Exam 2 - Acute HF

Question 1

BNP > _____ is closely associated with acute HF

Answer 1

> 400

Question 2

four classes of ADHF

Answer 2

I - warm and dry (normal)
II - warm and wet (pulm congestion)
III - cool and dry (hypoperfusion)
IV - cool and wet (hypoperfusion and pulm congestion)

Question 3

what initial IV dose should be used for diuretics in hospitalized pts with ADHF?

Answer 3

IV dose should equal or exceed the chronic daily dose and give as intermittent bolus (inc dose pt was receiving at home)

Question 4

when is vasodilator therapy used for ADHF?

Answer 4

used (in combo with diuretics) to reduce pulmonary congestion in wet, stage II and IV, HF

Question 5

venodilators inc venous capacitance and reduce _____ and reduce myocardial _____

Answer 5

preload; stress

Question 6

true or false: pts with symptomatic HTN should not receive vasodilators for ADHF

Answer 6

true

Question 7

which vasodilator favors venous vasodilation over arterial?

a. nitroprusside
b. NTG
c. nesiritide

Answer 7

b. NTG

Question 8

nitroprusside is a balanced vasodilator and decreases _____

Answer 8

SVR

Question 9

which vasodilator for ADHF is not used for HTN crisis?

a. nitroprusside
b. NTG
c. nesiritide

Answer 9

c. nesiritide (the other two are)

Question 10

nesiritide is a balanced vasodilator and increases what 2 things? (slide 23 of 34)

Answer 10

inc urine output and Na excretion

Question 11

which vasodilator for ADHF is not used for ACS?

a. nitroprusside
b. NTG
c. nesiritide

Answer 11

b. NTG

Question 12

what are the half lives for nitroprusside, NTG, and nesiritide when used for ADHF?

Answer 12

nitroprusside < 10 min
NTG ~1-4 min
nesiritide ~20 min

Question 13

which vasodilator for ADHF has an AE for cyanide toxicity?

a. nitroprusside
b. NTG
c. nesiritide

Answer 13

a. nitroprusside (usually > 3 days after use)

Question 14

which vasodilator for ADHF is NOT used alternatively to inotropes for cold and wet pts?

a. nitroprusside
b. NTG
c. nesiritide

Answer 14

b. NTG

Question 15

what are the 3 positive inotropes we talked about for ADHF?

Answer 15

dobutamine
milrinone
dopamine

(we also mentioned amrinone, but idk if we need to know this one)

Question 16

which positive inotrope stimulates adenylyl cyclase to increase cAMP?

a. dobutamine
b. milrinone
c. dopamine

Answer 16

a. dobutamine

Question 17

which positive inotrope is considered both an inotrope and a vasodilator (inodilator)?

a. dobutamine
b. milrinone
c. dopamine

Answer 17

b. milrinone

Question 18

does milrinone favor venous or arterial vasodilation?

Answer 18

venous

Question 19

in which subset are positive inotropes used for ADHF?

Answer 19

cold and wet (IV)

(or cold and dry if PCWP > 15)

Question 20

which positive inotrope is preferred in pts with high SVR or for a pt on BB?

a. dobutamine
b. milrinone

Answer 20

b. milrinone

Question 21

when should we consider dobutamine vs milrinone?

Answer 21

consider dobutamine if low BP; consider milrinone if on BB

Question 22

use of dopamine in ADHF

Answer 22

typically secondary role to dobutamine/milrinone; sometimes referred to as a vasopressor (inc BP)

Question 23

do diuretics decrease afterload, preload, or both?

Answer 23

dec preload

Question 24

do vasodilators reduce preload, afterload, or both?

Answer 24

both

Question 25

what is the only definitive long term therapy for ADHF?

Answer 25

cardiac transplant