Anesthesia Pharmacology Practice Questions: Congestive Heart Failure

Which one(s) of the following statements is/are diuretic resistance which may be encountered in management of congestive heart failure?
1. As long as daily dosing is maintained, effective diuresis is ensured.
2. Functional distinction between low intravascular volume due to significant diuresis versus reduced cardiac output may require assessment (invasive) of intracardiac filling pressures and cardiac output.
3. Both
4. Neither
Diuretic resistance may be associated with atherosclerotic renal artery disease.
1. True
2. False
Select the correct(s) statements concerning renal arterial perfusion pressure and diuretic resistance
1. In reduced renal arterial perfusion pressure due to reduce cardiac output or renal artery stenosis, angiotensin II maintenance of glomerular efferent arteriolar tone may be needed to ensure adequate glomerular filtration pressures.
2. ACE inhibitor administration or angiotensin1 receptor blockers administered concurrent with loop diuretics may cause reduced diuretic delivery and efficacy.
3. Both
4. Neither
Which one(s) of the following side effects of diuretic administration may be observed in CHF as a result of diuretic use.
1. Hypokalemia
2. Hypochloremic metabolic acidosis
3. Hyponatremia
4. A & B
5. A & C
6. B & C
7. A, B & C
Concerning oralv asodilators used for management of CHF which one(s) of the following, all of which improves symptoms, also improves survival?
1. Hydralazine-isosorbide dinitrate combinations
2. ACE inhibitors
3. Angiotensin 1 receptor antagonists
4. A & C
5. A, B & C
By contrast to nitroprusside, nitroglycerin (administered in the ICU setting at low infusion rates) appears relatively selective for arterial resistance vessels.
1. True
2. False
Hydralazine decreases renovascular resistance and increases renal blood flow to a greater extent than most other vasodilatory drugs, with the exception of angiotensin-converting enzyme inhibitors. Accordingly, hydralazine often may be administered to CHF patients with renal dysfunction who are unable to tolerate ACE-inhibitor therapy.
1. True
2. False
The combination of hydralazine with isosorbide dinitrate (BiDil) has been shown to decrease CHF mortality in patients with systolic dysfunction.
1. True
2. False
Angiotensin-converting enzyme inhibitors are preferential arterial vasodilators.
1. True
2. False
Administration of angiotensin-converting enzyme inhibitors would likely cause which one(s) of the following hemodynamic effects.
1. A reduction in left ventricular afterload
2. An increase in stroke volume
3. An increase in cardiac output
4. A & C
5. B & C
6. A,B & C