Pharm Heart Failure

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Pharm Heart Failure - Quiz

Heart failure is about as terrifying as it sounds, but suffering from it doesn’t necessarily mean the end every time. In this quiz, we’ll be looking at some of the means of treating this terrible condition with the use of pharmaceuticals. Let’s take a look and see how many questions you can get right.


Questions and Answers
  • 1. 

    Directions: questions 1-5 Match each drug used in cardiac failure with the appropriate description (each lettered option can be selected once, more than once, or not at all): This drug can cause peripheral vasodilation by increasing cAMP levels.

    • A.

      Captopril

    • B.

      Digoxin

    • C.

      Dobutamine

    • D.

      Furosemide

    • E.

      Losartan

    • F.

      Milrinone

    • G.

      Nesiritide

    • H.

      Propranolol

    • I.

      Spironolactone

    Correct Answer
    F. Milrinone
    Explanation
    Milrinone is a drug used in cardiac failure that can cause peripheral vasodilation by increasing cAMP levels.

    Rate this question:

  • 2. 

    Directions: questions 1-5 Match each drug used in cardiac failure with the appropriate description (each lettered option can be selected once, more than once, or not at all): This drug can increase the synthesis of cAMP in the heart

    • A.

      Captopril

    • B.

      Digoxin

    • C.

      Dobutamine

    • D.

      Furosemide

    • E.

      Losartan

    • F.

      Milrinone

    • G.

      Nesiritide

    • H.

      Propranolol

    • I.

      Spironolactone

    Correct Answer
    C. Dobutamine
    Explanation
    Dobutamine is the correct answer because it is a sympathomimetic drug that acts as a beta-1 adrenergic receptor agonist, which can increase the synthesis of cAMP in the heart.

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  • 3. 

    Directions: questions 1-5 Match each drug used in cardiac failure with the appropriate description (each lettered option can be selected once, more than once, or not at all): The chronic use of this diuretic can reduce mortality in patients with heart failure

    • A.

      Captopril

    • B.

      Digoxin

    • C.

      Dobutamine

    • D.

      Furosemide

    • E.

      Losartan

    • F.

      Milrinone

    • G.

      Nesiritide

    • H.

      Propranolol

    • I.

      Spironolactone

    Correct Answer
    I. Spironolactone
    Explanation
    Spironolactone is a diuretic that is commonly used in the treatment of heart failure. It works by blocking the effects of aldosterone, a hormone that can contribute to fluid retention in patients with heart failure. Studies have shown that chronic use of spironolactone can reduce mortality in patients with heart failure, making it an important medication in the management of this condition.

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  • 4. 

    Directions: questions 1-5 Match each drug used in cardiac failure with the appropriate description (each lettered option can be selected once, more than once, or not at all): This drug can cause peripheral vasodilation by increasing the synthesis of cGMP

    • A.

      Captopril

    • B.

      Digoxin

    • C.

      Dobutamine

    • D.

      Furosemide

    • E.

      Losartan

    • F.

      Milrinone

    • G.

      Nesiritide

    • H.

      Propranolol

    • I.

      Spironolactone

    Correct Answer
    G. Nesiritide
    Explanation
    Nesiritide is the correct answer because it can cause peripheral vasodilation by increasing the synthesis of cGMP.

    Rate this question:

  • 5. 

    Directions: questions 1-5 Match each drug used in cardiac failure with the appropriate description (each lettered option can be selected once, more than once, or not at all): This drug can increase central parasympathetic firing

    • A.

      Captopril

    • B.

      Digoxin

    • C.

      Dobutamine

    • D.

      Furosemide

    • E.

      Losartan

    • F.

      Milrinone

    • G.

      Nesiritide

    • H.

      Propranolol

    • I.

      Spironolactone

    Correct Answer
    B. Digoxin
    Explanation
    Digoxin can increase central parasympathetic firing.

    Rate this question:

  • 6. 

    A 68-year-old man recently diagnosed with heart failure, started a treatment with metoprolol, losartan, furosemide and digoxin. Which of the following molecular actions most likely mediated the positive inotropic action of digoxin?

    • A.

      Closing of calcium channels in cardiac cell membranes

    • B.

      Increased release of Ca++ from sarcoplasmic reticulum during systole

    • C.

      Activation of Na+/K+ ATPase

    • D.

      Activation of Ca++/Na+ exchanger in cardiac cell membranes

    • E.

