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? Inamrinone
5. 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 EXAM
13. Which of the following drugs if combined with enalapril would produce dangerous hyperkalemia?
STAGE A
At high risk of HF
but without structural
heart disease or
symptoms of HF
Structural
heart
disease
Development
of symptoms
of HF
-Treat hypertension
-Encourage smoking
cessation
-Treat lipid disorders
-Encourage regular
exercise
-Discourage alcohol
intake, illicit drug use
-Control metabolic
syndrome
THERAPY
GOALS
e.g.
-hypertension
-atherosclerotic disease
-diabetes
-obesity
-metabolic syndrome
-using cardiotoxins
-with family history of
cardiomyopathy
Patients with:
or
Patients
STAGE B
Structural heart
disease but without
signs or symptoms of
HF
e.g.:
-previous MI
-LV remodeling
including LVH and
low EF
-asymptomatic
valvular disease
Patients with
THERAPY
-All measures under Stage A
GOALS
DRUGS
-ACEI or ARB in appropriate
patients
-Beta-blockers in
appropriate patients
DRUGS
-ACEI or ARB in
appropriate patients
for vascular disease
or diabetes
STAGE C
Structural heart disease
with prior or current
symptoms of HF
e.g.:
-known structural
heart disease
-shortness of
breath and fatigue,
reduced exercise
tolerance
Patients with
and
THERAPY
GOALS
-All measures under Stages A and B
-Dietary salt reduction
DRUGS FOR
ROUTINE USE
-Diuretics for fluid retention
-ACEI
-Beta-blockers
DRUGS IN
SELECTED PATIENTS
-Aldosterone antagonists
-ARBs
-Digitalis
-Hydralazine, nitrates
DEVICES IN
SELECTED PATIENTS
-Biventricular pacing
-Implantable defibrillators
STAGE D
Refractory HF
requiring specialized
interventions
e.g.:
who have marked
symptoms at rest
despite maximal
medical
therapy
(e.g., those who are
recurrently
hospitalized or
cannot be safely
discharged from the
hospital without
specialized
interventions)
Patients
THERAPY
GOALS
-Appropriate measures
under Stages A, B, C
-Decision re: appropriate
level of care
OPTIONS
-Compassionate end-of-
life care/hospice
-Extraordinary measures

heart transplant
chronic inotropes
permanent
mechanical support
experimental
surgery or drugs

Refractory
symptoms of
HF at rest
Stages in the development of HF/recommended therapy by stages
At Risk for Heart Failure Heart Failure
AHA Guidelines
http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf