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 (B)</p> Signup and view all the answers

Why are potassium-sparing diuretics used in CHF treatment?

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

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

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

Which interaction might precipitate digitalis-related arrhythmias?

<p>Quinidine reducing digoxin binding (A)</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 (A)</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 (C)</p> Signup and view all the answers

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

<p>Digitoxin (B)</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 (B)</p> Signup and view all the answers

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

<p>Visual disturbances and severe bradycardia (A)</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 (A)</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 (B)</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 (A)</p> Signup and view all the answers

What interaction affects the absorption of Digoxin?

<p>Antacids reducing absorption (B)</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 (A)</p> Signup and view all the answers

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

<p>Dobutamine (A)</p> Signup and view all the answers

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

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

What role does hydralazine play in heart failure treatment?

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

Flashcards

Diuretics in Heart Failure

Drugs used to remove excess fluid from the body, particularly in patients with heart failure. They help reduce fluid overload, decrease pressure on the heart, and improve its efficiency.

High-Ceiling Diuretics

High-ceiling diuretics, like furosemide and bumetanide, are powerful drugs used to rapidly remove significant amounts of fluid in patients with severe heart failure.

Potassium-Sparing Diuretics

These diuretics, such as spironolactone, help remove fluid while preserving potassium levels, which is crucial for heart function.

Cardiotonics

Drugs that increase the force of the heart muscle's contraction, improving its ability to pump blood effectively.

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Cardiac Glycosides

Digoxin is a common example of a cardiac glycoside that is extracted from digitalis plants. It improves heart function by increasing its contractile force and slowing its rate.

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ACE Inhibitors in Heart Failure

ACE inhibitors like captopril, lisinopril, and enalapril, are essential in managing heart failure. They relax blood vessels, reduce pressure on the heart, and improve blood flow.

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Beta Blockers & Calcium Channel Blockers in Heart Failure

Drugs that slow down the heart rate, like propranolol, verapamil, and diltiazem, can be used in heart failure to improve rhythm and reduce oxygen demand.

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Digoxin Toxicity

Digoxin toxicity is a serious condition that can arise when too much digoxin is in the body. Symptoms may include nausea, vomiting, vision problems, and irregular heartbeats.

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What are diuretics used for in heart failure?

Diuretics are medications that remove excess fluid from the body, primarily used in heart failure to reduce fluid overload, decrease pressure on the heart, and improve its efficiency.

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What are high-ceiling diuretics used for?

High-ceiling diuretics, such as furosemide and bumetanide, are potent drugs used to rapidly remove significant amounts of fluid in patients with severe heart failure.

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What do potassium-sparing diuretics preserve?

Potassium-sparing diuretics, such as spironolactone, help remove fluid while preserving potassium levels, which is crucial for heart function.

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What are cardiac glycosides derived from?

Cardiac glycosides, such as digoxin, are extracted from digitalis plants and improve heart function by increasing its contractile force and regulating its rate.

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Why is digitoxin preferred over digoxin in renal failure?

Digoxin is a cardiac glycoside that is excreted by the kidneys, making it less suitable for patients with renal failure. Digitoxin is preferred in such cases as it is mainly excreted through the liver.

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What are the signs and treatment of digoxin toxicity?

Digoxin toxicity can be dangerous, presenting symptoms like nausea, vomiting, vision problems, and irregular heartbeats. Treatment involves stopping digoxin administration, giving antidotes like lidocaine, and managing any arrhythmias.

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What is the role of ACE inhibitors in heart failure?

ACE inhibitors, such as captopril, lisinopril, and enalapril, are crucial in managing heart failure. They relax blood vessels, reduce pressure on the heart, and improve blood flow.

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What are beta-blockers and calcium channel blockers used for in heart failure?

Beta-blockers like propranolol, verapamil, and diltiazem, can slow down the heart rate, improve rhythm, and reduce oxygen demand in heart failure patients.

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Vasodilators in acute heart failure

Vasodilators like glyceryl nitrate and hydralazine are used intravenously for rapid relief of acute left ventricular failure. They work by dilating blood vessels, lowering preload (the amount of blood in the heart before it contracts), and reducing strain on the heart.

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Hydralazine's role in heart failure

Hydralazine, a vasodilator, dilates resistance vessels, lowers aortic impedance, and promotes renal vasodilation. It is particularly beneficial for patients with mild to moderate heart failure with compromised renal function.

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Beta Blockers for Heart Failure

Beta-blockers, like bisoprolol and carvedilol, are used in heart failure to slow down the heart rate, reduce oxygen demand, and improve the heart's efficiency. They are often combined with ACE inhibitors, diuretics, and digoxin for optimal management.

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Cardiac Stimulants for Pump Failure

Cardiac stimulants like dopamine and dobutamine are potent drugs used in emergency situations of pump failure, like cardiogenic shock. They increase the force of heart contractions and improve blood flow, but require careful monitoring due to their strong effects.

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Dobutamine Role in Acute Heart Failure

Dobutamine, a relatively selective beta-1 agonist, is used in small doses for acute heart failure. Its positive inotropic effect improves heart contractions, while its vasodilating properties help with blood flow.

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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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