Chapter 31 Chronic Heart Failure

Which of the following natural products may have a beneficial effect on heart failure? Select All that Apply Fish oils Hawthorn Coenzyme Q10 Ginkgo Ma huang

Fish oils Hawthorn Coenzyme Q10 Hawthorn and coenzyme Q10 may reduce heart failure symptoms, while fish oils may decrease mortality and cardiovascular hospitalizations. Ma huang (ephedra) should be avoided

GV was brought to the emergency department for difficulty breathing and notable swelling of the face, lips, and tongue. His medical history is significant for diabetes and heart failure with reduced ejection fraction. He currently takes rosuvastatin, metformin, spironolactone, carvedilol, fosinopril, bumetanide and digoxin. Which medication should be discontinued? Bumetanide Carvedilol Digoxin Spironolactone Fosinopril

Fosinopril

The generic name of HK's current diuretic is: Hydrochlorothiazide Bumetanide Torsemide Lisinopril Furosemide

Furosemide

Eplerenone is a suitable alternative for patients experiencing which side effect of spironolactone? Hypertriglyceridemia Renal dysfunction Hyperkalemia Gynecomastia Hypotension

Gynecomastia

Which of the following is a common side effect of BiDil? Hair growth Headache Increased appetite Rash Sore, painful joints

Headache

Which of the following physical exam findings are consistent with symptomatic heart failure? Select all that apply Peripheral edema Jugular venous distention Rales Dyspnea Asterixis

Peripheral edema Jugular venous distention Rales Dyspnea

Which of the following correctly describes the hemodynamic effects of digoxin? Positive inotrope, negative chronotrope Negative inotrope, reduces afterload Negative inotrope, negative chronotrope Decreases preload, positive chronotrope Positive inotrope, positive chronotrope

Positive inotrope, negative chronotrope

Select the correct mechanism of action for Zestril. Blocks angiotensin II by binding directly to the AT1 receptor Prevents norepinephrine from binding to beta-adrenergic receptors Prevents the conversion of angiotensin I to angiotensin II

Prevents the conversion of angiotensin I to angiotensin II

JB is a 68 year old white male diagnosed with NYHA Class III heart failure. His symptoms include leg edema, bibasilar rales and shortness of breath. He has type 2 diabetes and allergies to codeine (nausea) and penicillin (hives). Today his vital signs are BP 165/95 mmHg, HR 67 BPM, RR 26 BPM, Temp. 37.8 C. His basic metabolic panel is normal. Which medications should be initiated to treat JB's heart failure? Select all that apply Digoxin Ramipril Coreg Torsemide Bidil

Ramipril Coreg Torsemide Patients with systolic heart failure should initially be started on mortality-reducing medications (ie.. beta-blocker plus an ACE inhibitor or ARB or Arni). A loop diuretic can be started if there are symtoms of fluid overload. Additional medications, such as Digoxin or BiDil, are added in select patients after the initial treatment has been titrated appropriately

Ivabrandine is indicated in heart failure patients with: QT prolongation HTN AFib Resting HR >= 70 bpm Bradycardia

Resting HR >= 70 bpmWhich

Which medical condition/s can be worsened by the use of carvedilol? Select all that apply BPH Diabetes Asthma Erectile dysfunction Cushing's syndrome

Diabetes Asthma Erectile dysfunction

WR has been taking digoxin 0.125 mg daily for several years. His renal function has declined from an estimated 55 mL/min to 24 mL/min during this time. WR is unable to stand and has vomited. His heart rate is 45 bpm and has an abnormal rhythm. Which medication is most appropriate to administer to WR? DigiFab Metoprolol Micro-K Digox Ivabradine

DigiFab

A patient with systolic heart failure is taking ramipril, digoxin, carvedilol, spironolactone, and furosemide. He is diagnosed with atrial fibrillation and prescribed amiodarone. Which medication dose should be reduced by 50% when starting amiodarone? Carvedilol Spironolactone Ramipril Digoxin Furosemide

Digoxin

What is the most likely cause of LB's symptoms?

