Question 1

What is the order for Heart failure treatment dugs

Accepted Answer

1. ACE inhibitors 
2. ARB's
3. B-blockers 
4. Neprilysin Inhibitor Combo
5. Loop diuretics 
6. Aldosterone Antagonists 
7. Phosphodiesterase Inhibitors
8. Cardiac glycosides

Question 2

ACE inhibitors

Accepted Answer

- ↓ Aldosterone → ↓ Na⁺/H₂O retention → ↓ preload
- ↓ LV end-volume → ↓ workload → ↑ cardiac output

Question 3

ARB's

Accepted Answer

Vasodilators - decrease systemic vascular resistance

Question 4

Beta Blockers

Accepted Answer

Block catecholamine effects 
- ↓ SNS stimulation → ↓ HR, ↓ conduction

Question 5

Neprilysin Inhibitor Combo

Accepted Answer

Blocks the breakdown of natriuretic peptides  
- ↓ BP, ↓ afterload, ↓ mortality

Keeps “good peptides” around → lowers BP, lowers afterload, improves survival.

Question 6

Loop Diuretics Block

Accepted Answer

Blocks Na+ reabsorption - water follows - increase urine output

Question 7

Aldosterone Antagonists

Accepted Answer

- ↓ Na⁺/H₂O retention, ↓ cardiac remodeling
** Monitor K⁺ and renal function**

Question 8

Phosphodiesterase Inhibitors

Accepted Answer

-  ICU drug: makes heart squeeze harder + vessels relax.
↑ cAMP → ↑ Ca²⁺ → stronger contraction
- Vasodilation → ↓ afterload

Question 9

Risk with Phosphodiesterase Inhibitors

Accepted Answer

High arrhythmia risk → continuous monitoring

Question 10

Cardiac Glycosides

Accepted Answer

Stronger squeeze, slower heart, slower AV conduction.

Increase contractility, slow heart rate, clow conduction through AV node

Question 11

Digoxin

Accepted Answer

Cardiac glycoside

Question 12

What is the therapeutic range for Digoxin

Accepted Answer

0.8-2ng/mL

Question 13

What is the significance of K+ levels with the admin of Digoxin

Accepted Answer

Low K⁺ = ↑ toxicity risk
High K⁺ = ↓ effect

Question 14

What are the signs of toxicity for Digoxin

Accepted Answer

GI upset → vision changes (yellow halos) → arrhythmias

Question 15

What are the nursing considerations for Digoxin

Accepted Answer

Before admin - apical pulse for 1 min 
Notify prescriber if less then 60 or greater than 100

Question 16

What is the antidote for Digoxin and when should it be given?

Accepted Answer

Digoxin Immune Fab 
Used when hyperkalemic or toxicity, life-threatening dysrhythmias, life threatening digoxin  overdose

Question 17

Valsartan

Accepted Answer

ARB

Question 18

Bisoprolol

Accepted Answer

Beta blocker

Question 19

Furosemide

Accepted Answer

Loop diuretic

Question 20

Spironolactone

Accepted Answer

Aldosterone antagonist

Question 21

Milrinone

Accepted Answer

Phosphodiesterase inhibitor

Question 22

Sacubitril

Accepted Answer

Neprilysin Inhibitor

Question 23

What are the types of diuretics

Accepted Answer

1. Loop diuretics - Strongest - work on the loop of henle 
2. Thiazides - common for BP control 
3. Potassium-sparing - weak diuretic but prevents K+ loss 
4. Osmotic - Pull fluid out of tissues 
5. Carbonic anhydrase inhibitors - used for glaucoma

Question 24

Acetazolamide

Accepted Answer

Carbonic anhydrase inhibitor - Weak diuretic 

Used for edema, glaucoma, altitude sickness 
*Not to use for pregnancy*

Question 25

Loop diuretics

Accepted Answer

Block Na+/K+/Cl- reabsorption in ascending loop of henle 
Causes: massive water loss, decreased in BP and pulmonary congestion 

*Risk of K+/Na+ depletion

Question 26

Pharmacokinetics for loop diuretics (PO&IV)

Accepted Answer

Po: O=30-60 min, Dur+ 8h
IV: O = 5 min, lasts 2 hours - used in emergencies (ex. pulmonary edema

Question 27

Furosemide

Accepted Answer

Most used loop diuretic 

Pulmonary edema 
HF 
Liver disease 
Nephrotic syndrome

Question 28

Considerations for Furosemide

Accepted Answer

Monito K+ levels 
BP 
Daily weights 
Slow push IV

Question 29

Osmotic diuretics (+contra)

Accepted Answer

Pull water from the cells into the proximal tube 
IV only 

**avoid in HF - risk of pulmonary edema**

Question 30

Mannitol (+SA)

Accepted Answer

Osmotic diuretic 
IV only 

SA: 
- convulsions 
- thrombophlebitis 
- Pulmonary congestion

Question 31

Potassium-sparing diuretics

Accepted Answer

Act against aldosterone in the distal tubule and collecting duct 
Preserve K +
Weak alone

Question 32

Spironolactone

Accepted Answer

Potassium-sparing diuretic - commonly used in ascites 
Po only 
** risk for hyperkalemia

