Heart Failure And Acute Mi Drugs

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Heart Failure Quizzes & Trivia

Pharm Exam 3


Questions and Answers
  • 1. 

    Your pt is on Enalapril and is complaining of a dry cough.  She states that she would prefer not to take this medication anymore.  What is an appropriate substitute?

    • A.

      Spironolactone

    • B.

      Metoprolol

    • C.

      Aspirin

    • D.

      Losartan

    Correct Answer
    D. Losartan
    Explanation
    The appropriate substitute for Enalapril in this case would be Losartan. Enalapril belongs to a class of medications called ACE inhibitors, which can sometimes cause a dry cough as a side effect. Losartan, on the other hand, belongs to a class of medications called ARBs (angiotensin receptor blockers) and is less likely to cause a dry cough. Therefore, switching to Losartan would be a suitable alternative for the patient who wishes to stop taking Enalapril due to the cough.

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  • 2. 

    ACE inhibitors are protective to the heart in all of the following ways, EXCEPT:

    • A.

      Decrease vascular resistance

    • B.

      Decrease venous tone

    • C.

      Increase Na retention

    • D.

      Decrease BP

    Correct Answer
    C. Increase Na retention
    Explanation
    ACE inhibitors are medications that work by inhibiting the action of the enzyme ACE, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor, so by inhibiting its production, ACE inhibitors can decrease vascular resistance and lower blood pressure. Additionally, ACE inhibitors can also decrease venous tone, further reducing the workload on the heart. However, ACE inhibitors do not increase sodium retention. In fact, they can have a mild diuretic effect, promoting the excretion of sodium and water from the body. Therefore, the correct answer is that ACE inhibitors do not increase Na retention.

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  • 3. 

    What are the two Beta Blockers approved for treatment of heart failure?

    Correct Answer
    Carvedilol and Metoprolol
    Metoprolol and Carvedilol
    Explanation
    Carvedilol and Metoprolol are both beta blockers that have been approved for the treatment of heart failure. These medications work by blocking the effects of adrenaline on the heart, which helps to reduce the workload on the heart and improve its function. Carvedilol and Metoprolol have been shown to reduce symptoms, improve exercise tolerance, and decrease the risk of hospitalization in patients with heart failure. Therefore, both Carvedilol and Metoprolol are considered important treatment options for managing heart failure.

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  • 4. 

    Beta blockers improve heart's function by:

    • A.

      Inhibiting renin release

    • B.

      Decreasing heart rate

    • C.

      Blocking deleterious effects of NE on cardiac muscle fibers

    • D.

      All of the above

    Correct Answer
    D. All of the above
    Explanation
    Beta blockers improve the heart's function by inhibiting renin release, decreasing heart rate, and blocking the deleterious effects of NE (norepinephrine) on cardiac muscle fibers. Renin is an enzyme that plays a role in regulating blood pressure, and by inhibiting its release, beta blockers help to lower blood pressure. By decreasing heart rate, beta blockers reduce the workload on the heart and improve its efficiency. NE is a neurotransmitter that can have negative effects on the heart, and beta blockers block its actions, further improving cardiac function. Therefore, all of the given options are correct explanations for how beta blockers improve heart function.

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  • 5. 

    Diuretics help in heart failure by: (check all that apply)

    • A.

      Decrease preload

    • B.

      Decrease cardiac workload

    • C.

      Increase preload

    • D.

      Increase after load

    • E.

      Decrease O2 demand

    Correct Answer(s)
    A. Decrease preload
    B. Decrease cardiac workload
    E. Decrease O2 demand
    Explanation
    Diuretics help in heart failure by decreasing preload, decreasing cardiac workload, and decreasing oxygen demand. Preload refers to the amount of blood filling the heart before it contracts, and by decreasing preload, diuretics reduce the volume of blood returning to the heart and ease the workload on the heart. Additionally, diuretics decrease the amount of fluid in the body, which reduces the workload on the heart and decreases oxygen demand. Therefore, these actions of diuretics help improve symptoms and outcomes in heart failure patients.

