Treatment of HF

Question 1

Class I HF according to NYHA classification

Answer 1

No limitation of physical activity

Question 2

Class II HF according to NYHA classification

Answer 2

Slight limitation of physical activity
Comfortable at rest

Question 3

Class III HF according to NYHA classification

Answer 3

Marked limitation of physical activity

Question 4

Class IV HF according to NYHA classification

Answer 4

Unable to perform physical activity
Symptoms at rest

Question 5

Class I HF based on EF value

Answer 5

HF with LVEF of 40% or less

Question 6

Class II HF based on EF value

Answer 6

HF with LVEF of 41-49%

Question 7

Class III HF based on EF value

Answer 7

HF with LVEF of 50% or more

Question 8

Signs and symptoms of LHF

Answer 8

Dyspnea
Orthopnea
PND
Diaphoresis
Cool extremities
S3 heart sound

Question 9

Signs and symptoms of RHF

Answer 9

Fluid retention –> pitting edema, ascites, and hepatomegaly
JVD
Epistaxis

Question 10

General goals in treatment of HF

Answer 10

Increase contractility
Decrease preload and afterload
Reduce edema

Question 11

Direct effects of digoxin on the heart

Answer 11

Inhibits Na/K ATPase resulting in increased force of contraction and decreased conduction velocity at AV node

Question 12

Indirect effects of digoxin

Answer 12

Inhibition of neuronal Na/K ATPase activates cholinergic and sympathetic systems

Question 13

Result of activation of cholinergic and sympathetic systems on the heart from digoxin

Answer 13

Cholinergic –> decrease HR
Sympathetic –> increase contractility

Question 14

Positively inotropic drugs for HF

Answer 14

Digoxin
Sympathomimetic - adrenoceptor agonists
Phosphodiesterase inhibitors (bipyridines)

Question 15

Clinical used of digoxin

Answer 15

CHF
SVT, except in WPW

Question 16

Half-life of digoxin

Answer 16

24-36 hrs

Question 17

Drugs that displace digoxin

Answer 17

Amiodarone
Propafenone
Quinidine
Verapamil

Question 18

GI adverse effects of digoxin

Answer 18

Anorexia
N/V/D

Question 19

CNS adverse affects of digoxin

Answer 19

HA
Disorientation
Visual halos

Question 20

Is digoxin metabolized by liver or kidneys?

Answer 20

Kidneys

Question 21

CVS adverse effects of digoxin

Answer 21

PVCs
AV block
Sinus bradycardia
Inverted T waves on ECG

Question 22

Triggers of digitalis toxicity

Answer 22

Hypokalemia
Hypomagnesemia
Hypercalcemia

Question 23

Drugs that may cause digitalis toxicity if taken with digoxin

Answer 23

Loop and thiazide diuretics
Quinidine
Verapamil
NSAIDs
Amiodarone
Erythromycin

Question 24

Antidote for digitalis toxicity

Answer 24

DigiFab/digiband
Supportive therapy –> electrolytes and anti-arrhythmics

Question 25

Adrenoceptor agonists used in HF as inotropic drugs

Answer 25

Dobutamine Dopamine

Question 26

Phosphodiesterase inhibitors used in HF as inotropic drugs

Answer 26

Inamrinone Milrinone

Question 27

Mechanism of phosphodiesterase inhibitors used in HF

Answer 27

Inhibits PDE Increase cAMP to increase contractility Increase cGMP to cause vasodilation

Question 28

Clinical use of phosphodiesterase inhibitors

Answer 28

Short-term for CHF

Question 29

Adverse effects of phosphodiesterase inhibitors

Answer 29

Hypotension Thrombocytopenia --> inamrinone

Question 30

Vasodilators used in HF

Answer 30

ACE inhibitors Angiotensin receptor blockers (ARB) Hydralazine Isosorbide Nesiritide

Question 31

Aldosterone antagonists used in HF

Answer 31

Spironolactone Eplerenone

Question 32

Beta-adrenoceptors blockers used in HF

Answer 32

Carvedilol Metoprolol Bisoprolol

Question 33

Diuretics used in HF

Answer 33

Furosemide Bumetanide Torsemide

Question 34

ER combination treatment for HF

Answer 34

Sympathomimetic --> dobutamine Diuretic ACE inhibitor Ca channel blocker Beta blocker Nesiritide

Question 35

Diuretic proven to reduce mortality from HF when combined with ACE inhibitor

Answer 35

Spironolactone

Question 36

Drug indicated for use in acute decompensated HF

Answer 36

Dobutamine

Question 37

Recombinant B type natriuretic peptide used for HF

Answer 37

Nesiritide

Question 38

Mechanism of nesiritide

Answer 38

Increases cGMP --> smooth muscle relaxation Increase natriuresis --> decrease preload

Question 39

Clinical use of nesiritide

Answer 39

Relieve dyspnea at rest in severe decompensated CHF

Question 40

Group 1 WHO classification of pulmonary HTN

Answer 40

Idiopathic

Question 41

Group 2 WHO classification of pulmonary HTN

Answer 41

Secondary to LHF

Question 42

Group 3 WHO classification of pulmonary HTN

Answer 42

Secondary to hypoxemia of lung diseases

Question 43

Group 4 WHO classification of pulmonary HTN

Answer 43

Secondary to chronic thromboembolism

Question 44

Group 5 WHO classification of pulmonary HTN

Answer 44

Secondary to other causes not covered by first for classifications

Question 45

Management of pulmonary HTN

Answer 45

Treat underlying condition, if present Ca channel blocker

Question 46

Endothelin receptor antagonists used in pulmonary HTN

Answer 46

Bosentan (both ETa and ETb) Ambrisentan (ETa)

Question 47

Condition where use of endothelin receptor antagonist is contraindicated

Answer 47

Pregnancy

Question 48

Adverse effects of endothelin receptor antogonists

Answer 48

Hypotension Flushing

Question 49

PDE5 inhibitors used in pulmonary HTN

Answer 49

Sildenafil Tadalafil

Question 50

Mechanism of PDE5 inhibitors for pulmonary HTN

Answer 50

Increase cGMP to cause vasodilation

Question 51

Prostacyclin analogs used in pulmonary HTN

Answer 51

Epoprostenol (IV) Iloprost (inhaled) Treprostinil (inhaled)

Question 52

Oral soluble guanylate cyclase inhibitor used in pulmonary HTN and its effect

Answer 52

Riociguat --> vasodilation

Question 53

Drugs used for acute HF

Answer 53

Carvedilol Furosemide Dobutamine Lisinopril

Question 54

Newly approved drug for HF for use in pts with EF <35% and sinus rhythm with HR >70. Reduces hospitalization.

Answer 54

Ivabradine

Question 55

Mechanism of Ivabradine, used for HF

Answer 55

Inhibits F channels in SA node to decrease ions and reduce HR

Question 56

Combination drug with neprilysin inhibitor and ARB used in HF in place of ACE inhibitor or ARB.

Answer 56

Sacubritril/Valsartan

Question 57

Mechanism of sacubritil

Answer 57

Inhibits nephrilysin, an endopeptidase, to increase natriuretic peptide