypotension if combined with phosphodiesterase-5 inhibitors (Viagra)

Answer 33

isosorbide dinitrate

Question 34

contraindicated in CAD

Answer 34

hydralazine

Question 35

could enhance side effects of beta-blockers

Answer 35

hydralazine

Question 36

PDE-3 inhibitor

Answer 36

milrinone (IV)

Question 37

increases Ca+ to increase contractility | increases artery vasodilation to decrease afterload

Answer 37

milrinone (IV)

Question 38

short term (<48 h) use in acute decompensated HF

Answer 38

milrinone

Question 39

cardiac glycoside

Answer 39

digoxin

Question 40

inhibits Na/K ATPase pump to increase intracellular Ca+ in myocytes

Answer 40

digoxin

Question 41

increases vagal tone to decrease HR

Answer 41

digoxin

Question 42

risk of toxicity if combined with spironolactone

Answer 42

digoxin

Question 43

antibiotics increase bioavailability, and it has a low therapeutic index

Answer 43

digoxin

Question 44

indications: CHF, Afib | no mortality benefit

Answer 44

digoxin