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  • 6. 

    What is the most commonly used diuretic in HF?

    Correct Answer(s)
    Loop Diuretics
    Explanation
    Loop diuretics are the most commonly used diuretics in heart failure (HF) because they are highly effective in reducing fluid overload. They work by inhibiting the reabsorption of sodium and chloride in the loop of Henle in the kidneys, leading to increased urine production and excretion of excess fluid. Loop diuretics, such as furosemide and bumetanide, are preferred in HF because they have a rapid onset of action and can provide significant symptomatic relief by reducing edema and congestion. Additionally, loop diuretics have been shown to improve outcomes in HF patients by reducing hospitalizations and mortality rates.

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  • 7. 

    What HF medication can help relieve pulmonary congestion and peripheral edema?

    • A.

      ACE inhibitors

    • B.

      ARBs

    • C.

      Diuretics

    • D.

      Direct Vasodilators

    Correct Answer
    C. Diuretics
    Explanation
    Diuretics are medications that help to increase urine production and reduce fluid retention in the body. They are commonly used to treat conditions such as pulmonary congestion and peripheral edema, which are characterized by excess fluid in the lungs and swelling in the extremities. By increasing the excretion of water and salt from the body, diuretics help to alleviate these symptoms and improve overall cardiovascular function. Therefore, diuretics are an appropriate medication for relieving pulmonary congestion and peripheral edema.

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  • 8. 

    Dilation of veins decreases ______, while dilation of arteries decreases _______.

    • A.

      Preload, afterload

    • B.

      Afterload, preload

    Correct Answer
    A. Preload, afterload
    Explanation
    Dilation of veins decreases preload, which is the amount of blood returning to the heart. This reduces the volume of blood in the heart, leading to decreased stretching of the heart muscle. On the other hand, dilation of arteries decreases afterload, which is the resistance the heart has to overcome to pump blood out of the heart and into the arteries. By dilating the arteries, the resistance is reduced, making it easier for the heart to pump blood.

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  • 9. 

    _______ are commonly used venous dilators in CHF.

    • A.

      Resins

    • B.

      Nitrates

    • C.

      Inotropic agents

    • D.

      Statins

    Correct Answer
    B. Nitrates
    Explanation
    Nitrates are commonly used as venous dilators in congestive heart failure (CHF). Nitrates work by relaxing and dilating the veins, which helps to reduce the workload on the heart and improve blood flow. This can help to relieve symptoms such as shortness of breath and reduce fluid buildup in the body. Nitrates are often used in combination with other medications for the management of CHF.

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  • 10. 

    You have an African American patient who is intolerant to beta blockers.  You know that what combination of medications is very effective in black patients?

    Correct Answer
    Hydralazine + isosorbide dinitrate
    Explanation
    The combination of hydralazine and isosorbide dinitrate is known to be very effective in black patients. This combination is often used as an alternative to beta blockers in black patients who are intolerant to them. Hydralazine works by relaxing and widening blood vessels, while isosorbide dinitrate helps to prevent the narrowing of blood vessels. Together, these medications can help to lower blood pressure and improve symptoms in black patients who cannot tolerate beta blockers.

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  • 11. 

    ______ reduces afterload, while _____ reduces preload.

    • A.

      Hydralazine, nitrate

    • B.

      Nitrate, hydralazine

    Correct Answer
    A. Hydralazine, nitrate
    Explanation
    Hydralazine reduces afterload, which refers to the pressure or resistance that the heart has to overcome to pump blood out of the left ventricle. By reducing afterload, hydralazine helps the heart pump more efficiently. On the other hand, nitrates reduce preload, which is the amount of blood that fills the ventricles during diastole. By reducing preload, nitrates decrease the workload on the heart and improve its ability to pump blood.

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  • 12. 

