handout- l38 - workshop 13(1)

8/12/2019 Handout- l38 - Workshop 13(1)

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CVR Workshop

Tuesday, October 29, 2013

Laszlo Kerecsen M.D.

1. Which of the following drugs will reduce the number of available Na+ channels? Lidocaine

2. Which of the following drugs will increase calcium influx in Phase 2 of the cardiac action potential? inamrinone

3. A 44-year-old African-American woman with congestive heart failure complains of shortness of breath even at rest, impaired

hearing, and ankle edema. The best drug for her treatment will (you must figure out that the edema is the major problem and

that the best drug for this situation is loop diuretics: Loops will increase PGE synthesis*****

4. Which of the following drugs decreases the elimination of cAMP? Inamrinone5. Which of the following two drugs act by dilating the capacitance vessels? Furosemide and Nitroglycerin

A. The point of this question is to get you to think about the involvement of the veins in the drug interaction with body

6. Stopping the treatment with enalapril will: Decrease bradykinin concentration

7. Digitalis treatment in a patient will produce? miosis/**Mydriasis**/no change

8. Which of the following drugs would be beneficial in hypercalcemia? Furosemide

9. The drug which increases calcium excretion also will? Inhibit the Na+/K+/2Cl-

10. Which of the following drugs would be beneficial for a patient with calcium containing renal calculi? hydrochlorothiazide

11. Which of the following drugs would promote the development of renal calculi? Furosemide or ***acetazolamide****

12. Which of the following shows the cardiovascular effects of nifedipine? YOU WILL SEE TWO TABLE ANSWERS ON EXAM13. Which of the following drugs if combined with enalapril would produce dangerous hyperkalemia?


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STAGE AAt high risk of HF

but without structuralheart disease or

symptoms of HF

Structuralheart

disease

Developmentof symptoms

of HF

-Treat hypertension-Encourage smokingcessation-Treat lipid disorders-Encourage regular

exercise-Discourage alcoholintake, illicit drug use-Control metabolicsyndrome

THERAPY

GOALS

e.g.-hypertension-atherosclerotic disease-diabetes-obesity-metabolic syndrome

-using cardiotoxins-with family history of

cardiomyopathy

Patients with:

or

Patients

STAGE BStructural heart

disease but withoutsigns or symptoms of

HF

e.g.:-previous MI-LV remodelingincluding LVH andlow EF-asymptomaticvalvular disease

Patients with

THERAPY

-All measures under Stage A

GOALS

DRUGS

-ACEI or ARB in appropriatepatients-Beta-blockers inappropriate patients

DRUGS

-ACEI or ARB inappropriate patientsfor vascular diseaseor diabetes

STAGE CStructural heart disease

with prior or currentsymptoms of HF

e.g.:-known structuralheart disease

-shortness ofbreath and fatigue,reduced exercisetolerance

Patients with

and

THERAPY

GOALS

-All measures under Stages A and B-Dietary salt reduction

DRUGS FORROUTINE USE

-Diuretics for fluid retention-ACEI

-Beta-blockersDRUGS IN

SELECTED PATIENTS-Aldosterone antagonists-ARBs-Digitalis-Hydralazine, nitrates

DEVICES INSELECTED PATIENTS

-Biventricular pacing-Implantable defibrillators

STAGE DRefractory HF

requiring specializedinterventions

e.g.:who have markedsymptoms at restdespite maximalmedicaltherapy(e.g., those who arerecurrentlyhospitalized orcannot be safely

discharged from thehospital withoutspecializedinterventions)

Patients

THERAPY

GOALS

-Appropriate measuresunder Stages A, B, C-Decision re: appropriatelevel of care

OPTIONS

-Compassionate end-of-life care/hospice-Extraordinary measures

heart transplantchronic inotropes

permanentmechanical supportexperimental

surgery or drugs

Refractorysymptoms of

HF at rest

Stages in the development of HF/recommended therapy by stages

At Risk for Heart Failure Heart Failure

AHA Guidelines


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http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdfhttp://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf


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handout- l38 - workshop 13(1)

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