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Questions and Answers

What is the primary action of phosphodiesterase inhibitors like milrinone in heart failure treatment?

  • Increase sodium retention
  • Block phosphodiesterase and increase myocardial contraction force (correct)
  • Decrease blood pressure by relaxing blood vessels
  • Prolong therapeutic response time to months
  • Which of the following adverse effects is associated with the use of phosphodiesterase inhibitors?

  • Hypertension
  • Increased myocardial oxygen demand
  • Hypernatremia
  • Hypokalemia (correct)
  • Which statement about direct vasodilators is true?

  • They increase myocardial contraction.
  • They significantly lower blood pressure. (correct)
  • They serve a major role in heart failure treatment.
  • They are the primary treatment for heart failure.
  • What should patients monitor while receiving treatment for heart failure?

    <p>Therapeutic levels with laboratory tests (A)</p> Signup and view all the answers

    Which of the following patient teachings is important regarding the use of medications for heart failure?

    <p>Do not stop taking medications abruptly (C)</p> Signup and view all the answers

    What is the recommended monitoring for heart failure patients taking medications?

    <p>Weight loss, pulse rate, and blood pressure (A)</p> Signup and view all the answers

    What critical symptom should patients report when on heart failure medications?

    <p>Fatigue and muscle cramps (D)</p> Signup and view all the answers

    Which of the following statements regarding the mechanisms of action of heart failure drugs is correct?

    <p>Phosphodiesterase inhibitors cause a positive inotropic response and vasodilation. (A)</p> Signup and view all the answers

    Which condition is characterized by the accumulation of blood in the left ventricle, leading to hypertrophy?

    <p>Left-sided heart failure (A)</p> Signup and view all the answers

    What is the primary effect of decreasing afterload in patients with heart failure?

    <p>Reduced workload for the heart (C)</p> Signup and view all the answers

    In heart failure, what is preload dependent on?

    <p>The degree of myocardial fiber stretching (C)</p> Signup and view all the answers

    Which of the following diseases is least likely to be directly associated with heart failure?

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

    Which of the following mechanisms is NOT part of the pharmacologic management of heart failure?

    <p>Increasing blood viscosity (C)</p> Signup and view all the answers

    What is a common symptom resulting from left-sided heart failure?

    <p>Cough and shortness of breath (D)</p> Signup and view all the answers

    Which term describes the law stating that myocardial fibers contract more forcefully the more they are stretched?

    <p>Frank-Starling law (B)</p> Signup and view all the answers

    Which statement is true regarding right-sided heart failure?

    <p>It primarily causes peripheral edema. (D)</p> Signup and view all the answers

    What is the primary focus of treatment for Stage A heart failure?

    <p>Implement lifestyle modifications and treat comorbid conditions (B)</p> Signup and view all the answers

    Which medication is commonly used in Stage B heart failure for patients with prior heart failure symptoms?

    <p>Beta blockers (C)</p> Signup and view all the answers

    What characterizes Stage C heart failure?

    <p>Symptoms like fatigue or dyspnea with structural heart disease (B)</p> Signup and view all the answers

    In the treatment of Stage D heart failure, what is likely to be included?

    <p>Intravenous medications like dobutamine or nitroglycerin (A)</p> Signup and view all the answers

    What is the main action of ACE inhibitors in the context of heart failure?

    <p>They reduce afterload and improve cardiac output (B)</p> Signup and view all the answers

    What additional treatment may be added for Stage C heart failure to control symptoms?

    <p>Beta blockers and aldosterone antagonists (B)</p> Signup and view all the answers

    Which condition is NOT a focus for intervention in Stage A heart failure?

    <p>Structural heart disease treatment (C)</p> Signup and view all the answers

    Which of the following best describes the treatment approach for symptomatic patients in Stage C heart failure?

    <p>Combination of ACE inhibitors or ARBs and further symptomatic treatments (C)</p> Signup and view all the answers

    What is the primary mechanism of action of lisinopril?

    <p>To inhibit ACE enzyme and decrease aldosterone secretion (B)</p> Signup and view all the answers

    Which of the following is NOT an adverse effect of ACE inhibitors?

    <p>Fluid retention (D)</p> Signup and view all the answers

    What is the main purpose of diuretics in cardiovascular treatment?

    <p>To reduce blood volume and cardiac workload (D)</p> Signup and view all the answers

    Which of the following describes the primary action of cardiac glycosides?

    <p>To improve cardiac output by increasing the force of heartbeat (C)</p> Signup and view all the answers

    Which adverse effect is specifically associated with digoxin?

    <p>Digitalis toxicity (A), Dysrhythmias (B)</p> Signup and view all the answers

    What is the primary benefit of using beta-adrenergic blockers in heart failure?

    <p>To reduce workload and slow heart rate (A)</p> Signup and view all the answers

    What is a common outcome of fluid retention caused by beta-adrenergic blockers?

