Heart Failure Non-Drug Therapy
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Questions and Answers

What effect does increased intracellular Na+ have on Ca2+ movement in cells?

  • Has no effect on Ca2+ movement
  • Enhances Ca2+ efflux from the cell
  • Prevents Ca2+ efflux from the cell (correct)
  • Stimulates Ca2+ influx into the cell

    • Which mechanism leads to increased vagal activity?

  • Release of catecholamines
  • Direct and indirect mechanisms (correct)
  • Hypoxia-induced sympathetic activation
  • Increased oxygen consumption in tissues

    • What is a key pharmacological effect associated with increased contractility?

  • Improvement of renal blood flow (correct)
  • Reduced renal blood flow
  • Increased systemic vascular resistance
  • Decreased tissue oxygenation

    • What does increased vagal tone primarily contribute to in cardiac function?

    <p>Decreased heart rate (bradycardia)</p> Signup and view all the answers

    Which statement is true regarding conduction velocity in the heart?

    <p>It is decreased by direct vagal effects</p> Signup and view all the answers

    What is the consequence of increased automaticity in the heart?

    <p>Increased risk of ectopic foci and arrhythmias</p> Signup and view all the answers

    How does relief of lung congestion primarily occur?

    <p>Increased contractility of the heart</p> Signup and view all the answers

    Which lifestyle modification is NOT recommended for heart failure management?

    <p>Increasing fat intake</p> Signup and view all the answers

    What is a characteristic feature of cardiac glycosides?

    <p>Contain a lactone ring and steroid moiety</p> Signup and view all the answers

    What incorrect assumption might someone make about the effects of increased vagal activity?

    <p>It can increase sympathetic activity</p> Signup and view all the answers

    Which of the following medications is NOT classified as a positive inotropic drug?

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

    Which of the following conditions would be essential to control in heart failure therapy?

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

    Which type of drug is primarily used for short-term treatment in heart failure?

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

    What is a common adverse effect of using sympathomimetics in heart failure therapy?

    <p>Increased blood pressure</p> Signup and view all the answers

    Which of the following therapies is recommended for the management of heart failure?

    <p>Alcohol moderation</p> Signup and view all the answers

    Which compound is known as the most widely used cardiac glycoside?

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

    What is the effect of digitalis in patients with acute myocardial infarction?

    <p>It increases infarct size and aggravates arrhythmias.</p> Signup and view all the answers

    In which condition should digoxin be avoided?

    <p>Renal disease.</p> Signup and view all the answers

    What should be prioritized before using digitalis in patients with pulmonary hypertension?

    <p>Correcting pulmonary hypertension.</p> Signup and view all the answers

    What effect do antacids like Kaolin have on digoxin absorption?

    <p>They bind digoxin in the gut and decrease its bioavailability.</p> Signup and view all the answers

    Which drug decreases the renal clearance of digoxin?

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

    What is the consequence of using digitalis before cardioversion in susceptible patients?

    <p>It can lead to fatal arrhythmias.</p> Signup and view all the answers

    In the context of hepatic dysfunction, which drug should be avoided?

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

    What effect does Metoclopramide have on digoxin absorption?

    <p>It decreases digoxin absorption by increasing gut motility.</p> Signup and view all the answers

    What condition can increase the binding and effect of digoxin?

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

    Which of the following is considered an extracardiac manifestation of digoxin toxicity?

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

    What is a recommended initial management step for digoxin toxicity?

    <p>Stop digitalis administration</p> Signup and view all the answers

    Which symptom is NOT commonly associated with digoxin toxicity?

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

    Which drug is used for ventricular arrhythmia associated with digoxin toxicity?

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

    What visual disturbance may occur due to digoxin toxicity?

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

    In the management of digoxin toxicity, which corrective action is primarily aimed at addressing hypokkalemia?

    <p>Administer oral potassium</p> Signup and view all the answers

    Which of the following is NOT a cardiac manifestation of digoxin toxicity?

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

    What is a potential consequence of using loop diuretics and thiazides together?

    <p>Hypokalemia and hypomagnesemia raising digitalis toxicity risk</p> Signup and view all the answers

    Which dosage method is appropriate for emergency conditions requiring rapid digitalization?

    <p>Two tablets (0.5 mg) twice daily for 2 days</p> Signup and view all the answers

    What precaution should be taken before administering intravenous digitalis?

    <p>Confirm the patient has not received digoxin in the last 14 days</p> Signup and view all the answers

    What is the maintenance dose of digitalis after initial digitalization?

    <p>One tablet (0.25 mg) daily, 5 days per week</p> Signup and view all the answers

    What factor can influence the time to reach steady state for digoxin levels?

    <p>The half-life of digoxin</p> Signup and view all the answers

    What is a possible risk when managing potassium levels during digitalis therapy?

    <p>Decreased potassium levels can lead to digoxin toxicity</p> Signup and view all the answers

    What is the recommended frequency of monitoring plasma K+ levels during digitalis therapy?

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

    What is the role of magnesium in digitalis therapy?

    <p>Low levels can increase risk of digitalis toxicity.</p> Signup and view all the answers

    Positive inotropic drugs primarily decrease the strength of heart contractions.

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

    Sodium restriction is not recommended as a lifestyle modification for heart failure management.

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

    Cardiac glycosides are derived from the Foxglove plant and contain a lactone ring.

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

    Dopamine and dobutamine are used for long-term treatment of heart failure.

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

    Monitoring dietary fat intake is an effective strategy to manage heart failure.

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

    Spironolactone is classified as a vasodilator in heart failure therapy.

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

    Avoiding stress, smoking, and alcohol is a recommended lifestyle modification for heart failure.

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

    Hydralazine is classified as a diuretic in the treatment of heart failure.

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

    Hypokalemia decreases the binding and effect of digoxin.

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

    Bradycardia is a common cardiac manifestation of digoxin toxicity.

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

    Visual disturbances such as yellow vision are unrelated to digoxin toxicity.

