Medical Pharmacology: Congestive
Heart Failure Practice Questions
Click on the correct answer.
Myocardial Performance Factors
For any given inotropic state, ventricular performance will be significantly affected by the degree of ventricular stretch as determined by ventricular end-diastolic volumes (EDV).
Inotropic state (myocardial contractility): Factors that influence the inotropic state affect ventricular performance at a given ventricular end-diastolic volume. These factors change the concentration of Ca2+ at the myofilaments
and include in part
Adrenergic nerve activity
Circulating catecholamines
Exogenously administered agents:
Cardiac glycosides
Dopamine/dobutamine
Caffeine
Isoproterenol
Theophylline
Calcium
Exogenously administered agents: Drugs that decrease ventricular performance:
Procainamide
Disopyramide
Calcium channel blockers
Alcohol
Barbiturates
Local and general anesthetics
This drug should probably not be administered to a patient with congestive heart failure because the drug may further reduce contractility; the drug should probably also not be prescribed to an asmatic since the drug may increase bronchiolar smooth muscle tone.
digoxin (Lanoxin, Lanoxicaps)
terbutaline (Brethine)
metoprolol (Lopressor)
atropine
In congestive heart failure, decreased cardiac output and changes in ANS activity produce:
increased blood volume
increased GFR
decreased renin levels
A & B
Factors that affect cardiac performance:
circulating epinephrine
digoxin (Lanoxin, Lanoxicaps)
rhythm of cardiac contraction
A, B & C
Most important in acutely altering the position of the force velocity and left ventricular function curve:
circulating catecholamine
dopamine levels
norepinephrine released from adrenergic nerves
total blood volume.
Drug(s) that affect left ventricular stroke volume:
furosemide (Lasix)
dobutamine (Dobutrex)
metoprolol (Lopressor)
all of the above
At any given preload and myocardial inotropic state, cardiac output would be significantly affected by afterload. Which drug(s) would reduce afterload soon after administration.
diazoxide (Hyperstat)
minoxidil (Loniten)
phentolamine (Regitine)
all of the above
Reduces preload
minoxidil (Loniten)
isosorbide dinitrate (Isordil, Sorbitrate)
hydralazine (Apresoline)
phentolamine (Regitine)
Reduces afterload in a CHF patient
minoxidil (Loniten)
captopril (Capoten)
phentolamine (Regitine)
all of the above
Reduces preload AND afterload
nitroprusside sodium (Nipride)
phentolamine (Regitine)
captopril (Capoten)
A & C
Cardiac physiological affects associated with the action of digoxin:
increases force developed during myocardial muscle fiber shortening at a given preload for a CHF patient
increases the force developed during myocardial muscle fiber shortening at a given preload for a normal individual
decreases the AV nodal effective refractory period.
A & B
Effect of norepinephrine on cardiac force-velocity curves in normal individuals and those with CHF:
shift upward (CHF patient)
shift upward (Normal)
both
neither
Mechanism for a decrease in heart rate by digoxin (Lanoxin, Lanoxicaps) in a congestive heart failure patient:
competive blocade of norepinephrine effects at the SA node
improvement of cardiac function decrease sympathetic drive and thus heart rate is decreased.
Associated with chlorthalidone (Hygroton) use in CHF management.
hyperuricemia
hypoglycemia
hypocalcemia
hypolipdemia
In severe congestive heart failure with significant pulmonary and peripheral edema and compromised renal function, furosemide (Lasix) may be more appropriate than hydrochlorothiazide (HCTZ, Esidrix, HydroDIURIL) because:
thiazides are less effective when renal blood flow is reduced
furosemide (Lasix) causes a larger excreted fraction of filtered sodium than hydrochlorothiazide
furosemide (Lasix) reduces preload by venous dilation
A, B & C
Useful in pharmacological management of congestive heart failure:
prazosin (Minipress)
captopril (Capoten)
hydralazine (Apresoline)
all of the above
Diuretic used in CHF that is most likely to cause hypokalemia
triamterene (Dyrenium)
amiloride (Midamor)
spironolactone (Aldactone)
furosemide (Lasix)
H. M. is a 63 year old male with a long history of hypertension and coronary vascular disease. He has had two myocardial infarctions over the past three years and complains of arthritic pain. He has been taking atenolol and chlorothalidone for his hypertension and verapamil to prevent recurrence of paroxysmal supraventricular tachycardia. He also takes large doses of non-steroidal anti-inflammatory drugs (high dose ibuprofen) for his arthritis. He presents with severe systemic edema as a result of congestive heart failure which had been gradually worsening over the past six months. His serum potassium is 2.9 mEq/L (3.5-5.3). What medications may have contributed to heart failure in this patient? H. M. is a 63 year old male with a long history of hypertension and coronary vascular disease. He has had two myocardial infarctions over the past three years and complains of arthritic pain
