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CHF Part 2 (all but comborbidities) - Andrews

Total questions: 92

Worksheet time: 46mins

Name
Class
Date
1.
What drugs induce or exacerbate HF by having negative inotropic effects
a)
Non-DHP CCB (verapamil, diltiazem)
b)
NSAIDs, COX-2 inhibitors
c)
androgens, estrogens, glucocorticoids
d)
thiazolidinediones (rosiglitazone, pioglitazone)
2.
What drugs induce or exacerbate HF through sodium and water retention
a)
Non-DHP CCB (verapamil, diltiazem)
b)
NSAIDs, COX-2 inhibitors
c)
androgens, estrogens, glucocorticoids
d)
thiazolidinediones (rosiglitazone, pioglitazone)
3.
What drugs induce or exacerbate HF for miscellaneous reasons
a)
DPP4 inhibitors (alogliptin and saxagliptin)
b)
cilostazol
c)
sympathomimetic (cocaine, caffeine)
4.
If a patient with HF must be on an antiarrhythmic agent with negative inotropic effects, which drugs are preferred
a)
amiodarone
b)
dofetilide
c)
NSAIDs
d)
rosiglitazone
e)
pioglitazone
5.
Ejection Fraction (EF) less than 40% is a diagnosis of HFrEF
a)
True
b)
False
6.
Drug therapy has clear evidence that drugs improve outcomes for patients with HFpEF
a)
True
b)
False
7.
Evidence to suggest improvement in prognosis is overwhelming for patients with HFrEF
a)
True
b)
False
8.
Drugs used for HFrEF are also used for HFpEF (or HFmrEF) to treat symptoms or modify risk factors such as HTN
a)
True
b)
False
9.
What drugs decrease the morbidity and mortality of HF
a)
beta blockers, ACE/ARB
b)
Angiotensin Receptor Neprilysin Inhibitor (ARNI)
c)
hydralazine and nitrates
d)
mineralcorticoid/Aldosterone Receptor Antagonists
e)
sodium glucose co-transporter 2
10.
What drugs decrease the symptoms of HF only
a)
beta blockers, ACE/ARB
b)
diuretics
c)
digoxin
d)
ivabradine
e)
sodium glucose co-transporter 2
11.
Beta blockers are recommended in ___ with current or prior symptoms ___
a)
all patients with HFrEF, unless contraindicated
b)
female patients with HFrEF, unless contraindicated
c)
male patients with HFrEF, unless contraindicated
d)
all patients with HFrEF, no matter what
e)
female patients with HFrEF, no matter what
12.
All of the following are benefits of beta-blockers being added to an ACE inhibitor EXCEPT
a)
decreased hospitalizations
b)
decreased mortality
c)
symptom improvement
d)
improved clinical status
e)
Contraindicate them
13.
Carvedilol provides
a)
alpha 2-blockade
b)
beta 1- blockade
c)
Mixed blockade (alpha 1, beta 1 and beta 2)
14.
How to beta blockers help decrease the morbidity and mortality of HF (SATA)
a)
decreases ventricular arrhythmias
b)
decreases cardiac hypertrophy and cardiac cell death
c)
decreases vasoconstriction and HR
d)
decreases atrial remodeling
15.
What is the target dose of Carvedilol (Coreg and Coreg CR) for HF
a)
50 mg bid
b)
25 mg bid if less than or equal to 85 kg
c)
80 mg daily for CR
d)
200 mg daily
e)
10 mg daily
16.
What is the target dose of Metoprolol Succinate for HF
a)
50 mg bid
b)
25 mg bid if less than or equal to 85 kg
c)
80 mg daily
d)
200 mg daily
e)
10 mg daily
17.
What is the target dose of Bisoprolol for HF
a)
50 mg bid
b)
25 mg bid if less than or equal to 85 kg
c)
80 mg daily
d)
200 mg daily
e)
10 mg daily
18.
When starting a patient on a beta blocker for HF, you should
a)
start low and double the dose every 2 weeks or as tolerated to target dose
b)
start with half a dose and double after 2 weeks or as tolerated to target dose
c)
start full dose
19.
A low dose beta blocker can be added to a HF patient's existing ACEi therapy (select 2)
a)
when HF symptoms are stable
b)
when HF symptoms are exacerbated
c)
patient is euvolemic
d)
patient is hypervolemic
e)
patient is hypovolemic
20.
In patient's with HF, beta blockers should be discontinued immediately if symptoms do not improve right away
a)
True
b)
False
21.
In patients taking higher doses of beta blocker for HF, if hypotension alone is a concern, what drug should be reduced first
a)
beta blocker
b)
ACE inhibitor
c)
ARB
22.
ACE inhibitors prevent the activity of ACE and the formation of ATII in order to derease production of aldosterone and vasopressin. How does this help patient's with HF (select 2)
a)
reduction in arterial blood pressure
b)
reduction in venous blood pressure
c)
reduction in afterload
d)
reduction in preload
23.
ACE inhibitors are recommended in all patients with ___ due to ___ and _____ (select 3)
a)
HFrEF
b)
HFpEF
c)
decreased hospitalization
d)
decreased mortality
e)
curing HF
24.
When starting a patient on an ACEi for HF, you should
a)
start low and double the dose every 1-4 weeks to target dose
b)
start with half a dose and double after 1-4 weeks to target dose
c)
start full dose
25.
When starting an ACEi for patients with HF, the patient may noticed symptom improvement in several weeks
a)
True
b)
False
26.
What are some contraindications of ACEi for HF patients
a)
patients who have experienced angioedema
b)
patients who are pregnant or plan to become pregnant
c)
patients who are on beta blockers
d)
patients who have HTN and HF
27.
All of the folling should be considered caustiously when starting a HF patient on an ACEi EXCEPT
a)
systolic BP < 80 mmHg
b)
SCr > 3 mg/dL
c)
elevated K; > 5 mEq/L
d)
bilateral renal artery stenosis
e)
HTN present
28.