    Avoid ________ in patients with HF.

    Correct Answer
    calcium channel blockers
    Explanation
    Patients with heart failure (HF) should avoid calcium channel blockers. This is because calcium channel blockers can cause negative effects on the heart's contractility and can worsen HF symptoms. They can also lead to fluid retention and increase the workload on the heart, which can be detrimental for patients with HF. Therefore, it is recommended to avoid calcium channel blockers in these patients to prevent exacerbation of their condition.

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  • 13. 

    All of the following are positive inotropic agents, EXCEPT: 

    • A.

      Beta adrenergic agonists

    • B.

      Digitalis glycosides

    • C.

      Beta adrenergic antagonists

    • D.

      Phosphodiesterase inhibitors

    Correct Answer
    C. Beta adrenergic antagonists
    Explanation
    Beta adrenergic antagonists, also known as beta blockers, are not positive inotropic agents. In fact, they have a negative inotropic effect, meaning they decrease the force of contraction of the heart. This is because beta blockers block the beta adrenergic receptors on the heart, which are responsible for the stimulatory effects of catecholamines such as epinephrine and norepinephrine. By blocking these receptors, beta blockers reduce the heart rate and contractility, making them useful in conditions such as hypertension and angina. However, they are not considered positive inotropic agents.

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  • 14. 

    Which of the following is the only oral inotropic agent available?

    • A.

      Dobutamine

    • B.

      Inamrinone

    • C.

      Digoxin

    • D.

      Milrinone

    Correct Answer
    C. Digoxin
    Explanation
    Digoxin is the only oral inotropic agent available among the options provided. Inotropic agents are medications that increase the force of contraction of the heart muscle, and Digoxin is commonly used for this purpose. Dobutamine and Milrinone are intravenous inotropic agents, while Inamrinone is not commonly used as an inotropic agent. Therefore, Digoxin is the correct answer as it is the only oral medication among the options that has inotropic effects.

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  • 15. 

    Which of the following are indications to prescribe Digoxin?

    • A.

      Pts with left ventricular systolic dysfunction

    • B.

      Pts with diastolic or right-sided HF

    • C.

      Pts who have HF with a fib

    • D.

      Pts with mild to moderate HF

    • E.

      Both A and C

    • F.

      Both C and D

    Correct Answer
    E. Both A and C
    Explanation
    pts with mild to moderate HF DO NOT require digoxin
    digoxin is NOT indicated in pts with diastolic or right-sided HF

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  • 16. 

    All of the following are factors predisposing a pt to digoxin toxicity, EXCEPT:

    • A.

      Hypokalemia

    • B.

      Hyperkalemia

    • C.

      Hypercalcemia

    • D.

      Hypomagnesemia

    Correct Answer
    B. Hyperkalemia
    Explanation
    Digoxin toxicity is more likely to occur in patients with low potassium levels (hypokalemia), as low potassium levels enhance the effects of digoxin on the heart. Hyperkalemia, on the other hand, can actually reduce the effects of digoxin, making toxicity less likely. Hypercalcemia and hypomagnesemia can also increase the risk of digoxin toxicity by enhancing the effects of digoxin on the heart.

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  • 17. 

    All of the following medications decrease preload, EXCEPT: 

    • A.

      Direct vasodilators

    • B.

      Diuretics

    • C.

      Alpha blockers

    • D.

      ARBs

    Correct Answer
    D. ARBs
    Explanation
    direct vasodilators, diuretics, and alpha blockers all decrease vascular resistance which will therefore decrease preload

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  • 18. 

    This medication prevents sodium retention, myocardial hypertrophy, and hypokalemia and is used in the most advanced cases of HF:

    • A.

      Epelerenone

    • B.

      Spironolactone

    • C.

      Abciximab

    • D.

      Clopidogrel

    Correct Answer
    B. Spironolactone
    Explanation
    Is a aldosterone antagonist

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  • 19. 

