DRUG THERAPHY FOR HEART FAILURE WORKMAN AND LACHARITY UNDERSTANDING
PHARMACOLOGY
Chapter 17: Drug Therapy for Heart Failure
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication
Safety, 2nd Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1. What does the term “afterload” mean?
a. The amount of blood entering the left ventricle that must be pumped out of the
heart
b. The peripheral resistance of the arterial system, including mean arterial pressure
c. The ability of the living muscle fibers of the heart to contract and pump blood
d. The percentage of blood pumped out of the heart with each heartbeat
ANS: B
Afterload is the pressure in the aorta that the left ventricle must overcome before blood can
move from it into the aorta. Mean arterial pressure (MAP) is also the pressure that the left
ventricle must overcome to move blood from the left ventricle into the aorta during
contraction (afterload). Afterload increases because of increased peripheral resistance usually
as a result of high blood pressure.
DIF: Cognitive Level: Remembering REF: p. 274
2. What is the most common cause of heart failure?
a. High blood pressure
b. Low blood pressure
c. Defective heart valves
d. Defective coronary arteries
ANS: A
Most heart failure is caused by hypertension. Other causes of heart failure include myocardial
infarction, coronary artery disease, cardiomyopathy, substance abuse (alcohol and illicit or
prescribed drugs), heart valve disease, congenital defects, cardiac infections and
inflammations, and conditions that increase cardiac output and energy demands such as sepsis.
DIF: Cognitive Level: Remembering REF: p. 278
3. What is the main physiological problem in most types of heart failure?
a. Overstretching of the right ventricle so that too much blood leaves the heart
b. Overstretching of the right ventricle so that too little blood leaves the heart
c. Overstretching of the left ventricle so that too much blood leaves the heart
d. Overstretching of the left ventricle so that too little blood leaves the heart
ANS: D
The muscle of the left ventricle becomes overstretched. When any muscle is overstretched, its
contraction is weaker. When the muscles of the left ventricle are overstretched or flabby and
the contraction is weak, too much blood remains in the left ventricle, and more blood arriving
from the left atrium is added to it. This overstretches the muscle more and continues to
weaken contractions, leading to heart failure.
, DIF: Cognitive Level: Remembering REF: p. 274
4. Which symptom occurs with only pure right-sided heart failure and does not occur with pure
left-sided heart failure?
a. Confusion
b. Shortness of breath
c. Decreased afterload
d. Swelling in the ankles and legs
ANS: D
When the right ventricle contracts poorly, signs and symptoms of peripheral congestion occur
(Box 17-2 in text) such as weight gain, swelling in the legs, jugular vein distention (Figure 17-
4 in text), and increased blood pressure.
DIF: Cognitive Level: Remembering REF: p. 276, Box 17-2
5. Which statement about drug therapy for heart failure is true?
a. The drugs work only directly on the heart muscle.
b. Drug therapy improves heart function but does not cure heart failure.
c. When heart function returns to normal, the drug therapy can be stopped.
d. Drug therapy for heart failure does not work when the patient continues to smoke.
ANS: B
Drug therapy only improves heart function; drugs do not cure heart failure. Because the
damage to the heart muscle is not reversible, the only real cure for heart failure is a heart
transplant.
DIF: Cognitive Level: Remembering REF: p. 277
6. What is a common side effect of hydralazine (Apresoline) therapy for heart failure?
a. Tachycardia
b. High blood pressure
c. Constipation
d. Difficulty sleeping
ANS: A
Common side effects of hydralazine include tachycardia and salt retention.
DIF: Cognitive Level: Remembering REF: p. 280
7. How should sublingual nitroglycerin tablets for heart failure be taken?
a. On a full stomach
b. On an empty stomach
c. Dissolved under the tongue
d. Placed under a patch on the chest
ANS: C
Sublingual means to place the drug under the tongue. Remind patients that sublingual
nitroglycerin should be kept in place until dissolved.