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

    Diarrhea, nausea, and vomiting can occur due to stimulation of the central trigger zone in digoxin toxicity.

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

    The first manifestation of digoxin toxicity is usually bradycardia.

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

    Atropine can be administered to manage tachycardia resulting from digoxin toxicity.

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

    Renal impairment can enhance the effects of digoxin, leading to toxicity.

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

    Correcting hypokalemia involves administering potassium supplements to the patient.

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

    Digitalis can be safely administered to patients with acute myocardial infarction without any effects.

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

    The use of digitalis in patients with cardiomyopathy is generally considered effective.

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

    Antacids like Kaolin decrease the bioavailability of digoxin by binding it in the gut.

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

    Quinidine increases the renal clearance of digoxin, making it safer to use concurrently.

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

    Metoclopramide increases gut motility, which can lead to reduced absorption of digoxin.

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

    In patients with hepatic disease, digoxin should be avoided while digoxin is acceptable.

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

    Loop diuretics and thiazides can increase the risk of digitalis toxicity due to hypomagnesemia.

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

    Digitalis can lead to fatal arrhythmias if used shortly before cardioversion.

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

    Atropine, by decreasing gut motility, leads to an increase in digoxin absorption.

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

    The rapid loading method for digitalis administration involves giving two tablets of 0.5 mg three times daily for two days.

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

    Initial digitalization for digoxin is achieved after three half-lives of the drug.

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

    It is safe to administer intravenous digitalis if the patient has received digoxin within the last week.

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

    The maintenance dose of digitalis is one tablet of 0.25 mg, taken five days a week.

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

    Continuous monitoring of plasma K+ levels is a precaution during digitalis therapy due to the risk of hyperkalemia.

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

    The initial digitalization dose for digoxin is 0.5 mg administered once daily for 5 days.

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

    Serum digoxin levels should be monitored regularly to assess for potential toxicity during treatment.

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

    Inamrinone and milrinone are both long-term treatment options for congestive heart failure.

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

    Phosphodiesterase inhibitors, like inamrinone, increase cAMP levels which leads to increased calcium influx in myocardial cells.

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

    Milrinone is considered more toxic than inamrinone.

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

    Increased liver enzymes are a potential adverse effect of using PDE inhibitors in heart failure therapy.

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

    Digitalis therapy is commonly effective in patients with severe cardiac arrhythmia.

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

    Positive inotropic drugs like PDE inhibitors do not possess vasodilator properties.

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

    What is the relationship between increased intracellular Na+ and cardiac contractility?

    <p>Increased intracellular Na+ enhances cardiac contractility by promoting Ca2+ influx through the Na+/Ca2+ exchanger.</p> Signup and view all the answers

    What are the ECG changes typically associated with digoxin use?

    <p>Prolonged PR interval, short QT interval, ST segment depression, and T-wave inversion.</p> Signup and view all the answers

    How does increased vagal activity affect heart rate and conduction?

    <p>Increased vagal activity leads to a decrease in heart rate (bradycardia) and a reduction in A-V conduction velocity.</p> Signup and view all the answers

    In which situations is digoxin primarily indicated for use?

    <p>Chronic CHF associated with atrial flutter or fibrillation.</p> Signup and view all the answers

    What are the consequences of improved renal blood flow (RBF) in heart failure?

    <p>Improved RBF promotes diuresis and decreases the renin-angiotensin-aldosterone system (RAAS) activity, reducing fluid retention.</p> Signup and view all the answers

    Name one absolute contraindication for the use of digoxin.

    <p>Heart block.</p> Signup and view all the answers

    Describe how the autonomic nervous system responds to hypoxia in relation to sympathetic activity.

    <p>During hypoxia, sympathetic activity decreases due to improved tissue oxygenation and increased vagal activity.</p> Signup and view all the answers

    Which condition poses a relative contraindication to digoxin due to bradycardia?

    <p>Sick sinus syndrome.</p> Signup and view all the answers

    What is the impact of systemic hypertension on the use of digoxin?

    <p>It can increase the strain on the left ventricle, necessitating prior correction of hypertension.</p> Signup and view all the answers

    What effect does vagal stimulation have on ectopic foci in the heart?

    <p>Vagal stimulation increases excitability and automaticity, leading to potential ectopic foci and arrhythmias.</p> Signup and view all the answers

    Which mechanisms lead to the relief of lung congestion in heart failure management?

    <p>Relief of lung congestion is achieved through increased contractility and improved renal blood flow, promoting fluid excretion.</p> Signup and view all the answers

    How does digoxin affect ventricular tachycardia?

    <p>Digoxin can increase excitability and automaticity, worsening the tachycardia.</p> Signup and view all the answers

    What is the consequence of using digoxin in patients with Wolff-Parkinson-White syndrome?

    <p>It can lead to increased conduction in the abnormal pathway, raising the risk of arrhythmias.</p> Signup and view all the answers

    How does digitalis influence A-V conduction in the heart?

    <p>Digitalis inhibits A-V conduction through direct effects and increases vagal tone, potentially leading to bradycardia.</p> Signup and view all the answers

    What adverse effect on heart rhythm is associated with increased automaticity?

    <p>Increased automaticity can lead to the development of arrhythmias, such as ectopic beats and other rhythm disturbances.</p> Signup and view all the answers

    Which two classes of medications are preferred over digoxin for managing atrial fibrillation alone?

    <p>Verapamil and beta-blockers.</p> Signup and view all the answers

    What should be done before administering digitalis to a patient with pulmonary hypertension?

    <p>Pulmonary hypertension must be corrected first by giving vasodilators.</p> Signup and view all the answers

    Why is digitalis ineffective in patients with cardiomyopathy?

    <p>Digitalis is considered useless in the treatment of cardiomyopathy.</p> Signup and view all the answers

    What is the consequence of administering digitalis to a patient with acute myocardial infarction?

    <p>Digitalis increases infarct size and may aggravate arrhythmias.</p> Signup and view all the answers

    In which patient population should digoxin be avoided due to renal impairment?

