Pharmacology Quiz: ACE Inhibitors and Nitrates

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary site of action for nitrates?

Venous (correct)

Capillary

Arterial

Both arterial and venous

Which drug is administered as a continuous intravenous infusion?

Captopril

Candesartan

Hydralazine

Na nitroprusside (correct)

What is a contraindication for using ACE inhibitors?

Bilateral renal artery stenosis (correct)

Hypotension with SBP > 90 mm Hg

Mild kidney dysfunction

Mild hyperkalemia

What is the characteristic side effect specifically associated with ACE inhibitors?

Dry cough Signup and view all the answers

Which combination of medications can be utilized when contraindications for ACE inhibitors and ARBs exist?

Hydralazine and Nitrates Signup and view all the answers

Which symptom is commonly associated with advanced heart failure (HF)?

Weight loss (Cachexia) Signup and view all the answers

Which of the following is a symptom that indicates fluid retention commonly seen in heart failure?

Bendopnea Signup and view all the answers

What is the significance of orthopnea in heart failure diagnosis?

It suggests difficulty breathing while lying flat. Signup and view all the answers

Which clinical finding is associated with right-sided heart failure?

Jugular venous distension Signup and view all the answers

What is a hallmark physical exam finding in heart failure related to fluid overload?

Pitting edema in legs Signup and view all the answers

Which factor is a known risk for developing heart failure?

Diabetes mellitus Signup and view all the answers

What does the presence of rales indicate during a physical examination?

Fluids in the lungs Signup and view all the answers

Cheyne-Stokes respiration is characterized by what breathing pattern?

Rapid shallow breaths followed by apnea Signup and view all the answers

Which of the following physical exam findings suggests worsening heart failure?

Bilateral ankle edema Signup and view all the answers

Which test is primarily used to assess the likelihood of heart failure based on natriuretic peptides levels?

BNP test Signup and view all the answers

What does a high level of NT-proBNP generally indicate?

Heart failure is likely Signup and view all the answers

Which of the following statements is true regarding routine clinical practice for natriuretic peptides?

It is not routinely done Signup and view all the answers

Which of the following represents a necessary step after determining the diagnosis of heart failure?

Assessment of comorbidities Signup and view all the answers

What is the primary goal when treating heart failure according to the outlined treatment steps?

Treat the underlying cause and symptoms Signup and view all the answers

What is a common characteristic of pulmonary edema in heart failure patients?

Can lead to acute respiratory distress Signup and view all the answers

Which natriuretic peptide level suggests that heart failure is not likely in a patient?

NT-proBNP of 25 pg/ml Signup and view all the answers

What type of treatment is included in the management of refractory heart failure?

Advanced therapies such as inotropes Signup and view all the answers

In heart failure management, what is indicated by the term 'etiology'?

The reason for the patient's symptoms Signup and view all the answers

How is echocardiography utilized in assessing heart failure?

To visualize heart structure and function Signup and view all the answers

What is the most common cause of segmental affection in heart conditions?

Hypertension, especially groups 2 and 3 Signup and view all the answers

Which of the following factors can lead to a change from stable heart failure to acute decompensated heart failure?

Excessive salt intake Signup and view all the answers

What could make heart failure refractory during treatment?

Failure to address underlying infections Signup and view all the answers

Which of the following conditions is associated with segmental affection?

Constrictive pericarditis Signup and view all the answers

What type of infections are particularly mentioned as triggers for heart conditions?

Infective endocarditis Signup and view all the answers

Which of the following is a known iatrogenic factor affecting heart conditions?

Non-DHP Calcium channel blockers Signup and view all the answers

Which substance is mentioned as a potential factor affecting contractility?

Alcohol Signup and view all the answers

What is the primary goal of decreasing cardiac load in the treatment of acute heart failure?

To alleviate symptoms and improve heart function. Signup and view all the answers

Which treatment is NOT typically used for reducing preload in acute heart failure?

Inotropic agents. Signup and view all the answers

What class of medications is aimed at reducing pathologic left ventricular remodeling?

Beta-blockers. Signup and view all the answers

Which of the following agents would be most appropriate for increasing myocardial contractility in acute heart failure?

Digitalis. Signup and view all the answers

Which treatment would be recommended for patients with heart failure and intraventricular conduction delay?

Cardiac resynchronization therapy (CRT). Signup and view all the answers

What is the recommended action for managing hypoxemia in acute heart failure?

Oxygen administration. Signup and view all the answers

Which medication class is represented by Ivabradine in the treatment of heart failure?

Rate control agents. Signup and view all the answers

Angiotensin Receptor-Neprilysin Inhibitor (ARNI) is used in heart failure treatment to target which pathway?