What needs to be monitored when a HF patient starts on ACEi or has a dose adjustment (select 2)

a)

SCr

b)

K+

c)

Glucose levels

d)

Sodium levels

e)

blood serum plasma

29.
The CHARM study suggests additive benefit of ARB and ACEi and is currently recommended for patients with severe HF
a)
True
b)
False
30.
When would an ARB be recommended to patients with HFrEF with current or prior symptoms over an ACEi
a)
people who prefer ARBs
b)
people who are unable to tolerate ACEi
c)
people who are unable to tolerate beta blockers
31.
What is the recommended initial daily dosing and target dose of Candesartan
a)
4-8 mg QD
b)
32 mg QD
c)
25-50 mg QD
d)
50-150 mg QD
e)
40 mg BID
32.
What is the recommended initial daily dosing and target dose of Losartan
a)
4-8 mg QD
b)
32 mg QD
c)
25-50 mg QD
d)
50-150 mg QD
e)
40 mg BID
33.
What is the recommended initial daily dosing and target dose of Valsartan
a)
160 mg BID
b)
32 mg QD
c)
25-50 mg QD
d)
50-150 mg QD
e)
40 mg BID
34.
What did the ASTRONAUT trial in 2013 showed that a direct renin inhibitor ____ in patients with HF
a)
showed no benefit
b)
showed great benefit
c)
showed minimal benefit
d)
was inconclusive
35.
In the PARADIGM-HF Trial, Entresto was shown to reduce the risk of ____ for heart failure in patients with HFrEF
a)

hospitalization and cardiovascular death

b)

fluid retention

c)

kidney damage

d)

vascular remodeling

36.
What are the different doses of Sacubitril
a)
24 mg
b)
49 mg
c)
97 mg
d)
26 mg
e)
51 mg
37.
What are the different doses of Valsartan
a)
103 mg
b)
49 mg
c)
97 mg
d)
26 mg
e)
51 mg
38.
Valsartan in Entresto is less bioavailable than valsartan in other tablet formulations
a)
True
b)
False
39.

