Which statement is accurate regarding the use of beta-adrenergic ...

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Which statement is accurate regarding the use of beta-adrenergic blockers for use in patients with heart failure?
 
  1. Higher doses are used initially until optimal vital signs are achieved.
  2. Dosage changes are done on a daily basis for the first 2 weeks.
  3. This drug class does not have an effect on the bronchioles of the lungs.
  4. They are generally used in combination with other heart-failure drugs.

Question 2

Lisinopril (Prinivil) is often used to treat heart failure because it lowers blood volume. Which of the following best explains how lisinopril lowers blood volume?
 
  1. It has an antagonistic effect on angiotensin-converting enzyme.
  2. It lowers aldosterone secretion, a hormone that increases sodium reabsorption.
  3. It causes hypernatremia and increased renal tubule permeability, resulting in a diuretic effect.
  4. It causes a diuretic effect by lowering the amount of sodium lost in the urine.

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Answer to Question 1

Correct Answer: 4
Rationale: Beta-adrenergic blockers are rarely used to treat heart failure alone. They are commonly used in combination with ACE inhibitors. Initial doses are small, and are doubled every 2 weeks until the optimal dose is achieved. Beta-adrenergic blockers can be selective to beta1 receptors or non-selective. Non-selective blockers block beta1 and beta2 receptors. The blockage of beta2 receptors can affect the bronchioles of the lungs.

Answer to Question 2

Correct Answer: 2
Rationale: ACE inhibitors lower blood volume by lowering the secretion of aldosterone from the adrenal cortex. Aldosterone is a hormone that increases the reabsorption of sodium and water. ACE inhibitors have an antagonistic effect on angiotensin-converting enzyme, but this action lowers blood pressure by reducing peripheral vascular resistance, not by lowering blood volume. Increasing sodium in the blood will not lower blood volume.

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