03 Spring 2011 Chf/hf Extra Needed Stuff Final?

Front 1

(+) Inotrope

Back 1

Increase force of contraction

How?

Hint 1

An increase in intracellular calcium

Front 2

chronotropic effect

Back 2

rate of contraction

Front 3

dromotropic effect

Back 3

conduction velocity

Front 4

THIAZIDE
ADVERSE-REACTIONS
include:


H+

Back 4

ADVERSE-REACTIONS
from ( __class__?) Rxs include:

Hypokalemia
and
Intravascular Volume Depletion with resulting:
:
Hepatic Dysfunction-emia.
Hyperglycemia
Hyperuricemia
Neutropenia
Prerenal Azotemia
Skin Rash-emia.
Thrombocytopenia

Hint 4

9ct
1+1(+7) = 9

H
IVVD:
:
H D
H G
H U
N
P A
S R
T-C-P

Front 5

Positive Inotropic Drugs:

3ct

Back 5

Positive Inotropic Drugs:

-Digitalis
-Beta-Adrenoceptor Agonist ?
-Phosphodiesterase Inhibitors ?

Hint 5

Beta-Adrenoceptor Agonist (Dobutamine)
Phosphodiesterase Inhibitors. (Milrinone)

Front 6

Digitalis
Beta adrenoceptor Agonists (?)
Phosphodiesterase Inhibitors (?)

Positively
or
Negative
Inotropic drugs:

Back 6

Positive Inotropes

Beta adrenoceptor Agonists (Name ?)
Phosphodiesterase Inhibitors. (Name ?)

Hint 6

Beta adrenoceptor Agonists (Dobutamine)
Phosphodiesterase Inhibitors. (Milrinone)

Front 7

Digoxin
Produces Modest +/- inotrope effect

Back 7

Modest + inotrope effect
(increase force of contraction)

How

Hint 7

caused by an increase in intracellular calcium

Front 8

Digoxin
Produces a +/- chronotropic effect of contraction

Back 8

Produces a (-) chronotropic effect of contraction
(decreased rate)

Front 9

Digoxin
Produces a +/- dromotropic effect

Back 9

Produces a (-) dromotropic effect
(a decrease in the conduction velocity).

Front 10

Digoxin Toxicity S/S

6ct

Back 10

-Arrhythmias: are Most-Serious-Manifestations.
-Siezures

The earliest signs are :
-Anorexia
-Nausea
-Vomiting
-Blurred vision
-Chromotropsia Yellow Green or Blue

Front 11

Beta-blockers
prevent what cardiac issues from occurring?

8ct

Back 11

Prevent excessive-stimulation leading to:
:
Cardiac Remodeling
Dilatation
Hypertrophy
Increases O2 demand
Increases infarct size
RAAS Activation (renin-angiotensin-aldo-system)
Tachycardia
Ventricular wall thinning/rigidity

Hint 11

C
D
H
I
I
R
T
V

Front 12

These Rx sub catagories can cause

Reflex Tachycardia
2ct

Back 12

Nitrates
or
Dihydropyridine - CCBs.

They cause what?

Hint 12

Reflex Tachycardia

Front 13

Major contraindications for BB

3ct

Back 13

-Bradyarrhythmias

-Bronchospastic Disease (Severe)

-Decompensated Heart Failure.

Front 14

Digoxin Causes a decrease or increase in parasympathetic tone

Back 14

Causes an Increase

Front 15

Digoxin
Causes an increase or decrease in
conduction
and
AV node conduction velocity

Back 15

Decreases

Front 16

Digoxin Causes an increase or decrease in the
AV Node Refractory Period

Back 16

Increases the AV-Node Refractory Period.

Front 17

This drug is MOST HELPFUL in
Heart Failure(CHF) combined with
Atrial Fibralation.

Back 17

Digoxin



This drug is MOST HELPFUL in ?

Hint 17

Heart Failure(CHF)
combined with
Atrial Fibralation.