What monitoring ARNI all of the following should be considered EXCEPT

a)

BP

b)

K+

c)

renal function

d)

s/sx of HF and angioedema

e)

Urea levels

40.

All of the following are contraindications for ARNIs EXCEPT

a)

concomitant use of an ACEi/ARB

b)

36-hours washout period of an ACEi when starting ARNI

c)

36-hrs washout period with an ARB when starting ARNI

d)

no washout period required with an ARB

e)

h/o angioedema

41.
Hydralazine/Isosorbide Dinitrate is recommended for patients with HFrEF self-described as _____ with NYHA class III-IV
a)
African American
b)
Native American
c)
Asian American
d)
Caucasian
42.

What is hydralazine in hydralazine/isosorbide dinitrate's method of action in heart failure (select 2)

a)

arterial vasodilator: reduces afterload

b)

enhances effect of nitrates through antioxidant mechanisms

c)

stimulates nitric acid signaling in the endothelium

d)

effective in reducing preload

43.
What is isosorbide dinitrate in hydralazine/isosorbide dinitrate's method of action in heart failure
a)
arterial vasodilator: reduces afterload
b)
enhances effect of nitrates through antioxidant mechanisms
c)
stimulates nitric acid signaling in the endothelium
d)
effective in reducing preload
44.

Sacubitril ___ neprilysin

a)

increases

b)

decreases

c)

does not change

d)

inhibits

45.
Which drug therapy blocks the SNS system to decrease heart rate, contractility, and vasoconstriction
a)
beta blocker
b)
ACE inhibitor, ARBs, ARA
c)
loop diuretics
d)
digoxin
e)
sacubitril
46.
Which drug therapy blocks the RAAS system to decrease vasoconstriction and fluid retention
a)
beta blocker
b)
ACE inhibitor, ARBs, ARA
c)
loop diuretics
d)
digoxin
e)
sacubitril
47.
Which drug therapy blocks fluid retention in the body directly
a)
beta blocker
b)
ACE inhibitor, ARBs, ARA
c)
loop diuretics
d)
digoxin
e)
sacubitril
48.
Which drug therapy increases the cardiac output of the heart by increasing positive ionotrope
a)
beta blocker
b)
ACE inhibitor, ARBs, ARA
c)
loop diuretics
d)
digoxin
e)
sacubitril
49.
Which drug therapy increases the natriuretic peptides in the body to increase vasodilation for patients with HF
a)
beta blocker
b)
ACE inhibitor, ARBs, ARA
c)
loop diuretics
d)
digoxin
e)
sacubitril
50.
Which drugs do not reduce morbidity/mortality for patients with HF
a)
beta blocker
b)
ACE inhibitor, ARBs, ARA
c)
loop diuretics
d)
digoxin
e)
sacubitril
51.
What is the dosage for fixed-dose BiDil
a)
hydralazine 37.5 mg
b)
isosorbide dinitrate 20 mg
c)
hydralazine 20 mg
d)
isosorbide dinitrate 37.5
52.
What is the dosing regimen for hydralazine
a)
25-75 mg three or four times a day
b)
10-40 mg three times daily
c)
start with 1 tablet TID and titrate to 2 tablets TID
d)
25-75 mg two to three times daily
e)
10-40 mg two times daily
53.
What is the dosing regimen for isosorbide dinitrate
a)
25-75 mg three or four times a day
b)
10-40 mg three times daily
c)
start with 1 tablet TID and titrate to 2 tablets TID
d)
25-75 mg two to three times daily
e)
10-40 mg two times daily
54.
What is the dosing regimen for BiDil
a)
25-75 mg three or four times a day
b)
10-40 mg three times daily
c)
start with 1 tablet TID and titrate to 2 tablets TID
d)
25-75 mg two to three times daily
e)
10-40 mg two times daily
55.

