Question 1

Digitalis may exert some of its beneficial effects by decreasing heart rate via a(n)_______ in _______ stimulation of the heart.&#10;A) increase; parasympathetic&#10;B) decrease; sympathetic&#10;C) increase; sympathetic&#10;D) decrease; parasympathetic&#10;E) A and B are true

Accepted Answer

Digitalis can exert its beneficial effects by both increasing parasympathetic stimulation and decreasing sympathetic stimulation of the heart, which leads to a decrease in heart rate.

Question 2

In people with heart failure,the best drugs for reducing fluid accumulation and congestion in the lungs and peripheral tissues are&#10;A) alpha blockers&#10;B) beta blockers&#10;C) angiotensin II receptor blockers&#10;D) calcium channel blockers&#10;E) diuretics

Accepted Answer

Diuretics are the best choice for reducing fluid accumulation and congestion in the lungs and peripheral tissues in people with heart failure. They work by promoting the excretion of excess fluid and sodium from the body, thereby reducing the volume of blood and relieving the overload on the heart. Other drug classes, such as alpha and beta blockers, angiotensin II receptor blockers, and calcium channel blockers, may be used in the management of heart failure, but they do not primarily target fluid accumulation and congestion.

Question 3

Phosphodiesterase inhibitors such as inamrinone and milrinone may help increase myocardial contraction in heart failure by ______ breakdown of cyclic adenosine monophosphate (cAMP),which leads to a(n)______ in calcium in cardiac cells.

A) inhibiting; increase
B) stimulating; increase
C) inhibiting; decrease
D) stimulating; decrease

inhibiting; increase

Accepted Answer

Phosphodiesterase inhibitors like inamrinone and milrinone work by inhibiting the breakdown of cyclic adenosine monophosphate (cAMP), which in turn leads to an increase in calcium levels in cardiac cells, enhancing myocardial contraction.

Question 4

In people with heart failure,the best drugs for reducing excessive sympathetic stimulation of the failing heart are&#10;A) alpha blockers&#10;B) beta blockers&#10;C) angiotensin II receptor blockers&#10;D) calcium channel blockers&#10;E) diuretics

Accepted Answer

Beta blockers are the best drugs for reducing excessive sympathetic stimulation of the failing heart. They work by blocking the beta receptors in the heart, which reduces the effects of the stress hormones epinephrine and norepinephrine on the heart. This leads to a reduction in heart rate, blood pressure, and workload on the heart, which can help improve symptoms and outcomes in patients with heart failure.

Question 5

All of the following types of drugs will decrease cardiac workload in people with heart failure EXCEPT&#10;A) angiotensin converting enzyme (ACE) inhibitors&#10;B) beta blockers&#10;C) alpha-1 stimulants&#10;D) vasodilators&#10;E) diuretics

Accepted Answer

Alpha-1 stimulants (such as phenylephrine) are vasoconstrictors that increase vascular resistance, leading to an increase in cardiac workload. Therefore, they would not be helpful in lowering cardiac workload in people with heart failure. The rest of the options (ACE inhibitors, beta blockers, vasodilators, and diuretics) all work to decrease cardiac workload.

Question 6

Cardiac glycosides such as digitalis are used to treat heart failure because these drugs exert&#10;A) a positive inotropic effect&#10;B) a negative inotropic effect&#10;C) a positive dromotropic effect&#10;D) a negative dromotropic effect&#10;E) a positive chronotropic effect

Accepted Answer

Cardiac glycosides such as digitalis exert a positive inotropic effect, which means they increase the force of contraction of the heart muscle. This helps to improve cardiac output and relieve symptoms of heart failure.

Question 7

The primary cardiac problem in digitalis toxicity is&#10;A) decreased coronary blood flow&#10;B) increased coronary oxygen demand&#10;C) decreased cardiac intracellular sodium concentration.&#10;D) arrhythmia&#10;E) isolated systolic hypotension

Accepted Answer

The primary cardiac problem in digitalis toxicity is arrhythmia, including atrial and ventricular arrhythmias.

Question 8

Angiotensin enzyme (ACE)inhibitors are often essential in treating heart failure because ACE inhibitors&#10;A) stimulate renin production from the kidneys&#10;B) increase heart rate&#10;C) prevent the detrimental effects of epinephrine on the failing heart&#10;D) may increase life expectancy in people with heart failure&#10;E) all the above are true

Accepted Answer

ACE inhibitors may increase life expectancy in people with heart failure by preventing the detrimental effects of angiotensin II on the heart and blood vessels, reducing afterload and improving cardiac function. ACE inhibitors also have other benefits such as reducing the risk of hospitalization, improving symptoms, and improving quality of life. Option A is incorrect because ACE inhibitors actually inhibit the renin-angiotensin-aldosterone system, thus decreasing renin production. Option B is incorrect because ACE inhibitors do not increase heart rate. Option C is incorrect because ACE inhibitors do not prevent the detrimental effects of epinephrine on the failing heart.

Question 9

Digitalis and the other cardiac glycosides increase the mechanical pumping ability of the heart by bringing about an increase in _________ concentration.&#10;A) extracellular potassium&#10;B) intracellular potassium&#10;C) extracellular calcium&#10;D) intracellular calcium&#10;E) extracellular sodium

Accepted Answer

Digitalis and cardiac glycosides inhibit the sodium-potassium pump, causing a buildup of intracellular sodium. This, in turn, leads to an increase in intracellular calcium concentration, which increases the mechanical pumping ability of the heart. So, the correct answer is intracellular calcium (choice D).

Question 10

A patient exhibiting symptoms of serious,life-threatening digitalis toxicity could be treated with&#10;A) positive inotropes (inamrinone, milrinone)&#10;B) epinephrine&#10;C) norepinephrine&#10;D) digoxin immune Fab (Digibind, DigiFab)&#10;E) none of the above; there is no emergency treatment for digitalis toxicity

Accepted Answer

The patient exhibiting serious, life-threatening digitalis toxicity can be treated with digoxin immune Fab (Digibind, DigiFab). Digoxin immune Fab binds to the digoxin in the bloodstream, forming a complex that is excreted through the kidneys. This removes the toxic effects of the digoxin from the body and can rapidly improve symptoms. Positive inotropes, such as inamrinone and milrinone, may actually exacerbate digitalis toxicity, while epinephrine and norepinephrine are unlikely to improve the patient's condition.

Question 11

Digitalis exerts its primary mechanical effect by _____ the sodium-potassium pump on the myocardial cell membrane,which leads directly to an _____ intracellular sodium concentration.&#10;A) stimulating; increase&#10;B) inhibiting; increase&#10;C) stimulating; decrease&#10;D) inhibiting; decrease

Accepted Answer

The answer of Digitalis exerts its primary mechanical effect by...

Deck 24: Treatment of Congestive Heart Failure