Addiction Medicine — MCQs

Q: In a patient with chronic congestive cardiac failure, which of the following drugs does NOT prolong survival?

Digoxin. In Chronic Congestive Cardiac Failure (CCF) with reduced ejection fraction (HFrEF), the primary goal of therapy is to block the maladaptive neurohormonal activation (Renin-Angiotensin-Aldosterone System and Sympathetic Nervous System) that leads to cardiac remodeling and disease progression. **Why Digoxin is the correct answer:** Digoxin is a positive inotrope that acts by inhibiting the **Na+/K+-ATPase pump**, increasing intracellular calcium. While it improves symptoms, increases exercise tolerance, and reduces the rate of hospitalizations (as shown in the **DIG Trial**), it has **no effect on overall mortality** [1]. It is primarily used for rate control in patients with concomitant Atrial Fibrillation or for symptomatic relief in refractory heart failure [1]. **Why the other options are incorrect:** * **Enalapril (ACE Inhibitor):** ACE inhibitors are the cornerstone of CCF therapy. They prevent the formation of Angiotensin II, reducing afterload and cardiac remodeling, thereby significantly improving survival [1]. * **Metoprolol (Succinate) & Carvedilol (Beta-blockers):** These drugs counteract the toxic effects of chronic catecholamine exposure. Large trials (e.g., MERIT-HF for Metoprolol, COPERNICUS for Carvedilol) have proven they reduce mortality in stable CCF patients [1]. *Note: Only Metoprolol Succinate (long-acting), not Tartrate, is proven for survival.* **High-Yield Clinical Pearls for NEET-PG:** * **Drugs that improve survival in HFrEF:** ACE inhibitors/ARBs, Beta-blockers (Carvedilol, Metoprolol succinate, Bisoprolol), Aldosterone antagonists (Spironolactone), ARNI (Sacubitril/Valsartan), and SGLT2 inhibitors (Dapagliflozin) [1]. * **Drugs that only improve symptoms (No mortality benefit):** Digoxin, Loop diuretics (Furosemide) [1]. * **Digoxin Toxicity:** Characterized by gastrointestinal upset and visual disturbances (Xanthopsia/yellow vision). Hypokalemia predisposes to toxicity.

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