L14: HF

Question 1

Why DO diseased hearts see an increase in CO with digitalis

Answer 1

PVR is already maxed out (sympathetic tone), can’t increase more to counteract contractility

Question 2

Don’t give beta blockers with

Answer 2

dobutamine

dopamine

Question 3

At any point if a patient shows signs of digoxin intoxication

Answer 3

discontinue
IF moderate to severe, give K+
IF severe, give Digitalis Immune Fab

Question 4

4 drugs that are positive inotropes (increase contractility)

Answer 4

Digoxin
Dobutamine
Dopamine
Milrinone

Question 5

Why is contractility decreased in HF

Answer 5

myocardial muscle fibers are stretched too far as ventricles become dilated

Question 6

Main side effect that occurs with ACE inhibitors but not ARBs?

Answer 6

Dry cough due to increased bradykinin

Question 7

Milrinone is given short term due to

Answer 7

Risk of arrhythmias

IV only

Question 8

why DON’T normal hearts see an increase in CO with digitalis?

Answer 8

Increased PVR counteracts the increased contractility

Question 9

Reduce preload with

Answer 9

venodilators

Question 10

Earliest signs of digoxin toxicity?

Answer 10

GI effects - even at low doses

Disappear after discontinuation

Question 11

Sacubitril/valsartan contraindication

Answer 11

pregnancy

Question 12

Cardioversion treatment is for

Answer 12

vfib caused by severe digitalis intoxication

Question 13

Reduce afterload with

Answer 13

arteriodilators

Question 14

ACE-I contraindication

Answer 14

Pregnancy

Question 15

Milirinone indications

Answer 15

palliative care for acute HF or severe exacerbation of chronic HF
IV only

Question 16

Bigemy

Answer 16

induced by digitalis, treated with K+

Question 17

Drugs to increase contractility

Answer 17

Inotropic drugs

Question 18

Digoxin MOA

Answer 18

Inhibition of membrane sodium pump (Na/K ATPase) leading to cardiac effects:

• Increased intracellular Na+
• Increased intracellular Ca2+ leads to increased SR Ca2+ stores
• Increased actin-myosin interaction by intracellular Ca2+

Question 19

most common cause of digitalis death

Answer 19

vfib

Question 20

All glycosides are

Answer 20

toxic

digoxin is a cardiac glycoside

Question 21

Most heart failure is

Answer 21

left ventricular dysfunction

Question 22

Beta blockers in late heart failure… (Carvedilol, Metoprolol)

Answer 22

DANGER: negative inotropic effet

Question 23

Digoxin can be displaced from tissue binding sites (increased toxicity) by

Answer 23

Quinidine (careful if your patient has HF and arrhythmias!)

Question 24

Most common and dangerous side effects of Digoxin?

Answer 24

Arrhythmias: sinus bradycardia, ectopic ventricular beats, AV block, and BIGEMINY

Question 25

Things that decrease digitalis toxicity/effects

Answer 25

1. Decreased GI absorption: cholestyramine, bran | 2. Calcium Channel Blockers→ decreased contractility→ contraindicated in heart failure

Question 26

Beta blockers in early heart failure... (*Carvedilol*, Metoprolol)

Answer 26

decrease mortality

Question 27

What is the most important role of the neprilysin inhibitor in the Sacubitril/Valsartan combo?

Answer 27

Reduced sodium retention Also: reduced vasoconstriction and cardiac remodeling

Question 28

Sodium nitroprusside effects

Answer 28

venous and arteriodilator | *MOSTLY VEINS*

Question 29

Hydralazine effects

Answer 29

vasodilation by NO

Question 30

Preload increases because

Answer 30

Increased sympathetic and RAAS activity —> Increased venous return —> Increased blood volume and venous tone

Question 31

When to use Ivabradin

Answer 31

It decreases HR when beta blockers can’t/won’t

Question 32

Afterload increases because

Answer 32

Increased sympathetic and RAAS activity —> increased peripheral resistance via arterial constriction

Question 33

Drugs to reduce contractility

Answer 33

B blockers

Question 34

Main side effects of Sacubitril/Valsartan?

Answer 34

Hypotension Hyperkalemia (from the ARB) COUGH and ANGIOEDEMA (increased bradykin)

Question 35

Diuretics to decrease mortality

Answer 35

spironolactone eplerenone aldosterone inhibition is beneficial

Question 36

Things that increase digitalis toxicity

Answer 36

1. Decreased renal clearance or volume of distribution: quinidine, amiodarone, captopril, verapamil, diltiazem, cyclosporine 2. Quinidine displaces digoxin from tissue binding sites 3. Increased digoxin GI absorption: erythromycin, omeprazole 4. Hypokalemia: thiazide/loop diuretics, diarrhea 5. Decreased SA/AV node activity: beta blockers 6. Myocardial sensitization to digoxin: NE releasing agents

Question 37

Monitor ______ when on digoxin therapy

Answer 37

PERFORM REGULAR EKGS, MEASURE K+ and DIGITALIS

Question 38

Isosorbide dinitrate is a...

Answer 38

precursor of nitric acid