      Opening of K+ channels in cardiac cell membranes

    Correct Answer
    B. Increased release of Ca++ from sarcoplasmic reticulum during systole
    Explanation
    Learning objective: explain the molecular mechanism of action digoxin.
    Answer: B
    At the molecular level all cardiac glycosides inhibit Na+/K+ ATPase, the membrane bound
    transporter called the sodium pump. The increased amount of sodium inside the cell inhibits the
    Ca++/Na+ exchanger, an antiport that uses the electrochemical potential for Na+ to drive Ca++
    extrusion. The consequence of this inhibition is that less Ca++ is removed from the cell. The
    increased intracellular calcium is stored in the sarcoplasmic reticulum during diastole, and
    therefore a greater amount of Ca++ is released from the sarcoplasmic reticulum during systole.
    A) Digitalis glycosides (at high concentration) can open, not close, cardiac calcium channels.
    C, D) (see explanation above)
    E) Digitalis glycosides have no effect on potassium channels.

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  • 7. 

    A 57-year-old man suffering from persistent atrial fibrillation started a treatment with digoxin, one tablet daily. Which of the following actions most likely mediated the therapeutic effect of digoxin in the present case?

    • A.

      Opening of Ca++ channels of cardiac cell membranes

    • B.

      Stimulation of vagal activity

    • C.

      Blockade of Ca++/Na+ exchanger

    • D.

      Blockade of Na+/K+ pump

    • E.

      Inhibition of phosphodiesterase

    Correct Answer
    B. Stimulation of vagal activity
    Explanation
    Learning objective: describe the main action leading to the therapeutic effect of digoxin in
    atrial fibrillation.
    Answer: B
    Digoxin is still used in persistent atrial fibrillation (even if it is no longer a first-line therapy)
    because it can decrease the AV conduction, so decreasing the high ventricular rate. This is
    accomplished by a stimulation of vagal activity due to:
    1) stimulation of vagal nucleus
    2) sensitization of carotid sinus baroreceptors
    3) facilitation of muscarinic transmission at the cardiac muscle cells.
    A, C, D) Digoxin does have all these actions but these are important for the positive inotropic
    activity, not for the decrease in the AV conduction.
    E) Cardiac glycosides do not inhibit phosphodiesterase.

    Rate this question:

  • 8. 

    A 57-year-old woman suffering from persistent atrial flutter started a treatment with digoxin, one tablet daily. Which of the following cardiac actions most likely occurred during the therapy?

    • A.

      Increased end systolic volume

    • B.

      Decreased abnormal cardiac automaticity

    • C.

      Decreased diastolic time

    • D.

      Increased atrial refractoriness

    • E.

      Decreased heart rate

    Correct Answer
    E. Decreased heart rate
    Explanation
    Learning objective: describe the cardiac actions of digoxin.
    Answer: E
    Digoxin decreases heart rate both in the normal and in failing heart (unless toxic effects of the
    drug supervene) due to a decreases AV conduction, which is a consequence of a direct action
    and of a parasympathomimetic action on the AV node.
    A) By increasing contractility digoxin decreases, not increase, the end systolic volume
    B) Digoxin dose-dependently increases abnormal cardiac automaticity, as indicated by many
    varieties of arrhythmia caused by the drug.
    C) By causing bradycardia digoxin increases, not decreases the diastolic time.
    D) Atrial refractoriness is decreased, not increased, by digoxin, due both to a direct action and of
    a parasympathomimetic action of the drug.

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  • 9. 

    A 61-year-old man, recently diagnosed with stage C heart failure, was admitted to the hospital for a control visit. It was found that he had an ejection fraction of 30% at rest and a treatment which included digoxin was started. Which of the following cardiovascular parameters did digoxin most likely increase in this patient?

    • A.

      Stroke volume

    • B.

      Total peripheral resistance

    • C.

      Oxygen consumption of the heart

    • D.

      End-diastolic volume

    • E.

      Heart rate

    Correct Answer
    A. Stroke volume
    Explanation
    Learning objective: Describe the hemodynamic actions of digoxin in the failing heart.
    Answer: A
    The increase in stroke volume is a direct consequence of the positive inotropic action of digitalis
    glycosides.
    B) Digoxin can cause peripheral vasoconstriction in the normal subject, but causes instead
    peripheral vasodilation in patients with cardiac failure because the increased cardiac output
    offsets the reactive vasoconstriction.
    C) Digoxin actually decreases oxygen consumption in the failing heart because:
    1) The increased contractility reduces the left ventricular end diastolic volume and so the stretch
    of the cardiac fibers (oxygen consumption of the heart is directly proportional to the stretch of the
    cardiac fibers).
    2) The increased cardiac output offsets the tachycardia induced by the sympathetic activation.
    D, E) (see explanation of item C).

