HF

Question 1

Inotropic drugs

Answer 1

Digoxin
Milrinone (PDEI)
Dobutamine
Dopamine

Question 2

Iondilator

Answer 2

Milrinone

Question 3

HF med when need increase in contractility and has low BP

Answer 3

Dopamine

Question 4

MOA of digoxin

Answer 4

inhibit Na/K ATPase –> increase intracellular Na –> decrease Ca export –> increased contractility and decreased HR

Question 5

HR decrease in normal hearts on digoxin

Answer 5

baroreflex causes increases sensitivity of SA node to Ach (vagal stimulation)

Question 6

HR decrease in HF hearts on digoxin

Answer 6

high sympathetic tone –> as digitalis increases myocardial contractility, sympathetic tone is reduced

Question 7

Most common SE of digoxin

Answer 7

cardiac: sinus bradycardia, AV block. ectopic ventricular beats, bigeminy

Question 8

Most common cause of death on digoxin

Answer 8

V. fib

Question 9

GI effects on digoxin

Answer 9

lower dose

Question 10

Mild arrhythmia on digoxin

Answer 10

give IV or oral vitamin K and lower dose

Question 11

Severe arrhythmia/life threatening on digoxin

Answer 11

DigiFab

Question 12

Decrease clearance of digoxin

Answer 12

quinidine
amiodarone
cyclosporine
captopril
verapamil
diltiazam

Question 13

Increase absorption of digoxin

Answer 13

omeprazole

erythromycin

Question 14

Decrease absorption of digoxin

Answer 14

Bran

Cholestyramine

Question 15

Other digoxin toxicities

Answer 15

vitamin K decreases
calcium increases
BB: bradycardia
CCB: dec. contractility

Question 16

PDEI

Answer 16

milrinone

Question 17

beta-1 agonist

Answer 17

dobutamine

Question 18

used in severe refractory cases of HF

Answer 18

Dobutamine

Dopamine

Question 19

Oral inotropic HF drug

Answer 19

digoxin

Question 20

Drugs that reduce mortality in HF

Answer 20

adosterone antagonists, ACE, ARBS, BB, ARBNI

Question 21

Diuretic that increases life span in HF

Answer 21

spironolactone

eplerenone

Question 22

ACE effects

Answer 22

dec. afterload (dec. ATII)

Dec. preload (dec. aldosterone release)

Question 23

Neprilysin

Answer 23

degrades natriuretic peptides, bradykinin and others

Question 24

Entresto

Answer 24

ARNI: good at reducing mortality; dec. vasoconstrction, sodium retention and cardiac remodeling

Question 25

SE of entresto

Answer 25

hypotension hyperkalemia (ARB) cough/angioedema

Question 26

Contra of entresto

Answer 26

pregnancy | ACE

Question 27

BB drugs

Answer 27

carvedilol | metoprolol

Question 28

Effects of BB

Answer 28

``` decrease mortality dec renin secretion attenuate effects of high catecholamines up-regulate b receptors dec. HR dec. remodeling ```

Question 29

When do you not use BB

Answer 29

severe, end stage HF (negative inotropic effect)

Question 30

Vasodilators

Answer 30

Sodium nitroprusside Isosorbide dinitrate Hydralazine

Question 31

How are vasodilators effect

Answer 31

reduce preload, afterload or both | dec. damaging remodeling of heart

Question 32

Ivabradine MOA

Answer 32

block funny current in SA node, thus decreasing HR

Question 33

When to use ivabradine

Answer 33

used when HR >70 bpm and beta blockers are at max dose or you can't take BB

Question 34

Adverse effects of ivabradine

Answer 34

bradycardia | conduction abnormalities: sinus arrest and heart block

Question 35

Nesiritide

Answer 35

synthetic BNP, vasodilation and diuresis