Front 18

the Dihydropyridine CCBs:
2ct

Back 18

the Dihydropyridine CCBs:
Amlodipine
Nifedipine

the NON-Dihydropyridine
CCBs: ?
2ct

Hint 18

the NON-Dihydropyridine CCBs:
Diltiazem
Verapamil

Front 19

Major -Contraindications for:

BB

3ct

Back 19

- Bradyarrhythmias
- (severe) Bronchospastic Disease
- Decompensated Heart Failure.

Name the BB?
2ct

Hint 19

Carvedilol/Metoprolol XL

Front 20

B-Blockers w\ Verapramil cause what?

Back 20

they significantly reduce
Cardiac Output.

What 2 Rxs do this?

Hint 20

B-Blockers w\ Verapramil

Front 21

Oraganic Nitrates\Nitrites
Release what?
&
have what effect on:
Vascular and Smooth Muscle Cells?

Back 21

release Nitric Oxide
in
vascular and smooth muscle cells

Relaxation

Front 22

Oraganic Nitrates\Nitrites have what effect on:

Venous Smooth Muscle?

Back 22

Relax venous smooth muscle

Front 23

Oraganic Nitrates\Nitrites have what effect on:

Arteriolar Smooth Muscle?

Back 23

Relax Venous Smooth Muscle
but
relatively small-to-little-effect on
Arteriolar Smooth Muscle.

ref+

Hint 23

Brenner 113 top Right

Front 24

Firstline Rx for Chronic Angina

Back 24

BB

Name the two?

Hint 24

Carvedilol

Metoprolol XL

Front 25

identify common adverse effects for
hydrochlorothiazide

Back 25

AEs =
hypokalemia,
electrolyte imbalances,
pH disturbance,
increase blood glucose, hyperuricemia (causing gout).

Front 26

identify common adverse effects for
furosemide

Back 26

AEs =
iuresis,
dehydration,
electrolyte imbalances.

Front 27

identify common adverse effects for

spironolactone

Back 27

AEs =
gynecomastia
impotence;
hyperkalemia.

Front 28

Describe the use of spironolactone as an aldosterone antagonist in patients with advanced HF

Back 28

Competes with aldosterone at the renal tubule and other tissues (heart).

Increase sodium excretion,

decrease potassium excretion,

has a moderate diuretic effect.
Potassium-sparing diuretic.

Prevents adverse effects of excessive aldosterone levels on the heart, and having high serum potassium.

Good for mild to moderate HF. Bad for elderly due to hyperkalemia.

Front 29

,
most commonly used
treatment of angina
describe
mechanism of action
Organic Nitrites & Nitrates

Back 29

increase total blood flow to heart, especially subendocardial tissue,

dilate collateral vessels, which decreases intraventricular pressure and decreases the resistance to perfusion.

Reduce wall tension via their effects on ventricular volume and pressure.

Act primary on venous tissue, and predominantly affect afterload.

Front 30

,
most commonly used
treatment of angina
describe
mechanism of action
Calcium Channel Blockers (CCBs):

Back 30

same Nitrites/Nitrates, but act on arteriolar muscle to reduce afterload.

Front 31

,
most commonly used
treatment of angina
describe
mechanism of action

Back 31

reduce intraventricular pressure. decrease heart rate & contractility

Front 32

(β-Blockers): are not used for
What?
&
Why?

Back 32

Not effective to tx
variant angina

because they cannot counteract vasospasm and increase coronary blood flow.

May actually reduce coronary blood flow by blocking the vasodilative effect of epinephrine.

Front 33

Describe why calcium channel blockers are generally avoided in patients with HF

Back 33

They suppress cardiac contractility

Front 34

beta-blockers ...concomitant conditions that may limit their use.

Back 34

NOT used in management of
vasospastic angina
or
acute anginal attacks.

Front 35

Ranolazine
Works
by

Back 35

modifying myocardial metabolism

What is another mechanical benifit?

Hint 35

reduces angina episodes without causing significant changes in
BP
or
Heart Rate

Front 36

platelet-inhibiting agents that are recommended for all patients with angina, unless contraindicated

Back 36

Aspirin
Clopidogrel