    Rate this question:

  • 10. 

    A 42-year-old man was admitted to the hospital in acute distress with breathlessness, markedly distended neck veins and atrial fibrillation. The blood pressure was 100/90 mm Hg, the pulse 120 bpm. An echocardiogram revealed an ejection fraction of 35%. A treatment was started with furosemide, captopril and digoxin. In this patient digoxin most likely decreased which of the following cardiovascular parameters?

    • A.

      Stroke volume

    • B.

      End-systolic volume

    • C.

      End diastolic volume

    • D.

      Systolic pressure

    • E.

      Pulse pressure

    Correct Answer
    B. End-systolic volume
    Explanation
    Learning objective: Describe the hemodynamic actions of cardiac glycosides in the failing
    heart.
    Answer: B
    An inotropic drug increases the force of heart contraction and therefore a higher fraction of the
    end-diastolic volume is ejected during systole. As a consequence the end systolic volume (that is
    the volume of blood remaining in the ventricle at the end of the systole) is decrease.
    A) All inotropic drugs increase, not decrease, the stroke volume.
    C) The end-diastolic volume (that is the volume of blood filling the ventricles at the end of the
    diastole) is the sum of the end systolic volume plus the stroke volume. Since the stroke volume
    is increased, and the end systolic volume is decreased by inotropic drugs, the end diastolic
    volume is not significantly changed.
    D) Digoxin increases, not decreases, the systolic blood pressure in patient with cardiac failure
    because of the increase in cardiac output.
    E)Pulse pressure may be sharply decreased in patients with heart failure since systolic pressure
    cannot be maintained because of the decrease in cardiac output, whereas diastolic pressure is
    normal or increased because of sympathetic activation. By increasing cardiac output digoxin
    increases the systolic pressure and offsets the reactive, sympathetically-mediated
    vasoconstriction. Therefore the pulse pressure is increased, not decreased.

    Rate this question:

  • 11. 

    A 68-year-old woman recently diagnosed with C heart failure, started a treatment with digoxin, 1 tablet daily. Knowing that digoxin has a CL of 7L/h and an oral bioavailability of 70%, which of the following doses was most likely given to achieve a steady state plasma concentration of 1 ng/mL?

    • A.

      1.4

    • B.

      0.125

    • C.

      0.24

    • D.

      2.0

    • E.

      0.5

    • F.

      2.4

    Correct Answer
    C. 0.24
    Explanation
    Learning objective: calculate the maintenance dose of digoxin, given sufficient data.
    Answer: C
    A maintenance dose of a drug is given by: D = (Css x Cl) / F. Therefore:
    Dose = (1 mcg/L x 7L/h) / 0.7 = 10 mcg/h = 240 mcg daily
    A, B, D, E, F) (see explanation above)

    Rate this question:

  • 12. 

    A 63-year-old man complained to his physician of nausea, vomiting and visual sensation of green-yellow halos around bright objects. The man, recently diagnosed with cardiac failure and atrial fibrillation, had started an appropriate treatment two weeks previously. Which of the following drugs most likely caused the patient’s symptoms?

    • A.

      Verapamil

    • B.

      Propranolol

    • C.

      Digoxin

    • D.

      Lidocaine

    • E.

      Furosemide

    • F.

      Captopril

    Correct Answer
    C. Digoxin
    Explanation
    Learning objective: Describe the main adverse effects of digoxin.
    Answer: C
    The most solid indication for digoxin is still the combination of chronic cardiac failure with atrial
    fibrillation. Because of its direct AV blocking effects and vagomimetic properties digoxin reduces
    the number of impulses conducted through the AV node an therefore controls the ventricular
    response rates in patients with atrial fibrillation. Most likely digoxin was included in the patient’s
    management and the symptoms of the patient are classic symptoms of digitalis toxicity.
    A, B) These drugs can control the ventricular response rates in patients with atrial fibrillation
    since they decrease AV conduction. However they do not cause the symptoms the patient is
    complaining of.
    D, E) These drugs do not decrease AV conduction and are of no value in atrial fibrillation.

    Rate this question:

  • 13. 