    <p>Digoxin must be avoided in patients with renal diseases.</p> Signup and view all the answers

    How do antacids such as Kaolin affect the bioavailability of digoxin?

    <p>Antacids bind digoxin in the gut and decrease its bioavailability.</p> Signup and view all the answers

    What effect does quinidine have on digoxin levels in the body?

    <p>Quinidine decreases renal clearance and displaces digoxin from plasma proteins.</p> Signup and view all the answers

    What is the potential risk of administering digitalis prior to cardioversion?

    <p>Digitalis may lead to fatal arrhythmias if given before cardioversion.</p> Signup and view all the answers

    What is the effect of Metoclopramide on the absorption of digoxin?

    <p>Metoclopramide increases gut motility, leading to decreased digoxin absorption.</p> Signup and view all the answers

    What is the primary mechanism through which PDE inhibitors like Inamrinone function in myocardial cells?

    <p>PDE inhibitors increase cAMP levels, leading to increased Ca2+ influx and enhanced myocardial contractility.</p> Signup and view all the answers

    Why are PDE inhibitors not recommended for long-term use in heart failure treatment?

    <p>They can cause significant adverse effects, including thrombocytopenia, arrhythmias, and hepatotoxicity.</p> Signup and view all the answers

    How do specific digitalis antibodies assist in treating heart failure?

    <p>They bind to digitalis, promoting its renal clearance and reducing its toxic effects.</p> Signup and view all the answers

    What distinguishes Milrinone from Inamrinone regarding toxicity?

    <p>Milrinone is considered less toxic than Inamrinone.</p> Signup and view all the answers

    What impact do PDE inhibitors have on vascular dynamics?

    <p>They possess vasodilatory properties, contributing to improved hemodynamics in heart failure management.</p> Signup and view all the answers

    In what context should PDE inhibitors be administered intravenously?

    <p>They should be used for short-term treatment in patients with CHF who do not respond to digitalis.</p> Signup and view all the answers

    What is the initial digitalization dose of digoxin?

    <p>0.25 mg/day for 5 days a week.</p> Signup and view all the answers

    How long does it take to achieve steady state (Cpss) for digoxin?

    <p>After one week or 5 half-lives.</p> Signup and view all the answers

    What is the rapid loading method for digitalization in emergencies?

    <p>2 tablets (0.5 mg) twice daily for 2 days.</p> Signup and view all the answers

    What is the importance of monitoring plasma K+ levels during digitalis therapy?

    <p>To prevent digoxin toxicity due to hypokalemia.</p> Signup and view all the answers

    Why should intravenous digitalis not be given if the patient received it in the last 14 days?

    <p>To avoid the risk of digitalis toxicity.</p> Signup and view all the answers

    What is the maintenance dose of digitalis after the initial digitalization?

    <p>One tablet (0.25 mg) per day, 5 days a week.</p> Signup and view all the answers

    What side effects can loop diuretics and thiazides cause that increase digoxin toxicity risk?

    <p>Hypokalemia and hypomagnesemia.</p> Signup and view all the answers

    List one relative contraindication for digitalis therapy.

    <p>Existence of severe renal impairment.</p> Signup and view all the answers

    Increased intracellular Na+ prevents Ca2+ ______ from the cell by the Na/Ca2+ exchanger.

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

    ↑ Contractility and COP are due to the ______ inotropic effect.

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

    Relief of lung ______ is one of the effects resulting from increased contractility.

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

    Bradycardia is due to ↑ vagal tone and ↓ ______ activity on the heart.

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

    Conducting system changes include ↑ intra atrial conduction velocity due to ______ stimulation.

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

    Increased automaticity can lead to ectopic foci and ______ of any type.

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

    The improvement of renal blood flow (RBF) contributes to ______ and ↓ RAAS.

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

    A-V conduction is decreased due to direct and ______ effects.

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

    Cardiac glycosides, such as ______, are derived from the Foxglove plant.

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

    Positive inotropic drugs improve heart ______.

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

    Lifestyle modifications for heart failure include dietary sodium ______.

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

    Avoidance of ______ is crucial in managing heart failure and reducing stress.

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

    Drugs such as ______ and dobutamine are used for short-term treatment of heart failure.

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

    Nitrates and hydralazine are classified as ______ in heart failure therapy.

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

    ACEIs are a common class of ______ used in the treatment of heart failure.

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

    Controlling risk factors in heart failure may include surgical correction of ______ diseases.

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

    Loop diuretics and thiazides may cause hypo______emia and hypomagnesemia.

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

    Initial digitalization is achieved by giving one tablet of 0.25 mg per day for ______ days/week.

    <p>5</p> Signup and view all the answers

    The Cs[subscript]s will be achieved after 5 ______ (i.e. after one week for digoxin).

    <p>t½</p> Signup and view all the answers

    In emergency conditions, rapid digitalization is achieved by giving 2 tablets of 0.5 mg ______ daily for 2 days.

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

    The maintenance dose of digitalis is one tablet of ______ mg per day, 5 days a week.

    <p>0.25</p> Signup and view all the answers

    Continuous monitoring of plasma ______+ level is essential during digitalis therapy.

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

    Never give digitalis intravenously without being sure that the patient has not received it during the last ______ days.

    <p>14</p> Signup and view all the answers

    Precautions during digitalis therapy include mentioning all the relative ______ conditions.

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

    Hypokalemia increases digoxin ______ and effect.

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

    The first manifestation of digoxin toxicity is ______ and anorexia.

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

    Lidocaine is used for ______ arrhythmia in digoxin toxicity.

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

    A common extracardiac manifestation of digoxin toxicity is ______ vision.

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

    Digoxin administration should be stopped to manage ______ toxicity.

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

    Hypocalcemia makes digitalis ______ effective.

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

    The management of digoxin toxicity includes correcting ______ by giving K+.

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

    Antiarrhythmic drugs may be needed for any type of ______ associated with digoxin toxicity.

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

    The use of digoxin is now limited to cases of chronic CHF associated with atrial ______ or fibrillation (AF).