Neurohormonal pathway. Signup and view all the answers

Which SGLT2 inhibitor is recommended for patients at risk of hospitalization and cardiovascular death due to heart failure?

Dapagliflozin. Signup and view all the answers

Which of the following is NOT a common treatment approach for symptomatic treatment of acute heart failure?

Inotropic agents for severe fatigue. Signup and view all the answers

Study Notes

Heart Failure Definition (2021)

A clinical syndrome
Due to a cardiac abnormality affecting the ventricle's ability to fill and/or eject blood, confirmed by at least one of the following:
- Increased natriuretic peptide levels
- Objective evidence of cardiogenic, pulmonary or systemic congestion

Etiology (Causes)

Pressure Overload:
- Systemic hypertension
- Valvular disease (aortic stenosis, pulmonic stenosis)
- Congenital disease (coarctation of the aorta)
- Hyperdynamic circulation (valvular disease, congenital disease)
Volume Overload:
- Valvular disease (mitral regurgitation, tricuspid regurgitation)
- Congenital disease (ventricular septal defect)
- Renal failure, fluid overload
- Segmental affection (e.g., myocardial infarction)
Contractility:
- Cardiomyopathy (dilated, hypertrophic)
- Myocarditis
- Pericardial disease (pericardial effusion, constrictive pericarditis)
Relaxation (Filling):
- Myocardial disease (hypertrophic cardiomyopathy, restrictive cardiomyopathy)
- Arrhythmias
Others:
- Toxic damage (heavy metals, alcohol, cocaine)

Precipitating Factors ("Triggers")

These can change a stable (compensated) state of HF into an acute decompensated state and can make HF refractory to treatment.
Infections:
- Infective endocarditis
Iatrogenic factors:
- Corticosteroids and CCBs (non-DHP, except amlodipine and felodipine)
- Discontinuation of heart failure treatment
- Excessive salt intake and intravenous fluids
Anemia, thyrotoxicosis:
- Other causes of hyperdynamic circulation
Acute coronary syndrome (e.g., myocardial infarction)
Hypertensive emergency
Arrhythmias (e.g., atrial fibrillation, bradyarrhythmias)
Acute mechanical causes (e.g., acute mitral regurgitation secondary to endocarditis)
Acute pulmonary embolism
Pregnancy and late labor
Physical and emotional stress

Pathophysiology

Forward Failure: Heart failure to eject sufficient cardiac output (CO)
Backward Failure: Heart failure to accept venous return
Pulmonary congestion: Left-sided HF
Systemic congestion: Right-sided HF
Compensatory Mechanisms (Cardiac Reserve): Mechanisms to restore CO
- Short-term: Adaptive (beneficial) within limits
- Long-term: Can exceed limits & become maladaptive
  - Tachycardia
  - Redistribution of blood flow
  - Hypertrophy (concentric)
  - Dilation (eccentric)

Neurohormonal (NH) Changes

Stimuli: Low CO/BP, decreased renal blood flow, increased sympathetic nervous system (SNS) activity, sodium and water retention, volume expansion, myocyte stretch, baroreceptor stimulation in carotid sinus and aortic arch
Beneficial Effects: Maintaining BP and perfusion of vital organs via increasing contractility (stroke volume) and heart rate
Adverse Effects:
- Increased afterload (vascular resistance)
- Increased preload (blood volume)
- Pathologic left ventricular (LV) remodeling (apoptosis and hypertrophy)
- Ischemia
- Arrhythmias.
Potential Treatments:
- RAAS blockers (ACE-I, ARB)
- Beta-blockers
- Diuretics
- Natriuretic peptides
- Vasodilators

Classification of Heart Failure

LVEF vs. RVF (also Biventricular HF): Left-ventricle dysfunction versus right-ventricle dysfunction
Acute vs. Chronic (also acute on chronic HF): Sudden onset vs. gradual onset of HF.

Stages in the Development and Progression of Heart Failure

Stage A: At risk for heart failure (no structural heart disease or symptoms)
Stage B: Pre-heart failure (structural heart disease but no symptoms)
Stage C: Heart failure (structural heart disease and symptoms)
Stage D: Advanced heart failure (severe symptoms despite optimal treatment)

Functional Classification (NYHA)

Classifies HF based on activity limitations (Class I-IV)

Prognosis Factors (for HF)

NYHA Classification (3or4)
Systolic blood pressure <100mm Hg
Resting tachycardia

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the pharmacological actions of nitrates and ACE inhibitors. This quiz covers key concepts such as administration routes, contraindications, and side effects. Perfect for students studying pharmacology or healthcare professionals seeking to refresh their understanding.