    A 63-year-old woman, admitted to the hospital for a control visit, was found to have a third degree AV block. The woman, who had been suffering from stage C heart failure, had been receiving captopril, furosemide and digoxin for two months and the disease was well controlled. The physician believed that the block was due to digoxin therapy. Which of the following would be an appropriate therapeutic conduct for this patient?

    • A.

      Discontinue digoxin and start milrinone

    • B.

      Add physostigmine and decrease digoxin dose

    • C.

      Add atropine and decrease digoxin dose

    • D.

      Discontinue digoxin and start metoprolol

    • E.

      Add dobutamine and decrease digoxin dose

    • F.

      Discontinue digoxin and start losartan

    Correct Answer
    C. Add atropine and decrease digoxin dose
    Explanation
    Learning objective: outline the therapy for a digoxin induced AV block.
    Answer: C
    A Digoxin-induced AV block is most likely due, at least in part, to the parasympathomimetic
    action of digoxin. Therefore a treatment with atropine and a reduction of digoxin dosage is a
    rational therapeutic approach.
    A) Milrinone is used only for short-term IV treatment of patients with end-stage heart failure.
    B) Physostigmine is a cholinergic drug and therefore it would worsen the AV block.
    D) To discontinue digoxin would be irrational since the ongoing therapy was effective. Moreover
    metoprolol is contraindicated in case of AV block.
    E) Beta-adrenergic agonists are used only for short-term IV treatment of patients with acute
    cardiac failure. Moreover, even if a beta-adrenergic agonist can increase the ventricular rate in
    patients with AV block due to increased vagal activity, it acts as a physiological antagonist of
    acetylcholine. In this case atropine is much better since a pharmacological antagonist is superior
    to a physiological antagonist in most cases.
    F) (see explanation D)

    Rate this question:

  • 14. 

    A 54-year-old woman presented to the hospital complaining of palpitations. The woman, recently diagnosed with stage C heart failure, started a therapy with metoprolol, digoxin and captopril one month ago. Her medications also included estrogens and calcium supplement for postmenopausal osteoporosis. Patient’s vital signs were: blood pressure 145/90, pulse 130 bpm. An ECG showed ventricular tachycardia. Significant plasma levels on admission were: K 5.8 mEq/L, Ca 12.2 mEq/L, creatinine 3.5 mg/dL . Which of the following events most likely triggered the patient’s arrhythmia?

    • A.

      The metoprolol-induced decrease in cardiac contractility

    • B.

      The increased serum K+ level

    • C.

      The captopril-induced vasodilation

    • D.

      The increased serum Ca++ level

    • E.

      The estrogen-induced hypertension

    Correct Answer
    D. The increased serum Ca++ level
    Explanation
    Learning objective: describe the factors that enhance the risk of digoxin toxicity.
    Answer: D
    Ventricular tachycardia is a serious adverse effect of digoxin. The reduced renal function of the
    patient (see the creatinine serum level) most likely decreased the renal excretion of digoxin, so
    increasing the risk of adverse effects. Digoxin toxicity is enhanced by many factors including
    hypercalcemia, which accelerates the overloading of intracellular calcium stores. An increased
    intracellular calcium appears to be responsible for an increased abnormal automaticity.
    A, B, C, E) (see explanation above)

    Rate this question:

  • 15. 

    A 61-year-old alcoholic male was admitted to the hospital with a 2-day history of epigastric pain associated with nausea and vomiting. The man had been suffering from systolic heart failure for two years. Present medications were captopril, furosemide and digoxin. Pertinent serum data on admission were: K+ 2.8 mEq/L, creatinine 3.2 mg/dL. An ECG showed an heart rate of 65 bpm with occasional premature ventricular contractions and runs of bigeminy. Which of the following would be an appropriate therapeutic conduct for this patient?

    • A.

      Add potassium supplementation and reduce digoxin dosage

    • B.

      Add atropine and reduce digoxin dosage

    • C.

      Increase furosemide dosage and reduce digoxin dosage

    • D.

      Discontinue digoxin and start losartan

    • E.

