Cardiology Medications Quiz
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Questions and Answers

What are the effects of diuretics in congestive heart failure?

  • Increase heart rate
  • Increase circulating volume
  • Enhance survival without reducing edema
  • Decrease preload and improve ventricular efficiency (correct)

    • Which of the following is a cardiac glycoside used in CHF treatment?

  • Lisinopril
  • Digoxin (correct)
  • Spironolactone
  • Furosemide

    • What is one of the main actions of digitalis in cardiac treatment?

  • Inhibit calcium entry
  • Increase heart rate
  • Decrease myocardial contraction force
  • Increase the force of myocardial contraction (correct)

    • What is a common side effect of digitalis toxicity?

    <p>Visual disturbances</p> Signup and view all the answers

    Why are potassium-sparing diuretics used in CHF treatment?

    <p>They maintain potassium levels</p> Signup and view all the answers

    What is a primary function of ACE inhibitors in managing CHF?

    <p>Decrease vascular resistance</p> Signup and view all the answers

    Which interaction might precipitate digitalis-related arrhythmias?

    <p>Quinidine reducing digoxin binding</p> Signup and view all the answers

    How long does it take for Digoxin to reach its maximum effect after oral dosing?

    <p>6 hours</p> Signup and view all the answers

    What is a primary benefit of using diuretics in congestive heart failure?

    <p>Decrease preload and reduce circulating volume</p> Signup and view all the answers

    Which medication is recommended for patients with renal failure instead of Digoxin?

    <p>Digitoxin</p> Signup and view all the answers

    What is a characteristic of the therapeutic index of cardiac glycosides?

    <p>Low, which increases the risk of toxicity</p> Signup and view all the answers

    Which of the following is a side effect of digitalis toxicity?

    <p>Visual disturbances and severe bradycardia</p> Signup and view all the answers

    What is the role of potassium-sparing diuretics in the treatment of congestive heart failure?

    <p>Increase potassium levels to counteract hypokalemia</p> Signup and view all the answers

    What may be a consequence of diuretics causing hypokalemia in patients on digitalis?

    <p>Precipitation of digitalis arrhythmias</p> Signup and view all the answers

    Which class of medication is effective in improving survival in patients across all severities of heart failure?

    <p>ACE inhibitors</p> Signup and view all the answers

    What interaction affects the absorption of Digoxin?

    <p>Antacids reducing absorption</p> Signup and view all the answers

    What is the primary function of glyceryl nitrate in acute heart failure?

    <p>Provide rapid relief by lowering preload</p> Signup and view all the answers

    Which medication is primarily a β1 agonist used in acute heart failure?

    <p>Dobutamine</p> Signup and view all the answers

    What is a common initial dosing recommendation for carvedilol in heart failure treatment?

    <p>50 mg/day</p> Signup and view all the answers

    What role does hydralazine play in heart failure treatment?

    <p>Dilates resistance vessels to decrease aortic impedance</p> Signup and view all the answers

    What is the dosage range for dopamine when used in cardiogenic shock?

    <p>3-10 mcg/kg/min</p> Signup and view all the answers

    Study Notes

    Congestive Heart Failure (CHF) Medications

    • Diuretics: Used to treat almost all cases of symptomatic CHF, increasing urine output to reduce fluid buildup.
      • High Ceiling Diuretics (e.g., Furosemide, Bumetanide): Preferred for mobilizing edema fluids.
      • Potassium-Sparing Diuretics (e.g., Spironolactone): Enhance diuresis, maintain potassium levels, and improve CHF survival.
      • Mechanism of Action: Decrease preload, improve ventricular efficiency by reducing circulating volume, remove peripheral edema and pulmonary congestion.

    Cardiotonics (Cardiac Stimulating Drugs)

    • Cardiac Glycosides (e.g., Digoxin, Digitoxin, Ouabain): Derived from digitalis plants.
      • Mechanism of Action:
        • Increase myocardial contractility by stimulating calcium influx.
        • Decrease heart rate (bradycardia) by stimulating the vagal center in the CNS and inhibiting electrical conduction in the SA node.
      • Pharmacokinetics:
        • Low therapeutic index (narrow margin of safety).
        • Variable onset of effect after oral dose (digoxin = 6 hrs, digitoxin = 12 hrs).
        • Slow excretion (digoxin = 36 hrs, digitoxin = 150 hrs).
        • Digoxin excretion is kidney-dependent, crucial in renal failure; digitoxin preferred when kidney function is impaired.
        • Maintenance Doses (approximate): Digoxin (0.012-0.5 mg daily), Digitoxin (0.05-0.2 mg daily).
      • Side Effects: High toxicity potential including nausea, anorexia, vomiting, visual disturbances, headache, severe bradycardia, arrhythmias, and gynecomastia.
      • Treatment of Toxicity: Discontinue further doses, administer antidotes (lidocaine and phenytoin), give atropine to alleviate bradycardia, and consider beta-blockers (e.g., propranolol).
      • Drug Interactions: Diuretics can cause hypokalemia, potentially precipitating digitalis arrhythmias; potassium supplements may be given prophylactically. Quinidine reduces digoxin tissue binding. Calcium channel blockers (CCBs) like diltiazem and verapamil may increase calcium concentration, which can oppose digitalis' positive inotropic action. Propranolol, verapamil, and diltiazem may depress AV conduction, opposing the positive inotropic action of digoxin. Phenobarbital, and other enzyme inducers reduce digoxin absorption. Metoclopramide, antacids, and neomycin reduce digoxin absorption. Succinylcholine can cause arrhythmias in patients taking digitalis.

    ACE Inhibitors

    • ACE Inhibitors (e.g., Captopril, Lisinopril, Enalapril, Ramipril): Improves survival in all severities of heart failure.
      • Essential Information:
        • Start low, titrate up carefully.
        • Examples and approximate starting doses: enalapril (2.5 mg BID), captopril (6.25 mg TID), lisinopril (5 mg BID).
        • If not tolerated, consider Angiotensin Receptor Blockers (ARBs) like losartan.
      • Mechanism of Action: Inhibit the renin-angiotensin system, relieving symptoms by decreasing the stimulation of the system.

    Vasodilators

    • Used intravenously in acute heart failure
    • Glyceryl nitrate provides rapid relief in acute left ventricular failure and significantly lowers preload (used with strong diuretics)
    • Hydralazine: Dilates resistance vessels, reduces aortic impedance, and may cause renal vasodilation, potentially useful in renal insufficiency.

    Beta-blockers

    • Beta-2 blockers (primarily carvedilol) have shown benefit in mild to moderate CHF treated with standard ACE inhibitors, diuretics, and/or digitalis.
    • Starting doses are very low: carvedilol (50 mg/day), bisoprolol (10 mg/day), metoprolol (50 mg/day).

    Cardiac Stimulants

    • Dopamine and dobutamine increase contractility and dilate blood vessels, useful in emergency pump failure.
    • Dobutamine: Relatively selective beta-1 agonist, used in acute heart failure (2-8 mcg/kg/min).
    • Dopamine: Used in cardiogenic shock (acute heart failure) (3-10 mcg/kg/min).

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    Description

    Test your knowledge on medications used for Congestive Heart Failure (CHF) and cardiotonics. This quiz covers diuretics, cardiac glycosides, and their mechanisms of action. Understand the pharmacokinetics and therapeutic effects of these essential drugs in heart failure management.و

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