NR508 Midterm study guide exam questions |\ |\ |\ |\ |\ |\
with answers |\
First line tx for CHF - CORRECT ANSWERS ✔✔ACEIs or ARBs, loop
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
diuretics, beta blockers |\ |\
ACEs and ARBs have been shown to decrease____ in CHF patients -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔mortality |\ |\
AA Tx for CHF - CORRECT ANSWERS ✔✔hydralazine + nitrates
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
(isosorbide dinatrate) |\
When should beta blockers be started in CHF patients - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔When stable on ACEIs, especially with low diastolic HF
|\ |\ |\ |\ |\ |\ |\ |\ |\
Loop diuretics are inhibited by what medication - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔NSAIDs
Does digoxin improve mortality in CHF patients? - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔No, but it does decrease symptoms and reduce hospital readmissions
|\ |\ |\ |\ |\ |\ |\ |\ |\
When should digoxin be used in heart failure patients - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔Only with systolic HF and Afib
|\ |\ |\ |\ |\ |\
,If giving lasix with digoxin, you should add _____ - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔spirinolactone to reduce risk of toxicity d/t hypokalemia |\ |\ |\ |\ |\ |\ |\
Sx of digoxin toxicity and Tx - CORRECT ANSWERS ✔✔Sx: SVT with AV
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
blocks, yellow/green/halo vision |\ |\
Tx: antidigitalis FAB antibodies and correction of hypokalemia
|\ |\ |\ |\ |\ |\ |\
If lasix not effective for fluid retention in CHF, add - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔spirinolactone or eplerenone if spirinolactone not tolerated |\ |\ |\ |\ |\ |\
When should a CCB be utilized in CHF and which ones should be used? -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔Only if needed for angina or hypertension and if
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
EF is preserved. May use amlodipine or felodipine
|\ |\ |\ |\ |\ |\ |\
Common ACEI medications - CORRECT ANSWERS ✔✔Benazapril,
|\ |\ |\ |\ |\ |\ |\
Captopril, Enalapril, Lisinopril, Quinapril, Ramipril |\ |\ |\ |\
Uses of ACEIs - CORRECT ANSWERS ✔✔HPTN, CHF, Proteinuria, Diabetic
|\ |\ |\ |\ |\ |\ |\ |\ |\
nephropathy, prevent unfavorable heart remodeling as result of chronic
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
HPTN
MOA of ACEIs - CORRECT ANSWERS ✔✔ACEIs inhibit ACE which
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
converts Angiotensin I to Angiotensin II. This prevents the actions of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Angiotensin II which are vasoconstriction and Na2+ and H2O rentention.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ACEIs also inhibit the breakdown of bradykinin. Bradykinin causes
|\ |\ |\ |\ |\ |\ |\ |\ |\
vasodilation which leaded to reduced SVR and increased CO. |\ |\ |\ |\ |\ |\ |\ |\
, Side effects of ACEIs - CORRECT ANSWERS ✔✔Cough, angioedema, fetal
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
renal malformations, increased GFR and creatinine, hyperkalemia, and
|\ |\ |\ |\ |\ |\ |\ |\
hypotension
ACEIs are contraindicated in - CORRECT ANSWERS ✔✔bilateral renal
|\ |\ |\ |\ |\ |\ |\ |\ |\
artery stenosis and C1 esterase inhibitor deficiency
|\ |\ |\ |\ |\ |\
ACEIs are ____ effective in AAs and they have a(n) _____ risk for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
angioedema - CORRECT ANSWERS ✔✔less, increased |\ |\ |\ |\ |\
If an ACEIs is not tolerated/contraindicated give - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔ARBs
Which antihypertensives are contraindicated in patients which asthma or
|\ |\ |\ |\ |\ |\ |\ |\ |\
COPD? - CORRECT ANSWERS ✔✔non-selective beta blockers can cause
|\ |\ |\ |\ |\ |\ |\ |\ |\
bronchospam. They include propranolol, pindolol, nadolol, sotalol, timolol, |\ |\ |\ |\ |\ |\ |\ |\
carvidelol, and labetalol. |\ |\
MOA of digoxin - CORRECT ANSWERS ✔✔Digoxin slows down the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Na2+/K+ ATPase pump. Na2+ builds up in cell and then leaves via the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Na2+/Ca2+ exchange instead. Ca2+ then builds up in the cell, leading to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
increased inotrophy (contractility). Increased contractility results in increased
|\ |\ |\ |\ |\ |\ |\
cardiac output and slight diuresis. Digoxin also increased the activity of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
vagus nerve, leading to decreased heart rate d/t decreased conduction
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