DIF: Cognitive Level: Remembering REF: p. 281
, 8. What is the mechanism of action for cardiac glycosides?
a. Slowing the heart rate and increasing the force of the heart muscle contraction
b. Increasing the heart rate and decreasing the force of the heart muscle contraction
c. Directly relaxing blood vessel muscles and decreasing afterload
d. Directly constricting blood vessel muscles and increasing afterload
ANS: A
Cardiac glycosides are a class of drugs that improve heart failure by slowing down a heart rate
that is too fast, allowing more time for the left ventricle to fill. They also work on the muscle
fibers in the heart and increase the force of each heartbeat (contractility).
DIF: Cognitive Level: Remembering REF: pp. 281-282
9. What is the most common side effect of cardiac glycoside drugs for heart failure therapy?
a. Abdominal cramping and constipation
b. Heart rhythm disturbances
c. High blood pressure
d. Skin rashes
ANS: B
The most common side effects of digoxin (Lanoxin), a cardiac glycoside, are heart rhythm
disturbances that are related to digoxin toxicity. Other common side effects to watch for
include fatigue, bradycardia (slow heart rate less than 60 beats/min), anorexia (loss of
appetite), nausea, and vomiting.
DIF: Cognitive Level: Remembering REF: p. 282
10. Which drug for heart failure is a common positive inotrope?
a. Amiloride (Midamor)
b. Nesiritide (Natrecor)
c. Captopril (Capoten)
d. Dobutamine (Dobutrex)
ANS: D
Dobutamine (Dobutrex) is a positive inotrope. This drug is a heart pump drug that makes the
heart muscle contract more forcefully. It also relaxes blood vessels so blood can flow better.
DIF: Cognitive Level: Remembering REF: p. 285
11. When are vasodilator drugs usually prescribed for heart failure?
a. When angiotensin-converting enzyme (ACE) inhibitors cannot be taken
b. When venous dilation is also needed
c. When beta blockers are also being taken
d. When heart failure is improving
ANS: A
Vasodilators act directly on the peripheral arteries, causing them to dilate, which leads to
decreased blood pressure and workload on the heart. When patients cannot take ACE
inhibitors or angiotensin II receptor blockers, vasodilators are often prescribed.
DIF: Cognitive Level: Remembering REF: p. 279
PHARMACOLOGY
Chapter 17: Drug Therapy for Heart Failure
Workman & LaCharity: Understanding Pharmacology: Essentials for Medication
Safety, 2nd Edition
MULTIPLE CHOICE
BASIC CONCEPTS
1. What does the term “afterload” mean?
a. The amount of blood entering the left ventricle that must be pumped out of the
heart
b. The peripheral resistance of the arterial system, including mean arterial pressure
c. The ability of the living muscle fibers of the heart to contract and pump blood
d. The percentage of blood pumped out of the heart with each heartbeat
ANS: B
Afterload is the pressure in the aorta that the left ventricle must overcome before blood can
move from it into the aorta. Mean arterial pressure (MAP) is also the pressure that the left
ventricle must overcome to move blood from the left ventricle into the aorta during
contraction (afterload). Afterload increases because of increased peripheral resistance usually
as a result of high blood pressure.
DIF: Cognitive Level: Remembering REF: p. 274
2. What is the most common cause of heart failure?
a. High blood pressure
b. Low blood pressure
c. Defective heart valves
d. Defective coronary arteries
ANS: A
Most heart failure is caused by hypertension. Other causes of heart failure include myocardial
infarction, coronary artery disease, cardiomyopathy, substance abuse (alcohol and illicit or
prescribed drugs), heart valve disease, congenital defects, cardiac infections and
inflammations, and conditions that increase cardiac output and energy demands such as sepsis.
DIF: Cognitive Level: Remembering REF: p. 278
3. What is the main physiological problem in most types of heart failure?
a. Overstretching of the right ventricle so that too much blood leaves the heart
b. Overstretching of the right ventricle so that too little blood leaves the heart
c. Overstretching of the left ventricle so that too much blood leaves the heart
d. Overstretching of the left ventricle so that too little blood leaves the heart
ANS: D
The muscle of the left ventricle becomes overstretched. When any muscle is overstretched, its
contraction is weaker. When the muscles of the left ventricle are overstretched or flabby and
the contraction is weak, too much blood remains in the left ventricle, and more blood arriving
from the left atrium is added to it. This overstretches the muscle more and continues to
weaken contractions, leading to heart failure.