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

    Absolute contraindications for digoxin include heart block and hypertrophic obstructive ______.

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

    Addition of digoxin can lead to severe bradycardia or even heart ______.

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

    Digitalis can increase the strain of the left ventricle in cases of systemic ______.

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

    In cases of atrial fibrillation alone, other drugs like ______ or beta-blockers are preferred.

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

    Wolff-Parkinson-White (WPW) syndrome can lead to increased ______ in the abnormal pathway with digitalis.

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

    Acute worsening of heart failure may occur when digoxin is used in patients with HOCM due to increased cardiac ______.

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

    Relative contraindications for digoxin include all causes of ______ due to the risk of worsening symptoms.

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

    Match the following lifestyle modifications with their respective benefits for heart failure management:

    <p>Dietary sodium restriction = Reduces fluid retention Weight reduction = Decreases cardiac workload Stress avoidance = Minimizes sympathetic stimulation Alcohol reduction = Prevents blood pressure increase</p> Signup and view all the answers

    Match the following cardiac medications with their primary category:

    <p>Digoxin = Cardiac glycoside Dopamine = Positive inotropic drug Hydralazine = Vasodilator Furosemide = Diuretic</p> Signup and view all the answers

    Match the following pharmacological agents with their therapeutic effects:

    <p>Nitrates = Vasodilation Spironolactone = Potassium-sparing diuretic Milrinone = Inotropic support ACE inhibitors = Blood pressure reduction</p> Signup and view all the answers

    Match the following symptoms of digoxin toxicity with their corresponding manifestations.

    <p>Visual disturbances = Yellow-green halos Bradycardia = Slow heart rate Nausea = Gastrointestinal upset Confusion = Neurological impairment</p> Signup and view all the answers

    Match the following conditions with their recommended treatments in heart failure:

    <p>Hyperthyroidism = Medications to manage hormone levels Hypertension = Antihypertensive agents Valvular diseases = Surgical correction Congestive heart failure = Positive inotropic drugs</p> Signup and view all the answers

    Match the following drugs with their mechanism of action:

    <p>Diuretics = Increase urine output Beta-blockers = Reduce heart rate Phosphodiesterase inhibitors = Increase intracellular cAMP ACE inhibitors = Block angiotensin II formation</p> Signup and view all the answers

    Match the following cardiac glycosides with their specific sources:

    <p>Digoxin = Foxglove plant derivatives Digitoxin = Plant-based origin Ouabain = Extracts from African plants Lanoxin = Formulated digoxin preparation</p> Signup and view all the answers

    Match the following side effects with their respective drug categories:

    <p>Hypokalemia = Diuretics Worsened renal function = ACE inhibitors Tachycardia = Sympathomimetics Gastrointestinal distress = Cardiac glycosides</p> Signup and view all the answers

    Match the following mechanisms of action to their effects in the context of digitalis:

    <p>Inhibition of Na+/K ATPase = Increased intracellular Ca2+ Increased Ca2+ release from sarcoplasmic reticulum = Enhanced cardiac contractility Accumulation of intracellular Na+ = Altered electrical activity Displacement of intracellular Ca2+ = Increased stroke volume</p> Signup and view all the answers

    Match the distribution of digoxin to the respective tissue concentration:

    <p>Heart = Twice that in skeletal muscle Skeletal Muscle = Equal to in plasma Plasma = Fifteen times less than in cardiac tissue Kidneys = Equal to in muscle</p> Signup and view all the answers

    Match the renal considerations of digoxin use with the associated advisement:

    <p>Dosage adjustment = Based on creatinine clearance Increased elimination = Renal function improvement Dosing frequency = Will not change regardless of renal function Monitoring = Not necessary in stable patients</p> Signup and view all the answers

    Match the following effects of digitalis to their descriptions:

    <p>Positive inotropic effect = Increased force of cardiac contractions Sympathomimetic effect = Increased heart rate Calcium displacement effect = Increased intracellular Ca2+ Na+ accumulation = Decreased cardiac excitability</p> Signup and view all the answers

    Match the following aspects of digoxin's pharmacokinetics to their characteristics:

    <p>Half-life = Longer in renal impairment Volume of distribution = High in cardiac tissues Onset of action = Delayed in renal dysfunction Peak plasma concentration = Achieved within hours after administration</p> Signup and view all the answers

    Match the potential consequences of digitalis therapy with the corresponding effects:

    <p>Hypokalemia = Increased digoxin toxicity risk Hypercalcemia = Exacerbates cardiac effects Electrolyte imbalances = Effect on digoxin efficacy Renal impairment = Increased digoxin levels</p> Signup and view all the answers

    Match the condition of digoxin toxicity to its related symptoms:

    <p>Visual disturbances = Yellow-green halos Bradycardia = Low heart rate Nausea and vomiting = Gastrointestinal upset Arrhythmias = Irregular heartbeat</p> Signup and view all the answers

    Match the various methods to manage digoxin toxicity with their actions:

    <p>Potassium supplementation = Addresses hypokalemia Digoxin-specific antibody fragments = Neutralizes digoxin effects Electrolyte monitoring = Prevents complications Drug discontinuation = Minimizes further toxicity</p> Signup and view all the answers

    Match the following predisposing factors with their descriptions related to digoxin toxicity:

    <p>Hypokalemia = Increases digoxin binding and effect Hypocalcemia = Makes digitalis less effective Renal impairment = Influences digoxin clearance Hypercalcemia = May potentiate digitalis effects</p> Signup and view all the answers

    Match the following cardiac manifestations with their descriptions:

    <p>Bradycardia = Reduced heart rate Paroxysmal atrial tachycardia = Rapid heart rate episodes Heart block = Impaired conduction between heart chambers Ventricular arrhythmia = Irregular rhythms originating in the ventricles</p> Signup and view all the answers

    Match the following extracardiac manifestations with their descriptions:

    <p>Fatigue = First manifestation in digoxin toxicity Nausea = Gastrointestinal symptom due to CTZ stimulation Hallucination = Central nervous system symptom Yellow vision = Visual disturbance associated with toxicity</p> Signup and view all the answers