through the AV node. |\ |\ |\
with answers |\
First line tx for CHF - CORRECT ANSWERS ✔✔ACEIs or ARBs, loop
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
diuretics, beta blockers |\ |\
ACEs and ARBs have been shown to decrease____ in CHF patients -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔mortality |\ |\
AA Tx for CHF - CORRECT ANSWERS ✔✔hydralazine + nitrates
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
(isosorbide dinatrate) |\
When should beta blockers be started in CHF patients - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔When stable on ACEIs, especially with low diastolic HF
|\ |\ |\ |\ |\ |\ |\ |\ |\
Loop diuretics are inhibited by what medication - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔NSAIDs
Does digoxin improve mortality in CHF patients? - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔No, but it does decrease symptoms and reduce hospital readmissions
|\ |\ |\ |\ |\ |\ |\ |\ |\
When should digoxin be used in heart failure patients - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔Only with systolic HF and Afib
|\ |\ |\ |\ |\ |\
,If giving lasix with digoxin, you should add _____ - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔spirinolactone to reduce risk of toxicity d/t hypokalemia |\ |\ |\ |\ |\ |\ |\
Sx of digoxin toxicity and Tx - CORRECT ANSWERS ✔✔Sx: SVT with AV
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
blocks, yellow/green/halo vision |\ |\
Tx: antidigitalis FAB antibodies and correction of hypokalemia
|\ |\ |\ |\ |\ |\ |\
If lasix not effective for fluid retention in CHF, add - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔spirinolactone or eplerenone if spirinolactone not tolerated |\ |\ |\ |\ |\ |\
When should a CCB be utilized in CHF and which ones should be used? -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔Only if needed for angina or hypertension and if
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
EF is preserved. May use amlodipine or felodipine
|\ |\ |\ |\ |\ |\ |\
Common ACEI medications - CORRECT ANSWERS ✔✔Benazapril,
|\ |\ |\ |\ |\ |\ |\
Captopril, Enalapril, Lisinopril, Quinapril, Ramipril |\ |\ |\ |\
Uses of ACEIs - CORRECT ANSWERS ✔✔HPTN, CHF, Proteinuria, Diabetic
|\ |\ |\ |\ |\ |\ |\ |\ |\
nephropathy, prevent unfavorable heart remodeling as result of chronic
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
HPTN
MOA of ACEIs - CORRECT ANSWERS ✔✔ACEIs inhibit ACE which
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
converts Angiotensin I to Angiotensin II. This prevents the actions of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Angiotensin II which are vasoconstriction and Na2+ and H2O rentention.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ACEIs also inhibit the breakdown of bradykinin. Bradykinin causes
|\ |\ |\ |\ |\ |\ |\ |\ |\
vasodilation which leaded to reduced SVR and increased CO. |\ |\ |\ |\ |\ |\ |\ |\
, Side effects of ACEIs - CORRECT ANSWERS ✔✔Cough, angioedema, fetal
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
renal malformations, increased GFR and creatinine, hyperkalemia, and
|\ |\ |\ |\ |\ |\ |\ |\
hypotension
ACEIs are contraindicated in - CORRECT ANSWERS ✔✔bilateral renal
|\ |\ |\ |\ |\ |\ |\ |\ |\
artery stenosis and C1 esterase inhibitor deficiency
|\ |\ |\ |\ |\ |\
ACEIs are ____ effective in AAs and they have a(n) _____ risk for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
angioedema - CORRECT ANSWERS ✔✔less, increased |\ |\ |\ |\ |\
If an ACEIs is not tolerated/contraindicated give - CORRECT ANSWERS
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
✔✔ARBs
Which antihypertensives are contraindicated in patients which asthma or
|\ |\ |\ |\ |\ |\ |\ |\ |\
COPD? - CORRECT ANSWERS ✔✔non-selective beta blockers can cause
|\ |\ |\ |\ |\ |\ |\ |\ |\
bronchospam. They include propranolol, pindolol, nadolol, sotalol, timolol, |\ |\ |\ |\ |\ |\ |\ |\
carvidelol, and labetalol. |\ |\
MOA of digoxin - CORRECT ANSWERS ✔✔Digoxin slows down the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Na2+/K+ ATPase pump. Na2+ builds up in cell and then leaves via the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Na2+/Ca2+ exchange instead. Ca2+ then builds up in the cell, leading to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
increased inotrophy (contractility). Increased contractility results in increased
|\ |\ |\ |\ |\ |\ |\
cardiac output and slight diuresis. Digoxin also increased the activity of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
vagus nerve, leading to decreased heart rate d/t decreased conduction
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
through the AV node. |\ |\ |\