Digoxin toxicity The presenting complaints and bradycardia are consistent with digoxin toxicity. A serum digoxin level should be ordered. Visual disturbances could present as blurred vision or seeing greenish halos around lights or objects

A systolic heart failure patient takes Vasotec 5 mg twice daily and Toprol XL 50 mg daily. His blood pressure is 130/80 mmHg and his heart rate is 78 bpm. He feels well overall but has noticed a tickle in his throat that causes a constant, irritating dry cough. The cough does not improve with drinking water. Which medication change is most appropriate for this patient? Titrate Vasotec to the target dose for heart failure Discontinue Vasotec and begin Valsartan Decrease the dose of Vasotec Discontinue Vasotec and start quinapril Discontinue Toprol XL and begin Lopressor

Discontinue Vasotec and begin Valsartan

RH has a past medical history of heart failure, anemia, rheumatoid arthritis and erectile dysfunction. His current medications include ramipril, metoprolol, furosemide, potassium chloride extended release, ferrous sulfate, methotrexate, mulitivitamin, sildenafil and coenzyme Q10. His cardiologist wants to start Bidil for heart failure. Which RF's current medications is contraindicated with Bidil? Methotrexate Coenzyme Q10 Sildenafil Ferrous sulfate Metoprolol

Sildenafil

Which of the following medications has been shown to improve survival in systolic heart failure? Select all that apply Spironolactone Metoprolol succinate Ivabradine Lisinopril Digoxin

Spironolactone Metoprolol succinate Lisinopril

Which of the following best describes safe dosing practices for the use of digoxin in treating heart failure? Start a 250 mg daily; reduce dose when CrCl < 30 mL/min Start at 0.25 mg daily; reduce dose when CrCl < 50 mL/min

Start at 0.25 mg daily; reduce dose when CrCl < 50 mL/min

Which statement/s regarding the dosing and administration of Toprol XL is/are true? (Select All That Apply) It can be converted to intravenous form using a 1:1 ratio The tablet should be swallowed whole and cannot be cut It should be started at a dose of 200 mg daily for heart failure The tablet can be cut in half at the score line if needed It should be taken with or immediately after meals

The tablet can be cut in half at the score line if needed It should be taken with or immediately after meals

Which medication should be added to HK's heart failure treatment regimen to provide additional mortality reduction? Digoxin Altace ToprolXL Amlodipine Entresto

ToprolXL

A woman with heart failure comes to the community pharmacy asking for help choosing a medication to treat her mild pain. Which of the following is a safe, over-the-counter analgesic to recommend? Advil Indomethacin Tylenol Aleve Celebrex

Tylenol

What is the therapeutic range for digoxin when used to treat heart failure? 0.5-0.9 ng/mL 1.6-2 ng/mL 1-1.5 ng/mL 2-3 ng/mL

0.5-0.9 ng/mL

What is the recommended target dose of the angiotensin receptor blocker LB is taking to treat her systolic heart failure? 160 mg BID 120 mg BID 320 mg BID 80 mg BID 40 mg BID

160 mg BID

Which dose of intravenous furosemide is equivalent to the oral furosemide dose LB takes at home? 10 mg BID 40 mg BID 20 mg BID 80 mg BID 60 mg BID

20 mg BID Furosemide IV:PO ratio is 1:2

KG has been diagnosed with heart failure and is beginning carvedilol immediate-release. He is 5 feet, 7 inches and weighs 78 kg. Assuming he tolerates the dose titrations, what is the target dose of carvedilol immediate-release for KG? 100 mg BID 50 mg BID 25 mg BID 12.5 mg BID 75 mg BID

25 mg BID

A patient with systolic heart failure brings a new prescription for Entresto 50 mg BID to the pharmacy. He was instructed to stop quinapril 20 mg BID but wants to know when to start the new medication. The patient should wait at least how long after stopping quinapril before taking the first Entresto dose? 36 hours 48 hours 18 hours 12 hours 24 hours

36 hours

A patient takes two tablespoons of KCL 10% oral solution daily. How many milliequivalents of potassium does the patient take each day? 40 mEq 10 mEq 7.5 mEq 60 mEq 20 mEq