    Match the following management steps with their descriptions for digoxin toxicity:

    <p>Stop digitalis administration = Initial action in managing toxicity Correct hypokalemia = Restores potassium balance Lidocaine = Used for ventricular arrhythmias Atropine = Used in case of bradycardia</p> Signup and view all the answers

    Match the following antiarrhythmic drugs with their specific uses:

    <p>Lidocaine = Ventricular arrhythmia management Phenytoin = Used with ventricular arrhythmia and heart block Atropine = Used for bradycardia Amiodarone = Not typically mentioned in digoxin management</p> Signup and view all the answers

    Match the following gastrointestinal symptoms with their descriptions in digoxin toxicity:

    <p>Vomiting = Common GIT symptom due to toxicity Diarrhea = Increases loss of fluids/electrolytes Anorexia = Loss of appetite often reported Abdominal pain = Less commonly associated symptom</p> Signup and view all the answers

    Match the following groups of symptoms with their manifestation types:

    <p>Cardiac manifestations = Bradycardia, heart block Extracardiac manifestations = Fatigue, yellow vision CNS manifestations = Delirium, hallucination Dermatological manifestations = Skin rash, gynecomastia</p> Signup and view all the answers

    Match the following potential complications with their causes in relation to digoxin therapy:

    <p>Hyperkalemia = Possible due to potassium supplementation Renal failure = Can worsen digoxin clearance Arrhythmias = Can occur from digoxin toxicity Electrolyte imbalances = Result from diuretic use with digoxin</p> Signup and view all the answers

    Match the following conditions with their corresponding recommendations regarding digoxin usage:

    <p>Pulmonary hypertension due to chronic lung disease = Correct pulmonary hypertension before using digoxin Acute myocardial infarction = Avoid using digoxin Renal disease = Avoid digoxin use Hepatic disease = Avoid digitoxin use</p> Signup and view all the answers

    Match the following drugs with their effects on digoxin absorption:

    <p>Antacids - Kaolin = Bind digoxin and decrease bioavailability Cholestyramine = Decrease absorption of digoxin Metoclopramide = Increase gut motility leading to decreased digoxin absorption Atropine = Decrease gut motility leading to increased digoxin absorption</p> Signup and view all the answers

    Match the drugs with their specific interactions with digoxin:

    <p>Quinidine = Decreases renal clearance and displaces digoxin from plasma proteins Antacids = Bind digoxin in the gut Metoclopramide = Increases gut motility Atropine = Decreases gut motility</p> Signup and view all the answers

    Match the following potential outcomes with the respective treatment contexts:

    <p>Digitalis in pulmonary hypertension = Increased strain on RV if not corrected Digitalis in acute MI = Increased infarct size and aggravated arrhythmia Digitalis before cardioversion = Risk of fatal arrhythmia Digoxin in renal failure = Must be avoided</p> Signup and view all the answers

    Match the drugs with the patient conditions they must be avoided in:

    <p>Digoxin = Renal patients Digitoxin = Hepatic patients Antacids = Patients on digoxin Cholestyramine = Patients needing digoxin absorption</p> Signup and view all the answers

    Match the following drugs with their primary characteristics:

    <p>Inamrinone = More toxic PDE inhibitor Milrinone = Less toxic PDE inhibitor Digitalis = Promotes renal clearance PDE inhibitors = Increase cAMP levels</p> Signup and view all the answers

    Match the following effects with the corresponding drug action:

    <p>Inamrinone = Thrombocytopenia and hepatotoxicity Milrinone = Increased myocardial contractility Digitalis = Binds specifically to antibo PDE Inhibition = Increased Ca2+ influx</p> Signup and view all the answers

    Match the drugs with their specific characteristics or actions relevant to digoxin:

    <p>Metoclopramide = Increases gut motility Atropine = Decreases gut motility Quinidine = Displaces digoxin from plasma proteins Cholestyramine = Binds digoxin and decreases absorption</p> Signup and view all the answers

    Match the following statements with their appropriate pharmacological implications:

    <p>Digitalis in cardiomyopathy = Digitalis is ineffective Digitalis with renal impairment = Increase risk of toxicity Digitalis before cardioversion = Potentially fatal risk Digitalis and chronic lung disease = Must manage hypertension first</p> Signup and view all the answers

    Match the following adverse effects with their respective drug:

    <p>Inamrinone = Cardiac arrhythmias Milrinone = Less frequent liver enzyme increase Digitalis = Visual disturbances PDE inhibitors = Potential for long-term use</p> Signup and view all the answers

    Match the following statements about digitalis with their outcomes:

    <p>Increased gut motility = Decreases digoxin absorption Binding to plasma proteins = Decreases free digoxin concentration Cardiomyopathy usage = Digitalis offers no benefit Improper management of pulmonary hypertension = Increases RV strain</p> Signup and view all the answers

    Match the following drug classes with their typical usage:

    <p>Positive inotropes = Short-term treatment for CHF PDE inhibitors = Used intravenously only Digitalis = Specific therapy for CHF Beta-blockers = Long-term management of heart failure</p> Signup and view all the answers

    Match the following drugs to their recommended characteristics in heart failure treatment:

    <p>Inamrinone = Not for long-term use Milrinone = Short-term intravenous use Digitalis = Promotes renal clearance PDE inhibitors = Only for CHF patients not responding to digitalis</p> Signup and view all the answers

    Match the following outcomes with the corresponding drug mechanisms:

    <p>PDE Inhibitors = Increase cAMP and Ca2+ influx Digitalis = Binds digitalis and increases contractility Inamrinone = Increase in myocardial contractility Milrinone = Vasodilatory properties</p> Signup and view all the answers

    Study Notes

    Heart Failure Therapy

    • Non-Drug Therapy: Lifestyle modifications are essential for managing heart failure.
      • Rest is crucial to reduce strain on the heart.
      • Dietary adjustments include restriction of sodium and fat intake.
      • Stress management is important; avoid smoking and alcohol consumption.
      • Weight reduction can alleviate symptoms.
      • Control risk factors, including surgical correction of valvular diseases and treatment of hyperthyroidism and hypertension.
      • Avoid drugs that can elevate blood pressure, such as sympathomimetics and sodium-containing medications.