    <p>Increased blood volume (D)</p> Signup and view all the answers

    Which statement is true regarding angiotensin II receptor blockers (ARBs)?

    <p>They are primarily used when patients cannot tolerate ACE inhibitors. (D)</p> Signup and view all the answers

    Flashcards

    Heart Failure Stage A

    High risk of heart failure, no structural heart disease or symptoms.

    Heart Failure Stage A Treatment

    Lifestyle changes and treat conditions like high blood pressure, high cholesterol, and diabetes.

    Heart Failure Stage B

    Heart disease, no symptoms. Examples include previous heart attack or valve disease.

    Heart Failure (HF)

    Inability of the heart's ventricles to pump enough blood to meet the body's needs, often caused by aging or disease.

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    Left-sided Heart Failure

    Blood backs up into the lungs due to the weakened left ventricle, leading to shortness of breath and coughing.

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    Heart Failure Stage B Treatment

    Continue lifestyle changes, treat risk factors. ACE inhibitors or ARBs added if needed.

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    Heart Failure Stage C

    Heart disease, symptoms like fatigue, fluid build-up, or shortness of breath.

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    Right-sided Heart Failure

    Blood backs up into the veins, causing swelling in the body (edema) and organ engorgement.

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    Heart Failure Stage C Treatment

    Continue lifestyle changes, treat risk factors and consider ACE inhibitors, ARBs or Entresto, beta blockers, isosorbide dinitrate/hydralazine, digoxin or aldosterone antagonist.

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    Preload

    The degree to which the myocardial fibers are stretched before contraction. It affects cardiac output (the amount of blood pumped by the heart).

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    Heart Failure Stage D

    Symptoms of heart failure even when properly treated.

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    Afterload

    The pressure in the aorta that must be overcome for the left ventricle to pump blood.

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    Cardiac output

    The amount of blood pumped by the heart per minute.

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    Heart Failure Stage D Treatment

    Lifestyle changes and many medicines to manage symptoms (IV medicines, etc.)

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    Positive inotropic agents

    Drugs that increase the force of the heart's contractions.

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    Pharmacologic management of Heart Failure

    Treatment of heart failure using medications to slow heart rate, increase strength of contractions, or decrease heart's workload.

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    ACE Inhibitors

    Drugs that block the ACE enzyme, lowering blood pressure and reducing blood volume by dilating veins.

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    ARBs

    Angiotensin II Receptor Blockers. Drugs similar to ACE inhibitors, used when ACE inhibitors cause issues.

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    Diuretics

    Drugs that increase urine output, reducing blood volume. Used with other meds.

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    Cardiac Glycosides

    Drugs that strengthen and slow the heartbeat, improving cardiac output. 2nd line for HF.

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    Beta-Blockers

    Drugs that slow heart rate and lower blood pressure to reduce risk of heart problems.

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    Digoxin

    A specific cardiac glycoside.

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    Lisinopril

    A prototype ACE inhibitor.

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    Metoprolol

    A prototype Beta-blocker.

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    Direct Vasodilators in Heart Failure

    Direct vasodilators have a minor role in treating heart failure, lowering blood pressure and relaxing blood vessels.

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    Phosphodiesterase Inhibitors

    These drugs block the enzyme phosphodiesterase, increasing calcium for stronger heart muscle contractions.

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    Milrinone (Primacor)

    A prototype phosphodiesterase inhibitor used for short-term heart failure treatment.

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    Positive Inotropic Response

    Increased force of heart muscle contractions.

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    Vasodilation

    Relaxation of blood vessels, reducing blood pressure.

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    Heart Failure Treatment Timeframe

    The effects of heart failure treatments may take weeks or months to show.

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    Sodium & Potassium Restrictions

    Patients with heart failure may need to limit sodium and potassium in their diets.

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    Adverse Effects of Phosphodiesterase Inhibitors

    Potential side effects include hypokalemia, hypotension, and ventricular dysrhythmias.

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    Study Notes

    Heart Failure (HF)

    • Inability of ventricles to pump sufficient blood for body's needs
    • Heart muscle weakens due to aging or diseases

    Diseases Associated with Heart Failure

    • Coronary artery disease (CAD)
    • Mitral stenosis
    • Myocardial infarction (MI)
    • Chronic High Blood Pressure (HTN)
    • Diabetes mellitus
    • No cure, only prevention and slowing of progression is possible

    Left-Sided Heart Failure

    • Blood accumulates in left ventricle
    • Left ventricle thickens and enlarges (hypertrophy)
    • Cardiac remodeling occurs
    • Blood backs up into lungs
    • Cough and shortness of breath result

    Right-Sided Heart Failure

    • Blood backs up into veins
    • Causes peripheral edema and organ engorgement
    • Less common than left-sided HF

