Pharm Heart Failure Med

Question 1

What BB is used for Hf

Answer 1

Metoprolol succinate
Bisoprolol
Carvedilol

Question 2

True or false is metoprolol succinate superior to metoprolol tartrate?

Answer 2

True metoprolol succinate is superior to metroprolol tartrate

Question 3

What are three adverse effects with beta blockers on heart failure

Answer 3

Bradycardia
Worse heart failure if dose is titrated up too high
Respiratory issues

Question 4

Ivabradine when to use in therapy ?

Answer 4

Place in therapy is patient is on Max dose of Bb and heart rate is still high above 70 beats per minute

Question 5

What is ivabradine mechansim of action

Answer 5

Inhibit SA node, slows heart rate but has no effect on inotrophic activity,

Question 6

Besides coronary artery disease what are other causes that increase risk for developing, HF ?

Answer 6

Hypertension, hyperthyroid, smoking, obesity, pregnancy

Question 7

Presentation of heart failure signs and symptoms

Answer 7

Shortness of breath
Dyspnea,on exertion
Ascites,
Hepatomegaly
Peripheral edema

Question 8

Which heart failure is due to a problem with ejection of blood to the lungs or systemic circulation?

Answer 8

Heart failure with reduced ejection failure

Result of dilation and hypertrophy

Question 9

What is preserved heart failure

Answer 9

Inability for heart to fill appropriately
Tx is not well definite
Usually results from stiffness of myocardium

Question 10

What are the four mortality reducing agents in heart failure

Answer 10

Ace, arb , ENTRESTO
Bb
Aldosterone blocker agent, spironolactone
Hydralizine for African Americans

(Also work to reduce morbidity)

Question 11

Which drugs work to reduce morbidity

Answer 11

Digoxin
Loop, diuretic, furosemide (careful monitor electrolytes)

Question 12

What is treatment for a patient in stage B (structural disease no symptoms of heart failure) class 1

Answer 12

Ace or arb, and BB

Question 13

Stage c acc guideline for heart failure

Answer 13

Stage C class 1-4
Always ARNI, ace, arb, bb, diuretic if needed

Class 2-4 getting groceries sob
Add spironolactone
If black, class 3- hydralyzine
4 meds
Entrestro,
SGLT2 with and without dm
spitonllactone

Hydralizine, if African American (class 3/4)

Question 14

Ace and arbs mechanism of action

Answer 14

Interfere with RAAS and disrupt angiotensin 2
Reduce sodium and water retention

Question 15

Is ace or arbs preferred for heart failure

Answer 15

Ace are recommends, no efficacy difference but cost differs

Question 16

Ace and arbs contraindicated with

Answer 16

Pregnancy
Angioedema
Hyperkalemia
Renal artery stenosis

Question 17

How long must u wait before switching from an ace to entresto ? and why?

Answer 17

Must wait 36 hours after last dose of ace inhibitor

Must wait this long to reduce risk of Angioedema which is increased when ace and neprisylin are combined together

Question 18

Beta blocker target goal

1. Metoprolol succinate, goal is ____mg/day
2. Bisoprolol= ___mg per day
3. Carvedilol,=___mg twice daily

Answer 18

1. 200 mg
2. 10 mg
3. 25 mg twice daily

Question 19

When to add on spirnolactone or Eplerone

Answer 19

If stage C and D heart failure but still symptomatic, despite max ace/arb or ARNI and bb

Question 20

Hydralizine moa

Answer 20

Direct arterial vasodilation
Vasodilation in coronary, and renal arteries

Question 21

Isorbide dinitrate is a direct ____, converts into _____

Answer 21

Venodilator
Nitric acid

Question 22

Hydralizine and isosorbide dinitrate, used for what patients

Answer 22

African American pts,

They don’t respond to ace as well as Caucasian due to low renin

Question 23

Loop diuretic moa

Answer 23

Active transport of sodium and water , cause excretion of water and sodium
Work on loop of henle

Question 24

Loop diuretic may require higher than usual dose in pts who have ____

Answer 24

Renal failure

Question 25

Loop diuretics when are they used ?

Answer 25

In a pt who has symptomatic heart failure (C or D)

Question 26

Electrolyte imbalance with loop

Answer 26

Hyperglycemia Hyperuricemia Hypokalemia Hypomagnesium

Question 27

Digoxin mechanisms of action

Answer 27

Positive inotropic activity, and negative chronotropic activity, increase in the force of contraction, (increase sodium and calcium intracellular) Increases force of contraction

Question 28

Digoxin normal dose with normal renal function In pt with renal insufficient or elderly

Answer 28

0.125 a day .125 every other day

Question 29

Hypokalemia ____ effects of digoxin

Answer 29

Increases

Question 30

Hyperkalemia ____ effects of digoxin

Answer 30

Decreases

Question 31

SGLT2 meds

Answer 31

Dapagliflozin Empagliflozin

Question 32

SGLT2i mechansim of action

Answer 32

SGLT2 found in kidneys, reabsorbs glucose, SGLT2i prevent reabsorption result in glucose excretion in kidneys

Question 33

Diastolic heart failure x Tx

Answer 33

Focus on treatment for Comorbities Initiate SGLT2i, and entresto

Question 34

SGLT2 trial what was the outcome

Answer 34

1out of 20 benefiting and prevent heart failure risk

Question 35

Digoxin causes what disturbances in electrolyte

Answer 35

Hypomagnesium Hypokalemia

Question 36

Most common side effect of digoxin

Answer 36

GI disturbances. ,

Question 37

You have a patient who is on max dose of beta blocker, and lisinopril, furosemide and spironolactone, his heart rate is elevated at 80 and he has fatigue and Dyspnea what medication would u want to add on

Answer 37

Ivabradine On max beta blocker and heart rate remains over 70

Question 38

John 68 year old male with sob confirmed heart failure ef at 30% currently on carvedilol and ARNI and spironolactone what other meds would I want to add?

Answer 38

Want to add on loop and SGLT2 Class c now cuz having more symptoms

Question 40

Digoxin is most likely to cause toxicity in which population?

Answer 40

Elderly because they have smaller volume of distribution