    Drug Therapy

    • Positive Inotropic Drugs: Enhance heart muscle contraction.
      • Cardiac glycosides: Digoxin is the most commonly used.
      • Dopamine and dobutamine are for short-term use only; stimulate the heart.
      • Phosphodiesterase inhibitors: Inamrinone and milrinone are examples.
    • Additional Medications:
      • Diuretics help reduce fluid overload.
      • ACE inhibitors (ACEIs) lower blood pressure and reduce workload on the heart.
      • Vasodilators, such as nitrates and hydralazine, improve blood flow.
      • Beta-blockers and spironolactone also play a role in managing heart failure.

    Cardiac Glycosides - Digoxin

    • Derived from the foxglove plant; contains a lactone ring and steroid moiety attached to sugar molecules.
    • Increases intracellular sodium, thereby preventing calcium expulsion and enhancing contractility.
    • Autonomic Effects:
      • Increases vagal activity and decreases sympathetic activity, improving tissue oxygenation.

    Pharmacological Effects

    • Increases Contractility and Cardiac Output (COP):
      • Enhances renal blood flow and diuresis, reducing fluid retention through reduced RAAS activity.
      • Alleviates lung congestion.
    • Decreases Heart Rate:
      • Caused by increased vagal tone and inhibition of the AV conduction system, potentially leading to bradycardia.
    • Conducting Velocity:
      • Intra-atrial conduction increases; A-V conduction decreases due to vagal effects.
    • Excitability and Automaticity:
      • Can lead to ectopic foci and various arrhythmias.

    Clinical Considerations

    • Cardiac Conditions:
      • In cases of acute myocardial infarction or cardiomyopathy, digoxin may worsen the situation.
      • Digitalis should be avoided in renal or hepatic disease.
    • Drug Interactions:
      • Antacids, cholestyramine, and metoclopramide can affect digoxin absorption and bioavailability.
      • Quinidine increases digoxin levels and can lead to toxicity.
      • Loop diuretics may cause hypokalemia, enhancing digoxin's effects and toxicity risk.

    Dosage and Administration

    • Digoxin Digitalization:
      • Initial dosing involves 0.25 mg per day for five days, with the goal of achieving steady-state concentration after one week.
      • In emergencies, rapid loading at 0.5 mg twice daily for two days may be required.
    • Maintenance Dose:
      • Continue with one tablet (0.25 mg) daily, five days a week.

    Digitalis Toxicity

    • Predisposing Factors:
      • Hypokalemia increases digoxin binding and effect; hypomagnesemia also raises toxicity risk.
      • Renal impairment poses additional risk for toxicity.

    Toxicity Manifestations

    • Cardiac Symptoms:
      • Bradycardia, various degrees of heart block, and any type of arrhythmia.
    • Extracardiac Symptoms:
      • Fatigue, anorexia, gastrointestinal disturbances (diarrhea, nausea, vomiting).
      • Central Nervous System effects: headache, delirium, hallucinations, and vision changes (e.g., yellow vision).
      • Additional symptoms may include skin rash and gynecomastia.

    Management of Digitalis Toxicity

    • Discontinue digitalis administration immediately.
    • Correct hypokalemia via oral or IV potassium.
    • Administer antiarrhythmic drugs such as:
      • Lidocaine for ventricular arrhythmias.
      • Phenytoin for ventricular arrhythmias complicated with heart block.
      • Atropine for bradycardia or heart block.

    Heart Failure Therapy

    • Non-drug therapy includes lifestyle modifications: rest, dietary sodium and fat restriction, stress avoidance, smoking cessation, and alcohol elimination.
    • Weight reduction is crucial, along with controlling risk factors, such as surgical correction for valvular diseases and managing hyperthyroidism and hypertension.
    • Avoid sympathomimetics and sodium-containing drugs due to potential increases in blood pressure.

    Drug Therapy

    • Positive inotropic agents:
      • Cardiac glycosides (e.g., Digoxin).
      • Dopamine and Dobutamine are for short-term use only.
      • Phosphodiesterase inhibitors (Inamrinone, Milrinone).
    • Other important drug classes include diuretics, ACE inhibitors, vasodilators (nitrates, hydralazine), beta-blockers, and spironolactone.

    Cardiac Glycosides

    • Derived from natural plant sources (e.g., Foxglove).
    • Contain a lactone ring and a steroid moiety linked to sugar molecules.
    • Digoxin is the most common glycoside used.
    • Caution in patients with pulmonary hypertension or acute myocardial infarction, as digitalis may worsen their condition.
    • Contraindicated in renal disease (use caution with Digoxin) and in hepatic disease (avoid Digitoxin).
    • Can lead to fatal arrhythmias if used prior to cardioversion.

    Drug Interactions

    • Antacids and cholestyramine can reduce digoxin bioavailability.
    • Metoclopramide increases gut motility, decreasing digoxin absorption; Atropine has the opposite effect.
    • Quinidine can increase serum digoxin levels by decreasing renal clearance.
    • Diuretics (loop or thiazide) may cause hypokalemia, increasing the risk of digoxin toxicity.

    Dosage and Administration

    • Initial dosage: 0.25 mg/day for 5 days to achieve therapeutic levels.
    • Rapid loading method involves a higher initial dose (0.5 mg) twice daily for two days if in an emergency.
    • Maintenance dose: 0.25 mg/day, five days a week.
    • Monitor plasma potassium levels continuously during therapy.

    Digitalis Toxicity

    • Predisposing factors include hypokalemia, renal impairment, and hypomagnesemia.
    • Cardiac manifestations include bradycardia, heart block, and various arrhythmias.
    • Extracardiac symptoms: fatigue, anorexia, gastrointestinal symptoms (diarrhea, nausea), CNS effects (headache, delirium), and vision changes (chromatopsia).
    • Management includes stopping digitalis, correcting hypokalemia, and administering antiarrhythmic drugs (Lidocaine, Phenytoin, Atropine), as well as specific digoxin antibodies (Digibind).