    This medication is a competitive antagonist of aldosterone at mineralcortioid receptors and reduces mortality in left ventricular systolic dysfunction and HF after acute MI

    • A.

      Epelerenone

    • B.

      Spironolactone

    • C.

      Melrinone

    • D.

      Clopidogrel

    Correct Answer
    A. Epelerenone
    Explanation
    Epelerenone is a medication that acts as a competitive antagonist of aldosterone at mineralocorticoid receptors. This means that it blocks the action of aldosterone, a hormone that promotes sodium and water retention and potassium excretion. By blocking aldosterone, epelerenone helps to reduce fluid retention and decrease blood pressure, making it an effective treatment for heart failure (HF) and left ventricular systolic dysfunction. Additionally, it has been shown to reduce mortality in patients with HF after acute myocardial infarction (MI). Therefore, the correct answer is epelerenone.

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  • 20. 

    All of the following are platelet inhibitors, EXCEPT:

    • A.

      Aspirin

    • B.

      Ticlopidine

    • C.

      Abciximab

    • D.

      Warfarin

    • E.

      Eptifibatide

    Correct Answer
    D. Warfarin
    Explanation
    Warfarin is not a platelet inhibitor, but rather an anticoagulant. It works by inhibiting the synthesis of clotting factors in the liver. Platelet inhibitors, on the other hand, prevent platelets from aggregating and forming blood clots. Aspirin, Ticlopidine, Abciximab, and Eptifibatide are all examples of platelet inhibitors that work by different mechanisms to inhibit platelet function and prevent clot formation.

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  • 21. 

    A pt is in the ER c/o CP. She states that she has severe asthma and is finding it hard to breathe. What can you NOT give this patient?

    • A.

      Aspirin

    • B.

      Clopidogrel

    • C.

      Abciximab

    • D.

      Warfarin

    Correct Answer
    A. Aspirin
    Explanation
    Aspirin is contraindicated in pts who have asthma, nasal polyps, rhinitis; also not given to children < 16 for viral infections d/t potential for Reye's Syndrome

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  • 22. 

    This medication has an FDA black warning label for bleeding and stroke

    • A.

      Ticlopidine

    • B.

      Clopidogrel

    • C.

      Aspirin

    • D.

      Prasugrel

    Correct Answer
    D. Prasugrel
    Explanation
    Prasugrel is the correct answer because it has an FDA black warning label for bleeding and stroke. The black warning label is the most serious warning that the FDA can issue for a medication. This indicates that there is a significant risk of bleeding and stroke associated with the use of Prasugrel. Therefore, it is important to exercise caution when prescribing or taking this medication.

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  • 23. 

    Neutropenia, thrombotic thrombocytopenic purpura, and aplastic anemia are all side effects of....

    • A.

      Ticlopidine

    • B.

      Warfarin

    • C.

      Heparin

    • D.

      Lovastatin

    Correct Answer
    A. Ticlopidine
    Explanation
    Neutropenia, thrombotic thrombocytopenic purpura, and aplastic anemia are all side effects associated with Ticlopidine. Ticlopidine is an antiplatelet medication used to prevent blood clots. However, it can lead to a decrease in the number of neutrophils (a type of white blood cell) in the body, causing neutropenia. It can also cause thrombotic thrombocytopenic purpura, a rare blood disorder characterized by blood clot formation throughout the body, leading to low platelet count and damage to organs. Additionally, Ticlopidine can result in aplastic anemia, a condition where the bone marrow fails to produce enough new blood cells.

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  • 24. 

    Hx of stroke, brain tumor, metastatic cancer, head trauma or intracranial bleeding, or pts with healing wounds may not be administered what medication?

    • A.

      HMG CoA Reductase inhibitors

    • B.

      Beta Blockers

    • C.

      Thrombolytic agents

    • D.

      Aspirin

    Correct Answer
    C. Thrombolytic agents
    Explanation
    Altepase, streptokinase, urokinase

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