      Discontinue digoxin and start milrinone

    Correct Answer
    A. Add potassium supplementation and reduce digoxin dosage
    Explanation
    Learning objective: describe the therapy of digoxin toxicity.
    Answer: A
    The symptoms the patient was referring to (nausea and vomiting) as well as the arrhythmia
    shown by the ECG, are classical signs of digitalis toxicity. Furosemide treatment most likely
    caused hypokalemia which is a well recognized predisposing factor to digitalis toxicity. In fact in
    patients with serum K+ of 3 mEq/L, the dose of digoxin needed to produce toxicity is about one
    half of that needed in patients with serum K+ of 5 mEq/L. Moreover the patient had a reduced
    renal function (see the creatinine serum level) which most likely decreased the renal excretion of
    digoxin.
    A potassium supplementation is the rational therapy in case of hypokalemia. The dosage of
    digoxin must also be reduced because of the renal insufficiency.
    B) This strategy would be used when digoxin toxicity is due to an excessive
    parasympathomimetic activity of the drug (which is usually suggested by the presence of a
    severe bradycardia or by an AV block).
    C) This option is irrational: a reduced digoxin dosage would, of course, reduce toxicity, but an
    increased furosemide dosage would worsen the hypokalemia.
    D) Digoxin was quite effective for three years, which indicates that the heart failure was serious
    enough to require an inotropic drug. Therefore it would be irrational to withdraw an inotropic
    medication.
    E) Milrinone is an effective inotropic drug but, because of its toxicity, is used only when other
    drugs are not able to improve the symptoms of the disease. When a drug is effective but causes
    adverse effects (like in this case) the first procedure to follow is to adjust the dosage.

    Rate this question:

  • 16. 

    A 72-year-old man was admitted to the hospital because of anuria. The man had a long history of severe systolic cardiac failure and chronic obstructive pulmonary disease. Shortly after the admission the patient started vomiting, then become agitated, verbally abusive, and disoriented in space and time. He was telling the nurse that he heard laud voices cursing him. An ECG showed atrial tachycardia with AV block. Which of the following drugs most likely caused the patient’s symptoms?  

    • A.

      Captopril

    • B.

      Digoxin

    • C.

      Ipratropium

    • D.

      Metoprolol

    • E.

      Ethacrynic acid

    • F.

      Albuterol

    Correct Answer
    B. Digoxin
    Explanation
    Learning objective: describe the digoxin induced arrhythmias.
    Answer: B
    A patient with severe systolic dysfunction was most likely receiving a cardiac therapy that
    included digoxin. The patient probably developed an acute renal failure (as indicated by the
    sudden anuria) which increased substantially the toxicity of digoxin. In fact patient’s symptoms
    are typical of the so called “digitalis delirium.”
    A, C, D, E) These drugs do not cross the blood-brain barrier so central effects are unlikely.
    F) Albuterol crosses the blood-brain barrier and may cause feelings of apprehension and anxiety
    but not the symptoms exhibited by the patient.

    Rate this question:

  • 17. 

    A 65-year-old woman presented to the hospital with a chief complain of palpitations. The woman suffering from stage C heart failure had been receiving digoxin, furosemide and losartan for six months. Laboratory data on admission included: potassium 3.9 mEq/L (normal: 3.5 – 5.0), calcium 9.2 mg/dL (normal: 8.5 – 10.5), magnesium 2.5 mEq/L (normal 1.5 – 2.0) total T4 42 ng/mL (normal 50-110), TSH 15 mIU/mL (normal 0.5-5.5). An ECG showed junctional tachycardia that, according to the physician, was most likely due to digoxin treatment. Which of the following pathological conditions most likely increased the risk of digoxin toxicity in this patient?

    • A.

      Hypermagnesemia

    • B.

      Hyperaldosteronism

    • C.

      Hyperparathyroidism

    • D.

      Concomitant furosemide treatment

    • E.

      Hypothyroidism

    Correct Answer
    E. Hypothyroidism
    Explanation
    Learning objective: describe the factors that enhance the risk of digoxin toxicity.
    Answer: E
    The patient is suffering from hypothyroidism, as indicated by the low T4 and the high TSH levels.
    Hypothyroidism increases the risk of digitalis toxicity because elimination of digoxin is decreased
    and the heart is more sensitive to digitalis.
    A) Hypomagnesemia, not hypermagnesemia can increase digitalis toxicity.
    B) Hyperaldosteronism is unlikely since potassium levels are normal.
    C) Hyperparathyroidism is unlikely since calcium levels are normal.
    D) Concomitant furosemide treatment can increase digoxin toxicity mainly by causing hypokalemia, but this is quite unlike in the present case, since the patient has been receiving
    furosemide and digoxin for several months without adverse effects, and potassium levels are
    normal

    Rate this question:

  • 18. 