40 mEq

GS is currently taking furosemide 120 mg PO twice daily. Her prescriber wants to switch the furosemide to oral bumetanide. Which oral bumetanide dose is equivalent to the furosemide dose GS is currently taking 2 mg daily 4 mg daily 6 mg daily 8 mg daily 10 mg daily

6 mg daily

Which ACC/AHA stage and NYHA functional class best describe HK's heart failure? ACC/AHA Stage A ACC/AHA Stage C, NYHA Class II ACC/AHA Stage B, NYHA Class III ACC/AHA Stage D, NYHA Class IV ACC/AHA Stage C, NYHA Class IV

ACC/AHA Stage C, NYHA Class II

Select the correct mechanism of action for Entresto: Prevents the conversion of angiotensin I to angiotensin II Prevents potassium from binding to the Na+/K+ ATPase pump Blocks neprilysin form degrading vasodilatory peptides

Blocks neprilysin form degrading vasodilatory peptides

An order for which additional laboratory test would further evaluate HK's complaints? BNP

BNP

Choose the correct mechanism of action of carvidolol. Beta-1 and beta-2 blocker and alpha-1 blocker Beta-1 and beta-2 blocker and dopamine blocker Beta-1 and beta-2 blocker and norepinephrine reuptake inhibitor

Beta-1 and beta-2 blocker and alpha-1 blocker

Which beta-adrenergic blocking agent reduces mortality in systolic heart failure? Metoprolol tartrate Nebivolol Bisoprolol Atenolol Labetolol

Bisoprolol

Which medication requires a taper when discontinuing? Hydralazine Ivabradine Digoxin Sacubitril Bisoprolol

Bisoprolol

Select the correct mechanism of action for candesartan. Prevents the conversion of angiotensin I to angiotensin II Block angiotensin II by binding directly to the AT1 receptor

Block angiotensin II by binding directly to the AT1 receptor

Select the mechanism of action for Aldactone:

Blocks aldosterone receptors in the distal convoluted tubule

Rapid intravenous administration of which medication increases the risk of ototoxicity? Hydralazine Enalaprilat Bumentanide Digoxin Metoprolol

Bumentanide

Which of HK's medications can worsen heart failure? Neurontin Zoloft Zestril Cardizem CD Warfarin

Cardizem CD Non-dihydropyridine calcium channel blockers (diltiazem and verapamil) should not be used in patients with systolic dysfunction due to their negative inotropic effects

Which medication can be substituted for the ACE inhibitor on AM's profile for further mortality reduction? Aldactone BiDil Ivabradine Coreg Entresto

Entresto

Which of the following medications is most appropriate to decrease fluid volume in a patient with a sulfa allergy? Lanoxin Furosemide Ethacrynic Acid Bumex Torsemide

Ethacrynic Acid

Which of the following accurately describes HK's heart failure? Heart failure with diastolic dysfunction Heart failure with mid-range ejection fraction Heart failure with normal ejection fraction Heart failure with preserved ejection fraction Heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction

Which monitoring parameters are appropriate given AM's current medication regimen? Select all that apply Heart rate Digoxin levels Serum creatinine QT interval Postassium levels

Heart rate Serum creatinine Postassium levels

When used to treat systolic heart failure, digoxin has been shown to decrease: Myocardial infarctions Quality of life Strokes Mortality Hospitalizations

Hospitalizations

Which electrolyte abnormality increases the risk of digoxin toxicity? Select all that apply Hypercalcemia Hyperkalemia Hypophosphatemia Hypomagnesemia Hyponatremia

Hypercalcemia Hypomagnesemia also hypokalemia

Low cardiac output results in the activation of compensatory neurohormonal pathways. Activation of the sympathetic nervous system results in which of the following physiologic effects? Peripheral vasodilation Increased heart rate Diuresis Decreased cardiac contractility Fluid retention

Increased heart rate

Which laboratory abnormalities can occur with chronic use of Lasix? Select all that apply Increased calcium Increased triglycerides Decreased potassium Decreased uric acid Decreased magnesium Increased blood glucose

