Miscellaneous Quiz / CHF drugs

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QUIZ: Can you name the CHF drugs?

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B-type naturetic peptide drug
Reversibly inhibits the Na/K/ATPase which causes vagal nerve hyperpolarization and --> increased intracellular Ca and contraction
Watch dose in antibiotic use
MOA: inhibit aldosterone receptor and thus aldosterone-mediated increase in Na pump uptake of Na from lumen to blooc
Reduces preload and afterload --> decreased LVH and remodeling
Reduces mortality and improves CHF symptoms by blocking high levels of catecholamines --> decreased remodeling, upregulating beta receptors, decreasing HR, and decreases renin rele
Block angiotension type 1 (AT1) receptors without effects on bradykinin
Half life of 40 hours, steady state reached in 1 week
Given as a bolus followed by continuous infusion
Dosage related to creatinine clearance and body wt.
Class reserved for end-stage HF, refractory HF, and acute HF
B1 agonists - inotropes
B1 agonist SE
SE: n/v, thrombocytopenia, liver enzyme changes, bone marrow changes
Tx for hypovolemic MI
Start at low doses and work up slowly over weeks
DOC for refractory HF
Drugs that may increase dig toxicity
First line tx of CHF with reduced mortality
MOA: Inhibit NaCl transport in DCT preventing Na reabsorption
INdirect effect of digoxin
Released in response to ventricular pressure increases --> opposition of vasoconstrictor and Na and H2O retaining effects of S-ANS, RAAS --> decreased renin formation --> vasodilat
Treatment of Dig toxicity
Treats symptoms of CHF - dyspnea, orthopnea, edema, rales, JVD. Controls filling pressures
Phosphoesterase inhibitors - inotropes
Decreases ACE thus preventing conversion of angiotensin I --> angiotensin II and also inhibits breakdown of bradykinin --> decreased PVR without reflex --> decreased preload, after
Toxicity increased by HYPOkalemia
Direct effect of digoxin
Drugs that decrease afterload and preload
Methylxanthine phosphodiesterase inhibitor
Contraindicated in pregnancy and affected by NSAIDs
Tx of MI with severe shock
Class that increases cAMP mediated phosphorylation of voltage-gated Ca channels --> increased Ca conduction
Class used for LV systolic dysfunction
IV only for acute HF
SE: hyperkalemia, gonadal hormone issues (gynecomastia, decreased libido, hirsutism, impotence, menstrual irregularities), gastric dyspepsia and ulcers
MOA: inhibit Na-K-Cl exchanger in TAL
SE: increased SM tone of the gut, anorexia, diarrhea, hallucinations, visual disturbances, agitation, convulsions, gynecomastia, arrhythmias (AV junctional rhythm, bigeminy, PVCs,
Tx of MI with RV infarct, MR, and/or VSD
SE: direct decrease in LV function
SE: initial dose severe hypotension, RF, dry cough, angioedemia, hyperkalemia if RF present
Inotrope contraindicated in WPW. Usually used in rate contral and in the treatment of atrial arrhythmias
Cardiac glycoside - inotrope
Tx of MI with peripheral vasodilation
Digoxin has a wide OR narrow therapeutic window
Bipyridine phosphodiesterase inhibitor
Tx for MI with pulmonary congestion
Tx of MI with power failure (decreased atrial pressure, elevated LV filling pressure, decreased CO)

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