Question 33

Thiazide & Thiazide-Like diuretics

Accepted Answer

Block Na+/Cl-reabsorption  = increased urine 
Mild arteriolar dilation - Decreases preload and afterload

Question 34

Hydrochlorothiazide (+ pharmacokinetics)

Accepted Answer

Most common Thiazide diuretic 
Requires CrCl <30mL/min for effectiveness 
Risk for hypokalemia 

O - 2hr
P - 4-6hr 
Dur - 12hr

Question 35

Positive inotropic drugs

Accepted Answer

Increase heart contraction (ex. digoxin)

Question 36

Positive chronotropic drugs

Accepted Answer

Increase HR (not used with HF)

Question 37

Positive dromotropic drugs

Accepted Answer

Increases conduction ( for dysrhythmias)

Question	Answer
What is the order for Heart failure treatment dugs	1. ACE inhibitors 2. ARB's 3. B-blockers 4. Neprilysin Inhibitor Combo 5. Loop diuretics 6. Aldosterone Antagonists 7. Phosphodiesterase Inhibitors 8. Cardiac glycosides
ACE inhibitors	- ↓ Aldosterone → ↓ Na⁺/H₂O retention → ↓ preload - ↓ LV end-volume → ↓ workload → ↑ cardiac output
ARB's	Vasodilators - decrease systemic vascular resistance
Beta Blockers	Block catecholamine effects - ↓ SNS stimulation → ↓ HR, ↓ conduction
Neprilysin Inhibitor Combo	Blocks the breakdown of natriuretic peptides - ↓ BP, ↓ afterload, ↓ mortality Keeps “good peptides” around → lowers BP, lowers afterload, improves survival.
Loop Diuretics Block	Blocks Na+ reabsorption - water follows - increase urine output
Aldosterone Antagonists	- ↓ Na⁺/H₂O retention, ↓ cardiac remodeling Monitor K⁺ and renal function
Phosphodiesterase Inhibitors	- ICU drug: makes heart squeeze harder + vessels relax. ↑ cAMP → ↑ Ca²⁺ → stronger contraction - Vasodilation → ↓ afterload
Risk with Phosphodiesterase Inhibitors	High arrhythmia risk → continuous monitoring
Cardiac Glycosides	Stronger squeeze, slower heart, slower AV conduction. Increase contractility, slow heart rate, clow conduction through AV node
Digoxin	Cardiac glycoside
What is the therapeutic range for Digoxin	0.8-2ng/mL
What is the significance of K+ levels with the admin of Digoxin	Low K⁺ = ↑ toxicity risk High K⁺ = ↓ effect
What are the signs of toxicity for Digoxin	GI upset → vision changes (yellow halos) → arrhythmias
What are the nursing considerations for Digoxin	Before admin - apical pulse for 1 min Notify prescriber if less then 60 or greater than 100
What is the antidote for Digoxin and when should it be given?	Digoxin Immune Fab Used when hyperkalemic or toxicity, life-threatening dysrhythmias, life threatening digoxin overdose
Valsartan	ARB
Bisoprolol	Beta blocker
Furosemide	Loop diuretic
Spironolactone	Aldosterone antagonist
Milrinone	Phosphodiesterase inhibitor
Sacubitril	Neprilysin Inhibitor
What are the types of diuretics	1. Loop diuretics - Strongest - work on the loop of henle 2. Thiazides - common for BP control 3. Potassium-sparing - weak diuretic but prevents K+ loss 4. Osmotic - Pull fluid out of tissues 5. Carbonic anhydrase inhibitors - used for glaucoma
Acetazolamide	Carbonic anhydrase inhibitor - Weak diuretic Used for edema, glaucoma, altitude sickness Not to use for pregnancy
Loop diuretics	Block Na+/K+/Cl- reabsorption in ascending loop of henle Causes: massive water loss, decreased in BP and pulmonary congestion *Risk of K+/Na+ depletion
Pharmacokinetics for loop diuretics (PO&IV)	Po: O=30-60 min, Dur+ 8h IV: O = 5 min, lasts 2 hours - used in emergencies (ex. pulmonary edema
Furosemide	Most used loop diuretic Pulmonary edema HF Liver disease Nephrotic syndrome
Considerations for Furosemide	Monito K+ levels BP Daily weights Slow push IV
Osmotic diuretics (+contra)	Pull water from the cells into the proximal tube IV only avoid in HF - risk of pulmonary edema
Mannitol (+SA)	Osmotic diuretic IV only SA: - convulsions - thrombophlebitis - Pulmonary congestion
Potassium-sparing diuretics	Act against aldosterone in the distal tubule and collecting duct Preserve K + Weak alone
Spironolactone	Potassium-sparing diuretic - commonly used in ascites Po only ** risk for hyperkalemia
Thiazide & Thiazide-Like diuretics	Block Na+/Cl-reabsorption = increased urine Mild arteriolar dilation - Decreases preload and afterload
Hydrochlorothiazide (+ pharmacokinetics)	Most common Thiazide diuretic Requires CrCl <30mL/min for effectiveness Risk for hypokalemia O - 2hr P - 4-6hr Dur - 12hr
Positive inotropic drugs	Increase heart contraction (ex. digoxin)
Positive chronotropic drugs	Increase HR (not used with HF)
Positive dromotropic drugs	Increases conduction ( for dysrhythmias)

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Heart failure drugs