Pharmacology Quiz: ACE Inhibitors and Nitrates
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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?

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

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

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

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

<p>Weight loss (Cachexia) (A)</p> Signup and view all the answers

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

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

What is the significance of orthopnea in heart failure diagnosis?

<p>It suggests difficulty breathing while lying flat. (D)</p> Signup and view all the answers

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

<p>Jugular venous distension (D)</p> Signup and view all the answers

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

<p>Pitting edema in legs (D)</p> Signup and view all the answers

Which factor is a known risk for developing heart failure?

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

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

<p>Fluids in the lungs (C)</p> Signup and view all the answers

Cheyne-Stokes respiration is characterized by what breathing pattern?

<p>Rapid shallow breaths followed by apnea (A)</p> Signup and view all the answers

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

<p>Bilateral ankle edema (D)</p> Signup and view all the answers

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

<p>BNP test (D)</p> Signup and view all the answers

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

<p>Heart failure is likely (A)</p> Signup and view all the answers

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

<p>It is not routinely done (C)</p> Signup and view all the answers

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

<p>Assessment of comorbidities (C)</p> Signup and view all the answers

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

<p>Treat the underlying cause and symptoms (C)</p> Signup and view all the answers

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

<p>Can lead to acute respiratory distress (B)</p> Signup and view all the answers

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

<p>NT-proBNP of 25 pg/ml (A)</p> Signup and view all the answers

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

<p>Advanced therapies such as inotropes (D)</p> Signup and view all the answers

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

<p>The reason for the patient's symptoms (B)</p> Signup and view all the answers

How is echocardiography utilized in assessing heart failure?

<p>To visualize heart structure and function (A)</p> Signup and view all the answers

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

<p>Hypertension, especially groups 2 and 3 (B)</p> 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?

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

What could make heart failure refractory during treatment?

<p>Failure to address underlying infections (C)</p> Signup and view all the answers

Which of the following conditions is associated with segmental affection?

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

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

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

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

<p>Non-DHP Calcium channel blockers (C)</p> Signup and view all the answers

Which substance is mentioned as a potential factor affecting contractility?

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

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

<p>To alleviate symptoms and improve heart function. (A)</p> Signup and view all the answers

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

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

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

<p>Beta-blockers. (B)</p> Signup and view all the answers

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

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

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

<p>Cardiac resynchronization therapy (CRT). (C)</p> Signup and view all the answers

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

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

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

<p>Rate control agents. (A)</p> Signup and view all the answers

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

<p>Neurohormonal pathway. (A)</p> Signup and view all the answers

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

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

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

<p>Inotropic agents for severe fatigue. (A)</p> Signup and view all the answers

Flashcards

Heart Failure

A condition where the heart muscle can't pump blood effectively, leading to fluid buildup in the body.

Diastolic Heart Failure

A type of heart failure where the heart muscle is stiff and can't relax properly, hindering its ability to fill with blood.

Systolic Heart Failure

A type of heart failure where the heart muscle is weak and can't pump blood forward effectively.

Heart Failure Triggers

Factors like infections, medications, or sudden changes in blood pressure that can worsen an already existing heart failure.

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Refractory Heart Failure

A state of heart failure that's severe and doesn't respond well to treatment.

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Constrictive Pericarditis

A form of heart failure where the sac around the heart becomes inflamed and thickened, restricting its ability to beat properly.

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Hypertension as a Heart Failure Cause

High blood pressure, especially types 2 and 3, is a common cause of heart failure.

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Heart Failure (HF)

A condition where the heart is unable to pump blood effectively to meet the body's needs.

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Cachexia

A significant decrease in body weight, often associated with loss of muscle mass.

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Orthopnea

A feeling of breathlessness, shortness of breath, or difficulty breathing when lying flat.

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Paroxysmal Nocturnal Dyspnea

Episodes of shortness of breath occurring during the night, often waking the individual.

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Jugular Venous Dilation

Dilation of the jugular veins in the neck, indicating increased pressure in the right atrium.

