(546.1) Refractory CHF

1. Which one of the following statements regarding pimobendan is true?

A. The most common adverse effect in dogs is tachyarrhythmias.

B. Pimobendan has a narrow therapeutic window and toxicity can occur at twice to three-times the recommended dose.

C. Higher doses of pimobendan have been shown to increase left atrial pressure in experimental studies of mitral valve insufficiency.

D. Pimobendan has been shown to improve both quality and quality of life in dogs with heart failure due to myxomatous mitral valve disease and dilated cardiomyopathy.

2. Furosemide is helpful in management heart failure because it:

A. Improves cardiac output by its action to reduce blood volume

B. Acts primarily as a vasodilator in addition to its diuretic effects

C. Reduces hydrostatic pressure in the pulmonary vessels by reducing blood volume

D. Improves myocardial performance by increasing calcium sensitivity of the myocardium.

3. Which of the following statements regarding diuretic resistance in refractory hypervolemic heart failure is true:

A. Poor oral absorption of diuretics in congestive heart failure is not a common factor that results in poor diuretic response.

B. Advanced heart failure resulting in decreases in renal perfusion triggers sodium and water absorption to maintain circulatory homeostasis and vascular volume.

C. Combination diuretic therapy is typically not useful to overcome increased sodium retention and diuretic resistance.

D. Increased plasma sodium is a sign associated with refractory heart failure and diuretic resistance.

4. Nitroprusside may be useful in refractory congestive heart failure because it:

A. May improve cardiac output and blood pressure due to its balanced vasodilatory actions.

B. May decreased blood volume by its diuretic effects and actions to decrease blood volume.

C. May improve cardiac output and blood pressure due to its positive inotropic effects.

D. May work to improve renal perfusion due to its efferent arteriolar vasodilatory effects in the renal glomerulus.

5. Hypertonic saline may be useful in refractory heart failure and diuretic resistance because it:

A. May transiently improve renal perfusion, sodium and drug delivery to the tubules of the nephron.

B. May stimulate the beta-receptors to increase heart rate and cardiac output.

C. May trigger sodium and chloride loss in the distal tubules by direct action on the aldosterone receptor.

D. May increase release of ACE and aldosterone to promote diuresis.

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(546.1) Refractory CHF

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