Heart Failure Drugs

Question 1

LV heart failure is also known as?

Answer 1

a. HF with reduced ejection fraction (HFrEF)

Question 2

Diastolic heart failure is also known?

Answer 2

a. HR with preserved LV ejection fraction (HFpEF)

Question 3

What drugs are recommended for use in the treatment of HF?

Answer 3

a. Diuretics
b. RAAS inhibitors
c. B-blockers
d. Digoxin

Question 4

What are the most common causes of LV heart failure?

Answer 4

a. CAD

b. HTN

Question 5

Signs/symptoms of LV heart failure?

Answer 5

a. SOB
b. Orthopnea
c. Elevated PAWP
d. Fatigue
e. Pulmonary congestion
f. Cough (white/pink phlegm)
g. tachypnea
h. LE edema
i. Cyanosis
j. tachycardia

Question 6

Signs/symptoms of right heart failure?

Answer 6

a. Fatigue
b. Inc peripheral venous pressures
c. Ascites
d. Splenohepatomegaly
e. JVD
f. Weight gain
g. Dependent edema
h. tachycardia

Question 7

What is orthopnea?

Answer 7

Dyspnea when lying down

Question 8

What are the pathological changes that occur with HF?

Answer 8

a. Ventricular remodeling
b. Cardiac fibrosis
c. Myocyte death

Question 9

What are the compensatory/adaptive changes that occur during heart failure?

Answer 9

a. Cardiac dilation
b. Increased sympathetic tone
c. H2O retention/volume expansion

Question 10

Why does heart failure result in water retention?

Answer 10

a. Have reduced GFR r/t decreased renal blood flow

b. Activation of RAAS

Question 11

What hormones are released from heart d/t stretching of the atria/ventricles?

Answer 11

ANP and BNP

Question 12

What are the adverse effects related to the compensatory mechanism seen in HF?

Answer 12

a. Reduced vent filling r/t increased HR
b. Reduced CO r/t arterial constriction/high pressures
c. Pulmonary/peripheral edema r/t H2O retention/high venous pressures
d. Hepatomegaly r/t H2O retention/high venous pressures

Question 13

What is the actual cause of death in a patient with HF?

Answer 13

Excessive cardiac dilation and edema

Question 14

What are the two classification systems for HF?

Answer 14

a. New York Heart Association (NYHA)
b. American College of Cardiology/American Heart
Association (ACC/AHA)

Question 15

What is the criteria for an NYHA Class I HF?

Answer 15

a. No limitation

Question 16

What is the criteria for an NYHA Class II HF?

Answer 16

a. Slight limitation of physical activity

b. Moderate activities produce symptoms

Question 17

What is the criteria for an NYHA Class III HF?

Answer 17

a. Marked limitations

b. Minimal activity produces symptoms

Question 18

What is the criteria for an NYHA Class IV HF?

Answer 18

Symptoms occur at rest

Question 19

What is the criteria for ACC/AHA Stage A HF?

Answer 19

a. High risk of HF

b. No structural disease or symptoms

Question 20

What is the criteria for ACC/AHA Stage HF?

Answer 20

Structural heart disease, no symptoms

Question 21

What is the criteria for ACC/AHA Stage C HF?

Answer 21

Structural heart disease with current or prior symptoms

Question 22

What is the criteria for ACC/AHA Stage D HF?

Answer 22

Refractory HF requiring specialized interventions

Question 23

Why are loop diuretics preferred in the tx of severe HF?

Answer 23

a. they mobilize large volumes of water

b. work even with low GFR

Question 24

Spironolactone and Triamterene are what class of drug?

Answer 24

Potassium sparring diuretics

Question 25

Eplerenone is what class of drug?

Answer 25

Aldosterone antagonist

Question 26

Captopril is what class of drug?

Answer 26

ACEi

Question 27

What are adverse effects of ACEi drugs?

Answer 27

a. Hypotension b. Hyperkalemia c. Intractable cough d. Angioedema

Question 28

Losartan is what class of drug?

Answer 28

ARB

Question 29

Valsartan is what class of drug?

Answer 29

ARB

Question 30

Ramipril is what class of drug?

Answer 30

ACEi

Question 31

What are the negative effects of aldosterone?

Answer 31

``` Promotes: • myocardial remodeling • Myocardial fibrosis • Activation of SNS • Suppresses NE uptake in the heart • Vascular fibrosis • Baroreceptor dysfunction ```

Question 32

What medication(s) is given with an ACEi or ARB in treatment of HF?

Answer 32

a. Aldosterone antagonist | b. Need periodic monitoring of potassium

Question 33

Which B-blocker(s) improve outcome in HF patients?

Answer 33

a. Carvedilol b. Bisoprolol c. SR metopolol

Question 34

Carvedilol brand name?

Answer 34

Coreg

Question 35

Digoxin is what class of drug?

Answer 35

a. Cardiac glycoside | b. Positive inotrope

Question 36

Digoxin brand name?

Answer 36

Lanoxin

Question 37

What is Digoxin’s MOA?

Answer 37

a. Inhibits Na-K-adenosine triphosphatase pumps (Na,K,ATPase) b. Causes intracellular Na retention, which inhibits Ca out/Na in exchange

Question 38

How does potassium interact with digoxin?

Answer 38

a. K competes with digoxin for binding on Na,K,ATPase b. Low potassium = increased dig effect c. High potassium = reduced dig effects

Question 39

Explain the cardiac action potential cycle movement of ions?

Answer 39

a. During AP: Ca/Na in, K out | b. After: exchange of Ca for Na (Ca out/Na in); exchange of Na for K (Na out/K in) Na,K,ATPase pump

Question 40

What effect does digoxin have on the kidneys?

Answer 40

Suppresses renin release

Question 41

How does digoxin reduce sympathetic tone/activity?

Answer 41

By inhibiting Na,K,ATPase in the vagal afferent nerve fibers

Question 42

What are the adverse effects of digoxin?

Answer 42

a. Dysrhythmias b. Anorexia c. N/V d. fatigue e. Blurred vision f. Seeing yellow g. Halos around dark objects

Question 43

What drugs can increase digoxin levels?

Answer 43

a. Quinidine b. Amiodarone c. Verapamil

Question 44

How is digoxin excreted?

Answer 44

By the kidneys

Question 45

What is digoxin’s half-life?

Answer 45

1.5 days

Question 46

What is digoxin time of onset and peak?

Answer 46

a. PO: 30 min – 2 hrs | b. Peak: 4-6 hrs

Question 47

Digoxin levels about __ng/mL offer no additional benefit but do increase risk of toxicity?

Answer 47

1ng/mL

Question 48

Which drug is specifically for the treatment of HF in African Americans?

Answer 48

Isosorbide dinitrate/hydralazine