    Pathophysiology of Heart Failure

    • Failing heart leads to decreased cardiac output
    • Diminished renal blood flow
    • Increased sympathetic activity leads to increased heart rate & force of contraction
    • Vasoconstriction increases blood pressure
    • Retention of sodium and water leads to increased plasma volume
    • Increased afterload
    • Increased cardiac workload
    • Myocardial dysfunction worsens heart failure
    • Pulmonary and peripheral edema occurs

    Preload

    • Affects cardiac output
    • Degree myocardial fibers stretched before contraction
    • Frank-Starling law: more stretched, more forceful contraction
    • Positive inotropic agents increase preload to increase contractility

    Afterload

    • Affects cardiac output
    • Pressure in aorta, must be overcome to eject blood from left ventricle
    • Lowering blood pressure decreases afterload, decreasing workload of the heart

    Pharmacologic Management of Heart Failure

    • Slowing heart rate
    • Increasing contractility
    • Reducing myocardial workload

    Drugs for Heart Failure

    • Treat symptoms: slow heart rate, increase contractility, reduce workload

    Stages for Treating Heart Failure

    • Stage A: High risk for developing HF, no structural heart disease or symptoms, lifestyle modifications, treat comorbid conditions.
    • Stage B: Structural evidence of heart disease (eg. previous MI), no symptoms, continue lifestyle changes, treat with ACE inhibitor or ARB; beta blockers can be added if prior or current symptoms
    • Stage C: Structural heart disease with symptoms, continue lifestyle/meds from stage B, consider beta blockers, other measures like digoxin, isosorbide dinitrate with hydralazine, or aldosterone antagonist to control symptoms
    • Stage D: Symptoms at rest or with minimal exertion, despite optimal medical therapy, lifestyle modifications/treatment as in stage C, or consider intravenous (IV) vasodilators or other medications like ivabradine, diuretics, dopamine, dobutamine and more intensive measures

    ACE Inhibitors

    • Reduce afterload
    • Drugs of choice for heart failure
    • Enhance excretion of sodium and water
    • Lower peripheral resistance, reduce blood volume
    • Increase cardiac output
    • Prototype drug: lisinopril (Prinivil, Zestril)
    • Mechanism: inhibit ACE enzyme and decrease aldosterone secretion
    • Primary use: to decrease blood pressure, reduce blood volume; dilate veins
    • Adverse effects: first-dose hypotension, cough, hyperkalemia, renal failure

    Angiotensin II Receptor Blockers (ARBs)

    • Actions very similar to ACE inhibitors
    • Often used for patients intolerant of ACE inhibitors

    Diuretics

    • Increase urine flow
    • Reduce blood volume and cardiac workload
    • Reduce edema and pulmonary congestion
    • Prescribed in combination with other drugs

    Cardiac Glycosides

    • Increase force of heartbeat, slow heart rate
    • Improve cardiac output
    • Second-line treatment for HF
    • Narrow therapeutic range
    • Prototype drug: digoxin (Lanoxin)
    • Mechanism: to cause more forceful heartbeat, slower heart rate
    • Primary use: to increase contractility or strength of myocardial contraction
    • Adverse effects: neutropenia, dysrhythmias, digitalis toxicity

    Beta-Adrenergic Blockers

    • Slow heart rate and reduce blood pressure
    • Inotropic effects
    • Reduce workload of heart
    • Prototype drug: metoprolol (Lopressor, Toprol XL)
    • Mechanism: Block cardiac action of the sympathetic nervous system to slow heart rate, blood pressure, reducing workload of heart
    • Primary use: reduce symptoms of heart failure, slow progression of disease
    • Adverse effects: fluid retention, worsening of heart failure, fatigue, hypotension, bradycardia, heart block

    Direct Vasodilators

    • Minor role in HF treatment
    • Lower blood pressure
    • Relax blood vessels

    Phosphodiesterase Inhibitors

    • Block enzyme phosphodiesterase
    • Increase calcium for myocardial contraction
    • Cause positive inotropic response and vasodilation
    • Increase contractility and decrease afterload
    • Short-term therapy only
    • Prototype drug: milrinone (Primacor)
    • Mechanism: to block enzyme phosphodiesterase in cardiac and smooth muscle, increasing myocardial contraction force and cardiac output
    • Primary use: as short-term therapy for heart failure
    • Adverse effects: hypokalemia, hypotension, ventricular dysrhythmias

    Patient Teaching

    • Therapeutic response (weeks/months)
    • Sodium and potassium restrictions
    • Avoid use with other medications/herbals/vitamins
    • Monitor sodium intake
    • Report weight loss, fatigue, muscle cramps
    • Change positions slowly
    • Monitor blood pressure/pulse, report pulse below 50
    • Report signs of worsening heart failure
    • Do not stop medication abruptly
    • Monitor therapeutic levels with laboratory tests
    • Know signs/symptoms of toxicity
    • Monitor pulse rate, report weight gain
    • Eat foods high in potassium
    • Report irregular/rapid heart rate
    • Report fever of 101°F or higher, chest pain
    • Report pain/swelling at IV infusion site

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