Increased triglycerides Decreased potassium Decreased magnesium Increased blood glucose

JC has systolic heart failure with an ejection fraction of 33%. Which of the following medications could possibly worsen JC's heart failure? Select all that apply Intraconazole Acarbose Daunorubicin Carbamazepine Procainamide Alogliptin Ramipril

Intraconazole Daunorubicin Procainamide Alogliptin

EG is a 67 year old white female with NYHA functional class III systolic heart failure. The cardiologist wants to begin spironolactone. Which finding would prohibit the use of this medication? CrCl = 60 mL/min K = 5.6 mEq/L Sulfa allergy History of angioedema Hemoglobin = 10.2 mg/dL

K = 5.6 mEq/L Aldosterone blockers like spironolactone should not be started if the potassium is > 5 mEq/L or if eGFR is < 30 mL/min/1.73m2

Where does Lasix exert its mechanism of action?

Lasix and other loop diuretics inhibit sodium reabsorption in the thick ASCENDING limb of the Loop of Henle

Counseling for HK should include these recommendation: Select all that apply Limit sodium intake to < 1500 mg per day Monitor and document body weight daily Receive influenza and pneumococcal vaccinations, when indicated Consume 3-4 liters of fluid per day Notify a healthcare provider if weight increase by > 3-5 pounds in 1 week

Limit sodium intake to < 1500 mg per day Monitor and document body weight daily Receive influenza and pneumococcal vaccinations, when indicated Notify a healthcare provider if weight increase by > 3-5 pounds in 1 week

The combination of hydralazine and isosorbide dinitrate is a suitable alternative to which medication in a patient with heart failure and bilateral renal artery stenosis? Furosemide Lisinopril Carvedilol Ivabradine Digoxin

Lisinopril Patients with bilateral renal artery stenosis should not be prescribed ACE inhibitors or ARBs. When an ACE inhibitor or ARB cannot be used to treat heart failure, a suitable alternative is the combination of hydralazine and isosorbide dinitrate

Losartan can decrease renal clearance and increase the toxicity risk of which medication? Rifampin Phenytoin Lithium Warfarin Amiodarone

Lithium

EK has systolic heart failure and is taking quinapril, carvedilol, torsemide, spironolactone and BiDil. She presents to the clinic with a mild fever and sore finger and arm joints and muscle aches. She reports she is more tired than usual and feels miserable. The patient is likely experiencing this drug adverse effect: Luminous phenomena Metabolic alkalosis Lupus-like syndrome Syncope Impotence

Lupus-like syndrome

Which potassium chloride formulation can be opened and sprinkled on food? Klor-Con M15 Micro-K K-Tab Klor-Con M10 Klor-Con 10

Micro-K

Which of the following medications require monitoring of serum potassium? Select all that apply Hydralazine Vasotec Carvidolol Entresto Lanoxin Eplerenone Candesartan

Vasotec Entresto Lanoxin Eplerenone Candesartan

JG is a 59 year old black male with Stage C heart failure. He has been receiving treatment, but his symptoms are not yet controlled. Which medication would be best to recommend adding to JG's regimen? Furosemide Carvedilol Entresto Cozaar hydralazine and isosorbide dinitrate

hydralazine and isosorbide dinitrate

Which of the following are common causes of heart failure? select all that apply Bipolar disorder chronic hypertension asthma MRSA infection Myocardial infarction

chronic hypertension Myocardial infarction

ST is a 38 years old female with systolic heart failure secondary to radiation exposure. She is well controlled on her current treatment regimen. Today, she is being seen in the clinic due to missed periods. Which of the following recommendations should be made to the prescriber regarding ST's current medication regimen? discontinue spironolactone discontinue bisoprolol start valsartan increase the torsemide dose discontinue ramipril

discontinue ramipril positive pregnancy test, ACE and ARBs CI

What changes should be made to AM's current regimen? Add Bumex increase the Toprol XL Increase the lisinopril dose Add digoxin Add Accupril

increase the Toprol XL

Which potassium chloride formulation can be cut and/or dissolved in water? K-Tab potassium chloride formulation Micro-K

potassium chloride formulation