    A 65-year-old man was brought to the emergency room in acute distress. He was agitated, incoherent, disoriented in time and space, and seemed to be hallucinating. The patient had been suffering from severe chronic cardiac failure for two years and his wife referred she found an empty bottle of digoxin tablets near the husband’s bed. Vital sings of the patient were: blood pressure 100/50 mm Hg, heart rate 45 bpm. An emergency treatment was instituted and a drug was given IV. Which of the following drugs was most likely administered?

    • A.

      Lidocaine

    • B.

      Atropine

    • C.

      Phenytoin

    • D.

      Potassium chloride

    • E.

      Digoxin antibodies

    • F.

      Amiodarone

    Correct Answer
    E. Digoxin antibodies
    Explanation
    Learning objective: describe the treatment of digoxin poisoning.
    Answer: E
    The history and the patient’s symptoms indicated that the patient attempted suicide by ingesting
    several digoxin tablets. The best way to treat digoxin poisoning is to administer digoxin
    antibodies (digoxin immune Fab) that bind digoxin with very high affinity, so removing the drug
    from its tissue binding sites. They are extremely effective in reversing digoxin intoxication.
    A, B, C, D, F) All these drugs may be used in case of digoxin toxicity, to treat specific digoxininduced
    cardiac symptoms (i.e. lidocaine in case of ventricular tachycardia, atropine in case of
    AV block, etc.) However when poisoning is severe and many body functions are seriously
    affected (see the psychic symptoms of the patient) digoxin antibodies must be administered first.

    Rate this question:

  • 19. 

    A 73-year-old man complained to his physician of increasing fatigue and increasing shortness of breath which was often worse at night forcing him to “sit bolt upright”. He also noticed that his feet were getting swollen. Past history of the patient was unremarkable. Vital signs were: blood pressure 150/90, respiratory rate 17/min. On examination a mild pitting edema was seen on the legs. An ECG disclosed a second degree AV block. The physician diagnosed an initial cardiac failure and prescribed an appropriate therapy. Which of the following drugs would be contraindicated for this patient?

    • A.

      Captopril

    • B.

      Hydrochlorothiazide

    • C.

      Digoxin

    • D.

      Losartan

    • E.

      Furosemide

    • F.

      Spironolactone

    Correct Answer
    C. Digoxin
    Explanation
    Learning objective: describe the main contraindication of digoxin.
    Answer: C
    Digoxin is relatively contraindicated in patient with significant AV block, since the drug
    decreases AV conduction due both to the parasympathomimetic action and to the direct
    depressive effect on the AV node. Since the patient is hypertensive all the other listed drugs are
    appropriate for initial heart failure or for hypertension.
    A, B, D, E, F) (see explanation above)

    Rate this question:

  • 20. 

    A 62-year-old woman was admitted to the hospital complaining of nausea, mental confusion, dizziness and palpitations. The woman, suffering from hypertension and recurrent atrial fibrillation, had been receiving furosemide, captopril and digoxin for several months. One week ago she started erythromycin and ibuprofen for an acute upper respiratory tract infection. Which of the following events most likely caused the patient’s symptoms?

    • A.

      Furosemide-induced hypokalemia

    • B.

      Erythromycin-induced increase in digoxin oral bioavailability

    • C.

      Furosemide-induced hypocalcemia

    • D.

      Captopril-induced decrease in digoxin clearance

    • E.

      Ibuprofen-induced decrease in digoxin clearance

    Correct Answer
    B. Erythromycin-induced increase in digoxin oral bioavailability
    Explanation
    Learning objective: describe the digoxin drug interaction of clinical importance.
    Answer: B
    Broad spectrum antibiotics like erythromycin can increase the oral bioavailability of digoxin
    because they kill bacteria present in normal intestinal flora (mainly Eubacterium lentum) which
    are able to metabolize digoxin. This is a major and clinically important drug interaction with
    digoxin.
    A) Even if hypokalemia can increase digoxin toxicity this is quite unlikely in the present case,
    since the patient has been receiving furosemide and digoxin for several months without adverse
    effects.
    C) Hypercalcemia, not hypocalcemia, can increase digoxin toxicity.
    D) Captopril can rarely decrease digoxin renal excretion but this is quite unlikely in the present
    case for the reasons explained above
    E) Ibuprofen can rarely decrease digoxin renal excretion but the effect is transient and clinically
    unimportant.

    Rate this question:

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  • Mar 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jul 08, 2012
    Quiz Created by
    Chachelly
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