    Other Positive Inotropic Drugs

    • PDE inhibitors (Inamrinone, Milrinone) increase cAMP levels, leading to enhanced myocardial contractility and vasodilation.
    • Used only intravenously for short-term treatment of heart failure; long-term use is not recommended due to toxicity risks.
    • Adverse effects: thrombocytopenia, cardiac arrhythmias, and liver enzyme elevation (hepatotoxicity), with Milrinone being less toxic than Inamrinone.

    Mechanisms of Action

    • Increased intracellular sodium (Na+) inhibits calcium (Ca2+) expulsion from the cell via the Na+/Ca2+ exchanger.
    • Autonomic effects include:
      • Increased vagal activity through direct and indirect mechanisms.
      • Decreased sympathetic activity due to relief of hypoxia and improved tissue oxygenation.

    Pharmacological Effects

    • Positive inotropic effect increases contractility and cardiac output (COP).
      • Enhances renal blood flow (RBF), leading to diuresis and decreased renin-angiotensin-aldosterone system (RAAS) activity, reducing fluid retention.
      • Alleviates lung congestion.
    • Decreased heart rate (bradycardia) results from:
      • Increased vagal tone and reduced sympathetic activity.
      • Direct inhibition of the atrioventricular (AV) conducting system.
    • Conductance enhancements occur:
      • Increased intra-atrial conduction due to vagal stimulation.
      • Decreased A-V conduction stemming from direct and vagal effects.
    • Increased excitability and automaticity may lead to ectopic foci and various arrhythmias.

    ECG Changes

    • Prolonged PR interval.
    • Shortened QT interval.
    • ST segment depression and T-wave inversion.

    Hemodynamic Effects

    • Normalization of arterial and venous pressures due to improved hemodynamics.

    Therapeutic Indications

    • Digoxin is indicated for chronic congestive heart failure (CHF) associated with atrial flutter or fibrillation (AF), balancing contractility enhancement and AV conduction reduction.
    • Other agents like verapamil or beta-blockers are preferred for AF alone.
    • Diuretics and ACE inhibitors are recommended for CHF without AF.

    Contraindications

    • Absolute contraindications:
      • Heart block, as digitalis worsens AV conduction.
      • Hypertrophic obstructive cardiomyopathy (HOCM), due to increased outflow tract resistance.
      • Wolff-Parkinson-White (WPW) syndrome, as it can exacerbate arrhythmias.
      • Paroxysmal ventricular tachycardia due to increased excitability from digitalis.
    • Relative contraindications:
      • Bradycardia conditions, which may worsen with digoxin addition.
      • Systemic hypertension that strains the left ventricle; must be corrected prior to use.
      • Chronic lung disease causing pulmonary hypertension increases right ventricle strain.
      • Certain cardiac diseases like acute myocardial infarction amplify infarct size and arrhythmia risk.
      • Renal or hepatic diseases; digoxin is contraindicated in renal failure, and digoxin should be avoided in hepatic failure.

    Drug Interactions

    • Antacids and cholestyramine reduce digoxin bioavailability.
    • Metoclopramide increases gut motility, reducing digoxin absorption.
    • Atropine increases digoxin absorption by decreasing gut motility.
    • Quinidine may increase digoxin serum levels by reducing renal clearance and displacing it from plasma proteins.
    • Diuretics may cause hypokalemia or hypomagnesemia, raising digitalis toxicity risk.

    Dosage and Administration

    • Initial digitalization involves administering 0.25 mg tablet daily, increasing dosage for rapid loading in emergencies.
    • Steady-state concentration achieved after one week.
    • Maintenance dose: 0.25 mg daily, five days a week.
    • Continuous monitoring of serum potassium levels is essential during digoxin therapy.
    • Specific digoxin antibodies (Fab fragments) can bind digoxin to promote renal clearance in cases of toxicity.

    Other Positive Inotropic Drugs

    • Phosphodiesterase (PDE) inhibitors such as inamrinone and milrinone increase cAMP and calcium influx, enhancing myocardial contractility and possessing vasodilatory properties.
    • Designed for short-term CHF management when digitalis is ineffective; not safe for long-term use due to adverse effects like thrombocytopenia, arrhythmia, and liver enzyme increase. Milrinone has lower toxicity compared to inamrinone.

    Non-Drug Therapy for Heart Failure

    • Implement lifestyle modifications: rest, dietary sodium and fat restriction, stress avoidance, and cessation of smoking and alcohol.
    • Weight reduction and management of risk factors are essential.
    • Surgical correction for valvular diseases and treatment of hyperthyroidism or hypertension may be needed.
    • Avoid medications that raise blood pressure, e.g., sympathomimetics and sodium-containing drugs.

    Drug Therapy for Heart Failure

    • Positive inotropic drugs improve heart contractility:
      • Cardiac glycosides (e.g., Digoxin).
      • Short-term use of dopamine and dobutamine.
      • Phosphodiesterase inhibitors: inamrinone and milrinone.
    • Diuretics help manage fluid retention.
    • ACE inhibitors are used to lower blood pressure and reduce heart workload.
    • Vasodilators such as nitrates and hydralazine improve blood flow.

    Cardiac Glycosides

    • Derived from natural plant sources like the foxglove plant.
    • Composed of a lactone ring, steroid moiety, and sugar molecules.
    • Digoxin is the most commonly used cardiac glycoside.
    • Increases intracellular sodium, resulting in calcium retention in cells.

    Autonomic Effects of Cardiac Glycosides

    • Enhances vagal activity and decreases sympathetic activity.
    • Improves tissue oxygenation, alleviating hypoxia effects.

