Naplex Quiz On Heart Failure! Exam

A patient with cardiac disease that has fatigue, palpitations, dyspnea, and/or angina after a 15-minute brisk walk (resulting in slight limitations of physical activity) would fit best in what category of HF according to the NYHA?

• Class I

• Class II

• Class III

• Class IV

A patient with hypertension, CAD, or diabetes would fit into what heart failure classification scheme according to the American College of Cardiology and the American Heart Association?

• Stage A

• Stage B

• Stage C

• Stage D

If a pt is considered "warm and wet", this means...

• The pt recently fell into a hot tub

• The pt has adequate perfusion and no s/s of volume overload.

• The pt has inadequate perfusion and no s/s of volume overload.

• The pt has adequate perfusion but s/s of volume overload.

• The pt has inadequate perfusion and no s/s of volume overload.

Which of the following statements is false?

• NSAIDs, glucocorticoids, rosiglitazone, and pioglitazone may worsen HF by causing sodium and water retention.

• HF is the only major CVD that is INCREASING is prevalence.

• The primary manifestations of HF are dyspnea/fatigue that may limit physical activity and fluid retention.

• Orthopnea, tachypnea, cough, ascites, jugular venous distention, hepatomegaly, and S3 gallop are other symptoms of HF.

• Pts with a LVEF less than 55% are generally considered to have systolic function.

• Pts with dyspnea secondary to HF will have elevated plasma BNP concentrations.

Which of the following is true regarding loop diuretics?

• May cause hypokalemia and hypomagnesmia

• NSAIDs may diminish the medication's diuretic effect

• Food decreases the bioavailability of furosemide and bumetanide

• Pts allergic to sulfa-containing meds may be allergic to loop diuretics

• Pt's may need to wear sunscreen while taking med

Match the ACE inhibitor to its brand/generic.

• Enalapril - Vasotec

• Ramipril - Altace

• Captopril - Zestril

• Quinapril - Accupril

• Perindopril - Aceon

• Trandolapril - Mavik

Which of the following are true regarding ACE inhibitors?

• ACEIs reduce mortality by 20-30% and slow the progression of HF

• Captopril should be taken on an empty stomach, either 1 hour before or 2 hours after meals

• Use of salt substitutes that contain potassium should be encouraged

• Cyclosporine and tacrolimus may increase the risk of nephrotoxicity and hyperkalemia

• ACEIs are pregnancy category A during the first trimester, but pregnancy category B during the second and third trimesters

Which of the following is fale regarding ARBs?

• Current guidelines recommend candesartan or valsartan for pts that can't take ACEIs

• Candesartan's brand name is Micardis

• Valsartan's brand name is Diovan

• ARBs are as likely as ACEIs to cause impaired renal function, hyperkalemia, & hypotension

Which of the following beta-blockers has been shown to reduce mortality and should be used in all stable pts with current/prior HF sx and reduced LVEF, unless CI?

• Immediate release metoprolol

• Extended release metoprolol

• Labetalol

• Bisoprolol

• Carvedilol

• Esmolol

Which of the following is a false counseling point for a patient taking beta-blockers for heart failure...

• Take carvedilol with food

• Beta blockers may cause worsening of HF and fluid retention upon initiation or dose titration, so weigh yourself regularly to assess for fluid overload

• Fatigue or weakness may occur initially, but should resolve within a few weeks

• Beta blockers can mask the signs of hypoglycemia (all except sweating)

• Be sure to take your medication as directed, it is important because beta blockers can decrease the risk of death and hospitalization associated with HF

• None - all of the above are true counseling points

___________ is eliminated 50% by the kidneys.  While ___________ and ___________ are metabolized by the liver.

• Carvedilol; bisoprolol and metoprolol

• Metoprolol, carvedilol and metoprolol

• Bisoprolol; metoprolol and carvedilol

A patient should be stable (minimal fluid overload/volume retention) before initiating a beta blocker.

• True

• False

What is the brand name for Eplerenone?

Zebeta is the brand name for which drug?

• Metoprolol

• Eplerenone

• Diltiazem

• Bisoprolol

• Digoxin

What is the effect if paroxetine/fluoxetine are used with metoprolol/carvedilol?

• Possible increased SSRI concentrations

• Possible decreased SSRI concentrations

• Possible increased plasma concentrations of the beta blocker

• Possible decreased plasma concentrations of the beta blocker

• No drug interaction

Which of the following is true regarding aldosterone antagonists?

• May cause bronchoconstriction in patients with COPD

• Spironolactone can increase digoxin plasma concentrations

• Eplerenone undergoes hepatic metabolism via P450

• Eplerenone can cause gynecomastia

• Serum creatinine should be < 2.5 mg/dL in men or < 2 mg/dL in women before intiating therapy

Major adverse events with digoxin occur in three body systems.  Which of the following is NOT included?

• Pulmonary (upper respiratory tract infections, cough)

• Carviovascular (cardiac arrhythmias, bradycardia, heart block)

• GI (anorexia, abdominal pain, N/V)

• Neurological (visual disturbances, disorientation, confusion, fatigue)

If quinidine, verapamil, or amiodarone is added to a drug regimen with digoxin, the dose of digoxin should be _______ by 50%.

• Increased

• Decreased

Which of the following are true regarding heart failure?

• Verapamil and diltiazem can precipitate or worsen heart failure

• Digoxin goal plasma concentrations is 2.5-5 ng/mL

• Patients with ADHF often require IV diuretics, vasodilators, and negative inotropes

• Headache, dizziness, and GI complaints are common adverse effects with hydralazine-isosorbide dinitrate

• No loading dose of digoxin is needed in HF; in fact, lower doses (0.125mg QOD) may need to be used in the elderly

Demadex is the brand name for ________.

• Milrinone

• Dobutamine

• Hydralazine-Isosorbide

• Torsemide

• Nesiritide