, DIF: Cognitive Level: Remembering REF: p. 274
4. Which symptom occurs with only pure right-sided heart failure and does not occur with pure
left-sided heart failure?
a. Confusion
b. Shortness of breath
c. Decreased afterload
d. Swelling in the ankles and legs
ANS: D
When the right ventricle contracts poorly, signs and symptoms of peripheral congestion occur
(Box 17-2 in text) such as weight gain, swelling in the legs, jugular vein distention (Figure 17-
4 in text), and increased blood pressure.
DIF: Cognitive Level: Remembering REF: p. 276, Box 17-2
5. Which statement about drug therapy for heart failure is true?
a. The drugs work only directly on the heart muscle.
b. Drug therapy improves heart function but does not cure heart failure.
c. When heart function returns to normal, the drug therapy can be stopped.
d. Drug therapy for heart failure does not work when the patient continues to smoke.
ANS: B
Drug therapy only improves heart function; drugs do not cure heart failure. Because the
damage to the heart muscle is not reversible, the only real cure for heart failure is a heart
transplant.
DIF: Cognitive Level: Remembering REF: p. 277
6. What is a common side effect of hydralazine (Apresoline) therapy for heart failure?
a. Tachycardia
b. High blood pressure
c. Constipation
d. Difficulty sleeping
ANS: A
Common side effects of hydralazine include tachycardia and salt retention.
DIF: Cognitive Level: Remembering REF: p. 280
7. How should sublingual nitroglycerin tablets for heart failure be taken?
a. On a full stomach
b. On an empty stomach
c. Dissolved under the tongue
d. Placed under a patch on the chest
ANS: C
Sublingual means to place the drug under the tongue. Remind patients that sublingual
nitroglycerin should be kept in place until dissolved.
DIF: Cognitive Level: Remembering REF: p. 281
, 8. What is the mechanism of action for cardiac glycosides?
a. Slowing the heart rate and increasing the force of the heart muscle contraction
b. Increasing the heart rate and decreasing the force of the heart muscle contraction
c. Directly relaxing blood vessel muscles and decreasing afterload
d. Directly constricting blood vessel muscles and increasing afterload
ANS: A
Cardiac glycosides are a class of drugs that improve heart failure by slowing down a heart rate
that is too fast, allowing more time for the left ventricle to fill. They also work on the muscle
fibers in the heart and increase the force of each heartbeat (contractility).
DIF: Cognitive Level: Remembering REF: pp. 281-282
9. What is the most common side effect of cardiac glycoside drugs for heart failure therapy?
a. Abdominal cramping and constipation
b. Heart rhythm disturbances
c. High blood pressure
d. Skin rashes
ANS: B
The most common side effects of digoxin (Lanoxin), a cardiac glycoside, are heart rhythm
disturbances that are related to digoxin toxicity. Other common side effects to watch for
include fatigue, bradycardia (slow heart rate less than 60 beats/min), anorexia (loss of
appetite), nausea, and vomiting.
DIF: Cognitive Level: Remembering REF: p. 282
10. Which drug for heart failure is a common positive inotrope?
a. Amiloride (Midamor)
b. Nesiritide (Natrecor)
c. Captopril (Capoten)
d. Dobutamine (Dobutrex)
ANS: D
Dobutamine (Dobutrex) is a positive inotrope. This drug is a heart pump drug that makes the
heart muscle contract more forcefully. It also relaxes blood vessels so blood can flow better.
DIF: Cognitive Level: Remembering REF: p. 285
11. When are vasodilator drugs usually prescribed for heart failure?
a. When angiotensin-converting enzyme (ACE) inhibitors cannot be taken
b. When venous dilation is also needed
c. When beta blockers are also being taken
d. When heart failure is improving
ANS: A
Vasodilators act directly on the peripheral arteries, causing them to dilate, which leads to
decreased blood pressure and workload on the heart. When patients cannot take ACE
inhibitors or angiotensin II receptor blockers, vasodilators are often prescribed.
DIF: Cognitive Level: Remembering REF: p. 279