All of the following should be monitored when a HF patient starts or is adjusted on Hydralazine/Isosorbide Dinitrate EXCEPT

a)

headache

b)

hypotension

c)

drug-induced lupus erythematous

d)

hypertension

56.
When are aldosterone receptor antagonists (ARAs) recommended for use in HF patients
a)
NYHA class II-IV
b)
NYHA class III-IV
c)
NYHA class II-III
57.
Do not start HF patients on ARA therapy under any of these conditions:
a)
K > 5 mEq/L
b)
eGFR < 30 mL/min/1.73 m^2
c)
SCr > 2.5 mg/dL (males)
d)
SCr > 2 mg/dL (females)
58.

Which of the following is NOT a MOA for ARAs

a)

decrease K and Mg loss (decrease ventricular arrhythmias)

b)

decrease Na retention (decrease fluid retention)

c)

eliminate catecholamine potentiation (decreases BP)

d)

blocks direct fibrotic actions on the myocardium

e)

increases catecholamines (stronger heart beat)

59.
What is the dosing regimen for Spironolactone
a)
12.5-25 mg/day
b)
25-50 mg/day
c)
25-100 mg/day
d)
12.5-50 mg/day
60.
What is the dosing regimen for Eplerenone
a)
12.5-25 mg/day
b)
25-50 mg/day
c)
25-100 mg/day
d)
12.5-50 mg/day
61.

When taking an aldosterone antagonist for HF, what needs to be monitored (select 2)

a)

gynecomastia

b)

abdominal distension

c)

K and SCr levles

d)

spironolactone may substitute eplerenone when there are painful adverse effects

62.
SGLT2 inhibitors are FDA approved in HFrEF without diabetes by demonstrating a decrease in
a)
morality
b)
hospitalizations
c)
weight loss
d)
urination
63.
What is the dosing regimen and guideline for Farxiga in patients with HF
a)
10 mg daily in the morning
b)
20 mg daily in the morning
c)
do not initiate if eGFR <30 mL/min/1.73 m^2
d)
do not initiate if eGFR <20 mL/min/1.73 m^2
64.
What is the dosing regimen and guideline for Jardiance in patients with HF
a)
10 mg daily in the morning
b)
20 mg daily in the morning
c)
do not initiate if eGFR <30 mL/min/1.73 m^2
d)
do not initiate if eGFR <20 mL/min/1.73 m^2
65.

What are some adverse effects of SGLT2 inhibitors for patients with HF (SATA)

a)

weight loss

b)

weight gain

c)

increased thirst

d)

increased urination

e)

decreased thirst

66.
Diuretic drugs are indicated in patients with evidence of
a)
fluid retention
b)
increased heart rate
c)
increased risk of heart failure
d)
increased blood sugar
67.
What does diuretics inhibit and where
a)

reabsorption of Na

b)

reabsorption of K

c)

ascending loop of Henle

d)

decending loop of Henle

e)

distal tubule

68.
What are some key points about dosing and administration of diuretics in patients with HF
a)
not to be used as a monotherapy
b)
start with low dose and double and titrate up according to pt's weight and diuresis
c)
for fluid overload-adjust therapy to result in 1-2 lbs of weight loss/day
d)
monitor and replace K and Mg as needed
69.
Loop diuretics are preferred for patients with HF and symptoms related to hypervolemia
a)
True
b)
False
70.
All patients with HF will require loop diuretic therapy
a)
True
b)
False
71.
Diuretics provide symptomatic relief and decreases mortality
a)
True
b)
False
72.

If a patient develops hypotension or increases in SCr while on ACEi and loop diuretics (select 2)

a)

decrease ACEi first

b)

decrease diuretic first

c)

maintain ACEi if possible

d)

maintain diuretic if possible

73.

Which of the following would not be an action taken in patients with diuretic resistance

a)

emphasize Na and fluid restriction

b)

increase loop diuretic dose to max recommended dose

c)

switch from oral dosing to parenteral dosing

d)

consider combining a second diuretic agent

e)

discontinue diuretic to reset body

74.