    Pharmacological Effects

    • Increases cardiac output and renal blood flow, leading to diuresis and reduced fluid retention.
    • Relieves lung congestion by decreasing heart rate via increased vagal tone.
    • Can lead to bradycardia due to vagal stimulation and inhibition of AV conduction.
    • Increased excitability may lead to ectopic foci and arrhythmias.

    ECG Changes with Digoxin

    • Prolongation of PR interval.
    • Shortening of QT interval.
    • ST segment depression and T wave inversion.
    • Normalization of arterial and venous pressures due to improved hemodynamics.

    Therapeutic Indications for Digoxin

    • Indicated for chronic congestive heart failure (CHF) with atrial fibrillation (AF).
    • Preferred treatments for AF without heart failure include verapamil or beta-blockers.
    • In CHF without AF, diuretics and ACE inhibitors are favored.

    Contraindications for Digoxin Use

    • Absolute contraindications include heart block (worsens conduction), hypertrophic obstructive cardiomyopathy (HOCM), Wolff-Parkinson-White syndrome, and paroxysmal ventricular tachycardia.
    • Relative contraindications involve bradycardia conditions and systemic hypertension.

    Dosage and Administration

    • Initial digitalization starts at 0.25 mg daily for five days.
    • Rapid loading method uses 0.5 mg twice daily for two days in emergencies.
    • Maintenance dose is 0.25 mg daily for five days a week.

    Precautions While Using Digoxin

    • Avoid intravenous administration without confirming the absence of prior digoxin in the last 14 days to prevent toxicity.
    • Continuous monitoring of potassium levels is crucial.

    Predisposing Factors for Digoxin Toxicity

    • Hypokalemia increases binding and effects of digoxin.
    • Presence of renal impairment enhances toxicity risk.

    Manifestations of Digoxin Toxicity

    • Cardiac symptoms: bradycardia, various arrhythmias, and atrial tachycardia.
    • Extracardiac symptoms: fatigue, anorexia, gastrointestinal disturbances, and central nervous system effects (e.g., headache, hallucinations).
    • Visual disturbances include yellow vision and diplopia.

    Management of Digoxin Toxicity

    • Discontinue digoxin immediately.
    • Correct hypokalemia with potassium supplements.
    • Antiarrhythmic drugs may be necessary (e.g., Lidocaine, Phenytoin) in case of ventricular arrhythmias.
    • Atropine may be administered for bradycardia or heart block.

    Therapy of Heart Failure

    • Non-drug therapy focuses on lifestyle modifications which include:

      • Rest and adequate sleep
      • Dietary sodium and fat restriction
      • Stress management, smoking cessation, and avoidance of alcohol
      • Weight reduction to improve heart health
      • Control of risk factors such as surgical correction of valvular diseases and treatment of conditions like hyperthyroidism and hypertension
      • Avoidance of drugs that can increase blood pressure, including sympathomimetics and sodium-containing drugs

    • Drug therapy options for heart failure:

      • Positive inotropic drugs:
        • Cardiac glycosides (e.g., Digoxin)
        • Dopamine and Dobutamine (short-term use)
        • Phosphodiesterase inhibitors (Inamrinone and Milrinone)
      • Diuretics to reduce fluid overload
      • ACE inhibitors for blood pressure control
      • Vasodilators such as nitrates and hydralazine
      • Other medications include beta-blockers and spironolactone

    Cardiac Glycosides

    • Sourced from natural plant derivatives like the Foxglove plant
    • Structure includes a lactone ring attached to a steroid (aglycone) and sugar molecules
    • Digoxin is the most commonly used cardiac glycoside

    Pharmacokinetics of Digoxin

    • Distributes widely in body tissues and accumulates in cardiac tissue
    • Concentration of Digoxin in the heart is twice that in skeletal muscle and at least 15 times that in plasma
    • Renal elimination necessitates dose adjustments based on creatinine clearance

    Mechanism of Action

    • Positive inotropic effect achieved by increasing intracellular calcium levels
    • Blocks Na+/K+ ATPase, leading to sodium and calcium accumulation within cells
    • This mechanism enhances calcium release from the sarcoplasmic reticulum and displaces calcium from binding sites
    • Important to manage pulmonary hypertension before using digitalis, as it can strain the right ventricle

    Clinical Considerations

    • In acute myocardial infarction (MI), digitalis can worsen infarct size and arrhythmias
    • Caution in patients with renal impairment and hepatic diseases
    • Risk of fatal arrhythmia if used shortly before cardioversion

    Drug Interactions with Digoxin

    • Antacids (e.g., Kaolin) bind Digoxin, reducing bioavailability
    • Cholestyramine affects absorption
    • Metoclopramide increases gut motility, decreasing Digoxin absorption
    • Quinidine decreases renal clearance and displaces Digoxin from proteins

    Digitalis Toxicity

    • Predisposing factors include hypokalemia, anemia, and renal impairment
    • Cardiac manifestations: bradycardia, variable heart block, and arrhythmias
    • Extracardiac symptoms: fatigue, anorexia, gastrointestinal issues (diarrhea, nausea), CNS effects (headache, delirium), visual disturbances (yellow vision), and skin reactions (rash, gynecomastia)

    Management of Digitalis Toxicity

    • Discontinue Digoxin
    • Correct hypokalemia through potassium supplementation
    • Use antiarrhythmic medications (Lidocaine, Phenytoin, Atropine)
    • Specific antidote includes digoxin-specific antibodies (Digibind)

    Other Positive Inotropic Drugs

    • Phosphodiesterase (PDE) Inhibitors:
      • Inamrinone and Milrinone increase intracellular cAMP, enhancing myocardial contractility
      • Exhibit vasodilatory properties and are used intravenously for short-term treatment in CHF
      • Long-term use is not recommended due to associated toxicity
      • Adverse effects may include thrombocytopenia and hepatotoxicity, with Milrinone being less toxic than Inamrinone

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    Description

    This quiz focuses on lifestyle modifications for managing heart failure without medication. It covers important factors such as diet, stress management, and risk control strategies. Test your knowledge on how these lifestyle changes can effectively contribute to heart health.

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