PAEA Internal Medicine Inpatient EOR Topics Exam
Questions And Answers Verified 100% Correct
what drugs have shown to decrease mortality rates in pts with heart failure?
ACE inhibitors (-prils), ARBs, beta-blockers (-lols), hydralazine + nitrates,
spironolactone
in pts who experience the following common side effects of an ACE inhibitor to
treat heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema
ARBs (-sartans) what vasodilators are often used to treat heart failure?
hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed what
is the most effective treatment for symptoms of heart failure?
diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on
these electrolytes), other s/e: hyperglycemia, hyperuricemia
-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e:
hyperkalemia, gynecomastia with spirono
-HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia,
hyperuricemia, hyperglycemia what medications are used to treat acute
severe heart failure?
sympathomimetics (positive inotropes to inc contractility)
,-digoxin: but has a narrow therapeutic index (can cause arrhythmias, seizures,
dizziness, GI upset, visual disturbances, gynecomastia); toxicity = downsloping ST
segment; antidote: Digoxin Immune Fab
-dobutamine: inc contractility (B1 agonist), peripheral vasodilation
-dopamine: inc contractility
giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart
failure?
-dec RAAS activity -inc Na+/H2O excretion why are beta-blockers started
after ACE inhibitors/diuretics in heart failure? want to decrease
afterload/preload before slowing down the heart rate
at what EF do heart failure patients need to receive an implantable cardioverter
defibrillator?
EF <35% because they tolerate arrhythmias poorly and there is inc mortality rate
what medication used to treat systolic heart failure is a selective sinus node
inhibitor that slows the sinus rate?
ivabradine: dec mortality rate in pts w/ EF ≤35%, in sinus rhythm, w/ resting pulse
≥70bpm, & already maxed out on BB dose or unable to take BB
what medication used to treat systolic heart failure works by increasing levels of
natriuretic peptides?
sacubitril-valsartan: decreases mortality rate in class II-IV HF w/ reduced EF
what is the treatment for acute pulmonary edema/congestive (aka
decompensated) heart failure?
LMNOP
-Lasix: removes fluids- improves sx's
-Morphine: reduces preload reducing heart strain
-Nitrates: vasodilator to reduce pre/afterload
-Oxygen
-Position: upright to dec venous return
, if severe may also need inotropic support hypertension is defined as
____/____ blood pressures on ____ or more visits
≥130/80 on 2 or more visits
-stage 1 is 130-139/80-89 -stage
2 is ≥140/90
although primary HTN makes up 95% of cases, when should secondary HTN be
considered? what are some causes of secondary HTN?
-if refractory to antihypertensives or severely elevated
-causes: renal artery stenosis, fibromuscular dysplasia, atherosclerosis, 1°
hyperaldosteronism, pheochromocytoma, cushing's syndrome, coarctation of the
aorta, sleep apnea, EtOH, OCPs, COX-2 inhibitors what are the complications of
HTN?
-CV (CAD, HF, MI, LVH, aortic dissection, aortic aneurysm, PVD)
-neurologic (TIA, CVA, rutured aneurysms, encephalopathy)
-nephropathy (renal stenosis & sclerosis leading to ESRD) -optic
(retinal hemorrhage, blindness, retinopathy)
thiazide type diuretics (HCTZ, chlorthalidone, metolazone) act on what part of the
nephron to increase water excretion? what are the side effects?
-distal diluting tubule
-s/e: hyponatremia/kalemia/calcemia, hyperuricemia/glycemia (use w/ caution in
gout and DM pts)
*these are 1st line in uncomplicated HTN
loop diuretics (furosemide, bumetanide) are the strongest class of diuretics and
can cause s/e's of volume depletion, hypokalemia/natremia/calcemia,
hyperuricemia/glycemia, hypochloremic metabolic alkalosis, and ototoxicity;
what are they contraindicated in?
Questions And Answers Verified 100% Correct
what drugs have shown to decrease mortality rates in pts with heart failure?
ACE inhibitors (-prils), ARBs, beta-blockers (-lols), hydralazine + nitrates,
spironolactone
in pts who experience the following common side effects of an ACE inhibitor to
treat heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema
ARBs (-sartans) what vasodilators are often used to treat heart failure?
hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed what
is the most effective treatment for symptoms of heart failure?
diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on
these electrolytes), other s/e: hyperglycemia, hyperuricemia
-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e:
hyperkalemia, gynecomastia with spirono
-HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia,
hyperuricemia, hyperglycemia what medications are used to treat acute
severe heart failure?
sympathomimetics (positive inotropes to inc contractility)
,-digoxin: but has a narrow therapeutic index (can cause arrhythmias, seizures,
dizziness, GI upset, visual disturbances, gynecomastia); toxicity = downsloping ST
segment; antidote: Digoxin Immune Fab
-dobutamine: inc contractility (B1 agonist), peripheral vasodilation
-dopamine: inc contractility
giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart
failure?
-dec RAAS activity -inc Na+/H2O excretion why are beta-blockers started
after ACE inhibitors/diuretics in heart failure? want to decrease
afterload/preload before slowing down the heart rate
at what EF do heart failure patients need to receive an implantable cardioverter
defibrillator?
EF <35% because they tolerate arrhythmias poorly and there is inc mortality rate
what medication used to treat systolic heart failure is a selective sinus node
inhibitor that slows the sinus rate?
ivabradine: dec mortality rate in pts w/ EF ≤35%, in sinus rhythm, w/ resting pulse
≥70bpm, & already maxed out on BB dose or unable to take BB
what medication used to treat systolic heart failure works by increasing levels of
natriuretic peptides?
sacubitril-valsartan: decreases mortality rate in class II-IV HF w/ reduced EF
what is the treatment for acute pulmonary edema/congestive (aka
decompensated) heart failure?
LMNOP
-Lasix: removes fluids- improves sx's
-Morphine: reduces preload reducing heart strain
-Nitrates: vasodilator to reduce pre/afterload
-Oxygen
-Position: upright to dec venous return
, if severe may also need inotropic support hypertension is defined as
____/____ blood pressures on ____ or more visits
≥130/80 on 2 or more visits
-stage 1 is 130-139/80-89 -stage
2 is ≥140/90
although primary HTN makes up 95% of cases, when should secondary HTN be
considered? what are some causes of secondary HTN?
-if refractory to antihypertensives or severely elevated
-causes: renal artery stenosis, fibromuscular dysplasia, atherosclerosis, 1°
hyperaldosteronism, pheochromocytoma, cushing's syndrome, coarctation of the
aorta, sleep apnea, EtOH, OCPs, COX-2 inhibitors what are the complications of
HTN?
-CV (CAD, HF, MI, LVH, aortic dissection, aortic aneurysm, PVD)
-neurologic (TIA, CVA, rutured aneurysms, encephalopathy)
-nephropathy (renal stenosis & sclerosis leading to ESRD) -optic
(retinal hemorrhage, blindness, retinopathy)
thiazide type diuretics (HCTZ, chlorthalidone, metolazone) act on what part of the
nephron to increase water excretion? what are the side effects?
-distal diluting tubule
-s/e: hyponatremia/kalemia/calcemia, hyperuricemia/glycemia (use w/ caution in
gout and DM pts)
*these are 1st line in uncomplicated HTN
loop diuretics (furosemide, bumetanide) are the strongest class of diuretics and
can cause s/e's of volume depletion, hypokalemia/natremia/calcemia,
hyperuricemia/glycemia, hypochloremic metabolic alkalosis, and ototoxicity;
what are they contraindicated in?