What should be monitored when a HF patient is on a loop diuretic (select 2)

a)

BUN, SCr, K

b)

orthostasis

c)

Na

d)

Glucose

e)

TG levels

75.
Which drugs are equivalent to each other
a)
40 mg Furosemide
b)
1 mg Bumetanide
c)
20 mg Torsemide
d)
20 mg Bumetanide
e)
1 mg Furosemide
76.
What is the ratio of Furosemide IV:PO
a)
1:2
b)
2:1
c)
1:1
77.
What is the ratio of Bumetanide and ethacrynic acid IV:PO
a)
1:2
b)
2:1
c)
1:1
78.
HCN channel blockers reduce the risk of hospitalization in which of the following patients:
a)
worsening HF pts w/ symptomatic (class II&III) stable, chronic HF with EF < or eq to 30%
b)
in sinus rhythm with Resting HR > or eq to 70 bpm
c)
on max tolerated doses of BB OR have a contraindication to BB use
79.

What is the initial dosing for a HCN channel blocker (select 2)

a)

5 mg BID

b)

2.5 mg BID

c)

7.5 mg BID

d)

3 mg BID

80.
After 2 weeks of initial dosing on an HCN for HF, the dose should be adjusted based on tolerability to achieve
a)
a resting heart rate b/w 50-60 bpm
b)
a systolic pressure < 130
c)
a diastolic pressure < 80
d)
a resting heart rate b/w 60-100 bpm
81.

Digoxin can be beneficial to patients with HF in all of the following ways EXCEPT

a)

decreasing hospitalizations

b)

decreasing symptoms

c)

improving exercise tolerance

d)

decreasing mortality

82.

Digoxin is a _____ and ___ and inhibits (3 apply)

a)

positive inotrope

b)

negative inotrope

c)

positive chronotrope

d)

negative chronotrope

e)

Na/K-ATPase

83.
Digoxin acting as a positive inotrope
a)
increases force of contraction
b)
increases cardiac output
c)
decreases rate of contraction
d)
increases filling time of ventricles
84.
Digoxin acting as a negative chronotrope
a)
increases force of contraction
b)
increases cardiac output
c)
decreases rate of contraction
d)
increases filling time of ventricles
85.
In most HF patients, what dosing regimen is recommended for Digoxin
a)
0.125 mg/day
b)
0.125 mg/every other day
c)
0.25 mg/day
d)
0.0625 mg/every other day
86.
Which patients would the normal dosing of Digoxin not be recommended (and instead it is recommended to dose 0.125 mg/every other day)
a)

>70 years

b)

<70 years

c)

renal insufficiency

d)

renal failure

e)

low lean body mass

87.
Digoxin concentrations increase with concomitant use of
a)
clarithromycin, erythromycin
b)
amiodarone, dronedarone
c)
itraconazole, posaconazole, voriconazole
d)
cyclosporine, tacrolimus
e)
verapamil
88.
What is the goal serum concentration for HF patients who are on digoxin
a)
K+: 4-5 mEq/L
b)
Mg+: >2 mEq/L
c)
K+: >2 mEq/L
d)
Mg+: 4-5 mEq/L
89.
What are the recommended serum concentrations of digoxin in patients with HF
a)

<4 ng/mL

b)

0.5-0.9 ng/mL

c)

<2 ng/mL

d)

<5 ng/mL

90.
What are some risks of taking Digoxin for patients with HF
a)
SCr should be monitored since 95% of the drug is cleared renally
b)
hyperkalemia
c)
risk of toxicity with increased age
91.

The risk of digoxin toxicity increases in all of the following EXCEPT

a)

with age and renal dysfunction

b)

presence of hypokalemia

c)

presence of hypomagnesemia

d)

hypercalcemia

e)

hypocalcemia

92.

Digoxin toxicity can be reversed using (select 2)

a)

Digibind

b)

potassium supplementation

c)

magnesium supplementation

d)

calcium supplements

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