(Cardiology) Pharmacology Of Heart Failure

Front 1

Which of these terms is used to denote systemic vascular resistance:

A. Chronotropy
B. Inotropy
C. Preload
D. Afterload

Back 1

D. Afterload

Front 2

Which of these terms is used to denote the intravascular volume:

A. Chronotropy
B. Inotropy
C. Preload
D. Afterload

Back 2

C. Preload

Front 3

Does blocking the Sodium-Potassium-ATPase pump increase or decrease the level of calcium inside a heart cell?

Back 3

Increases the amt of calcium

Front 4

Dysregulation of calcium homeostasis, changes in regulation and expression of contractile proteins, and alterations in beta adrenoceptor signaling transduction pathways are all associated with what?

Back 4

Decrease in cardiac contractility

Front 5

As heart cells fail, what happens to the number of beta receptors?

Back 5

They decrease due to a bombardment of chatecolamines.

Front 6

What are the 3 goals for pharmacologic therapy of heart failure?

Back 6

Improve symptoms
Slow / reverse deterioration of myocardial function
Reduce mortality

Front 7

Digoxin is not recommended as a first line drug for the treatment of heart failure - especially of patients with a NYHA class I or II - unless there is what condition attached?

Back 7

Atrial fibrillation

Front 8

Does digoxin make you pee more or less? Why or why not?

Back 8

May make you pee a little more as it inhibits re-absorption of Na+ at the kidney.

Front 9

Review: Digoxin is used to treat which arrhythmias?

Back 9

It is use to slow ventricular rate (<100 bpm) in atrial flutter / fibrillation

However, these are used as a second line drug (calcium channel blockers are used more commonly)

Front 10

In general, how would you describe the therapeutic window of digoxin?

Back 10

It's crappy

Front 11

What are the most common type of side effects reported with Digoxin?

A. GI problems
B. Cardiac problems
C. CNS (including halos around lights)

Back 11

A.

Front 12

(T/F) Digoxin can cause pretty much any abnormal brady or tachydysrhythmia - except atrial fibrillation with rapid ventricular response

Back 12

True

Front 13

When it comes to heart failure medications, what do these 3 classes of drugs have in common:

Cardiac glycosides
Beta adrenergic receptor agonists
Phosphodiesterse inhibitors

Back 13

These all increase cardiac contractility

(You probably had to be reading my mind to get it right)

Front 14

Which drug can cause CNS side effects that include seeing yellow halos around lights?

Back 14

Digoxin

Front 15

This drug is an IV infusion used in acute decompensated heart failure. It has an extremely short half life. Adverse effects are rare at therapeutic doses but include atrial and ventricular dysrhythmias and myocardial ischemia

Back 15

Dobutamine

Front 16

This class of drugs increases contractility by raising the level of cAMP which in turn helps to raise the amount of calcium in the sarcoplasmic reticulum.

Front 17

The primary therapeutic goal of diuretic use is to reduce the edema by reducing the extra cellular fluid volume.

In terms of the heart, will this reduce preload or afterload?

Back 17

Preload

Front 18

Which part of the nephron do loop diuretics work?

Back 18

Well they're called loop diuretics for a reason…

They work on the thick ascending loop and the loop of henle

Front 19

Furosemide and bumetanide are two front-line drugs in this class: (be specific)

Back 19

LOOP Diuretics

Front 20

What's the generic name for Lasix? What class is it in?

Back 20

Furosemide - Loop diuretics

Front 21

What is the side effect that we have to know for loop diuretics?

Back 21

Hypokalemia

Front 22

Spironolactone antagonizes ______

Back 22

Aldosterone

Front 23

In which location of the nephrons do potassium sparing diuretics work?

Back 23

Collecting tubules

Front 24

Which class of diuretics was the only one shown to improve survival in NYHA class III and IV

Back 24

Potassium sparing diuretics

Front 25

Nitric oxide donors, ACE inhibitors, ARBs, and to a lesser extent, beta blockers, hydralzine, and Nesiritide, all work on improving which of the following:

A. Contractility
B. Vascular tone
C. Volume control

Back 25

B. Vascular Tone

Note that a few of the drugs listed can also be classified based on their other functionalities

Front 26

Nitric oxide donors increase _______ leading to vasodilatation

Back 26

cGMP

Front 27

At therapeutic doses, nitric oxide donors work on venules reducing ______ (preload/afterload) reduction, while at higher doses, they work on arterials leading to ______ (preload/afterload) reduction

Back 27

At lower doses they work on venules to reduce PRELOAD while at higher doses they work on arteries to reduce AFTERLOAD.

Front 28

What is the most common side effect of nitroglycerin?

Back 28

Headache

Other less common side effects include dizziness, lightheadedness, and hypotension

Front 29

Which N.O. donor is often used to treat hypertensive emergencies?

Back 29

Sodium NTROPRUSSIDE

Front 30

What is the toxic intermediate produced by sodium nitroprusside that can be very deadly? Luckily the intermediate is quickly cleared.

Back 30

Cyanide

The liver quickly clears it to thiocyanate.

Front 31

This class of drug inhibits angtiotensin II, arteriolar vasoconstriction, salt reabsorption, and antidiuretic hormone release

It also inhibits bradykinin metabolism

Back 31

ACE inhibitors

Front 32

Do bradykinins vaso-dilate or vaso-constrict?

Back 32

Vaso-dilate

Front 33

When you see the suffix -pril which class of drugs are you thinking?

Back 33

ACE inhibitors

Front 34

(T/F) ACE inhibitors are often used as first-line drugs in heart failure because they improve survival In heart failure

Back 34

True

Front 35

When you see the side effects, cough, angioedema, and hypotension, what drug class is screaming at you?

Back 35

ACE inhibitors

Front 36

What can happen if you mix potassium sparing diuretics with ACE inhibitors

Back 36

Hyperkalemia

Front 37

Which causes less cough, ACE inhibitors or Angiotensin II receptor blockers?

Which affects bradykinin metabolism more?

Back 37

ACE inhibitors produce more coughs, but they inhibit bradykinin metabolism

Front 38

What are the two most common angiotensin II receptor blockers?

Back 38

Losartan and Valsartan

Front 39

This drug is often used with nitrates in heart failure for those patients who cannot tolerate ACE inhibitors.

Back 39

Hydalazine

(Actually this combo can improve survival)

Front 40

Does hydalazine dilate arterioles or venules

Back 40

Arterioles

Front 41

This key side effect of this drug is drug-induced lupus rythermatosus (although the side effect is very uncommon - hypotension is actually the most common side effect for this one)

Back 41

Hydalazine

Front 42

What are natriuretic peptides? Which is the most common type released by ventricles?

Back 42

natriuretic peptides are hormones released by atria ventricles, and vasculature. They are released in response to increased intravascular volume

BNP (B-type) is released by ventricles

Front 43

Nesiritide is related to which type of hormones

Back 43

Natriuretic peptides (specifically BNP)

Front 44

This class of drugs seems counter-intuitive to use in HF patients because it actually lowers inotropy and chronotropy

Back 44

Beta blockers

Front 45

Which class of drugs is good to use to prevent a secondary acute coronary event?

Back 45

Beta blockers

Front 46

Are beta-blockers used more often as acute therapy or long-term therapy?

Back 46

Long term!

It takes several months to work

Front 47

…lol

Back 47

Beta blockers