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Cheyne-Stokes Respiration

A type of breathing pattern characterized by periods of deep breathing followed by periods of apnea (no breathing)

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Tachycardia

An abnormal heart rhythm, often characterized by a fast heart rate.

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Myocarditis

Inflammation of the heart muscle.

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Cardiac murmur

A type of heart murmur that can indicate heart valve problems.

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Venodilators

Drugs that dilate veins, reducing blood returning to the heart, thereby lowering preload.

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Arteriodilators

Drugs that dilate arteries, lowering resistance to blood flow and reducing afterload.

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ACE inhibitors (ACE-I)

A class of drugs that block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.

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Angiotensin II Receptor Blockers (ARBs)

Drugs that directly block angiotensin II receptors, preventing its vasoconstriction and aldosterone release effects.

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H-ISDN

A combination therapy for heart failure, where hydralazine (arteriodilator) and isosorbide dinitrate (venodilator) work together.

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Reducing Cardiac Load

Rest, diet control, especially salt restriction, diuretics, and vasodilators help reduce the workload of the heart in acute heart failure.

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Decreasing Pathological LV Remodeling

ACE-I, ARB, and beta-blockers help stop the heart from getting bigger and weaker, preventing further damage.

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Digitalis Use in Heart Failure

Digitalis is a medication used for both chronic and acute heart failure when there is atrial fibrillation.

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Other Inotropic Agents

Dopamine, dobutamine, phosphodiesterase inhibitors, and levosimendan all help the heart pump more strongly in acute heart failure.

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CRT for Heart Failure

Cardiac resynchronization therapy (CRT) is used in patients with heart failure and heart rhythm issues.

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Treating Hypoxemia in HF

Oxygen administration is used to treat hypoxemia in patients with heart failure.

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Treating Cardiac Dyspnea

Aminophylline is used to relieve the shortness of breath associated with heart failure.

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Ivabradine for Heart Failure

Ivabradine is a medication that slows down the heart's electrical activity, improving heart function and decreasing hospitalizations in heart failure.

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ARNI in Heart Failure

Angiotensin receptor-neprilysin inhibitor (ARNI) is a combination medication that benefits heart failure patients by blocking the RAAS system and lowering levels of harmful substances.

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SGLT2-I in HF

Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) such as dapagliflozin and empagliflozin can significantly reduce hospitalizations and cardiovascular death in heart failure patients.

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What is heart failure?

A heart condition where the heart muscle can't pump blood effectively, leading to fluid buildup in the body. This can be caused by various factors, including high blood pressure, heart attacks, and valve problems.

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What are natriuretic peptides?

A measurement used to assess the severity of heart failure. Levels reveal how well the heart's pumping function is working.

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When is echocardiography recommended?

This test is usually done when natriuretic peptides indicate a high probability of heart failure, helping to confirm the diagnosis and understand the severity.

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What does "Aetiology" mean in the context of heart failure?

This refers to the specific cause leading to heart failure, for example, it could be high blood pressure, a heart infection, or a valve problem.

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What does "Treatment" involve in managing heart failure?

A complex series of treatments aimed at reversing or managing heart failure. It can include medications, lifestyle changes, and sometimes even surgery.

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What is involved in "Treatment of the Syndrome of Heart Failure"?

This refers to managing the symptoms of heart failure, like shortness of breath, swelling, and fatigue. It focuses on improving the quality of life for individuals with heart failure.

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What is "Treatment of Refractory Heart Failure"?

This refers to managing heart failure that is severe and doesn't respond well to conventional treatments. It often requires more aggressive therapies to improve the heart's function.

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What is pulmonary oedema?

A serious complication of heart failure where fluid accumulates quickly in the lungs, causing difficulty breathing. It requires urgent medical attention.

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What are "precipitating factors" in heart failure?

This refers to any factor that can worsen an existing heart failure. These can include infections, certain medications, or sudden changes in blood pressure.

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What is "Management of Comorbidities" in heart failure?

This involves managing any existing health conditions along with heart failure. It's crucial for overall health and managing heart failure effectively.

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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

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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.

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