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Pharm II MHM - FINAL > Acute HF > Flashcards

Flashcards in Acute HF Deck (45):
1

MOA of Loop Diuretics

Increase Na excretion at the loop of henle

2

ADEs of loop diuretics

Electrolyte abnormalities- hyponatremia, hypokalemia, hypomagnesemia
Renal dysfunction
Hypotension

3

Name loops

Furosemide
Butemanide
Torsemide

4

What is the Function and indication of ultrafiltration aka aquaphoresis

Removes a predictable amount of H2O
Diuretic resistance
Severe renal impairment
Only a minimal drop in BP

5

What are the vasodilators?

Nitroprusside
Nitroglycerin

6

What is the cornerstone drug in acute heart failure?

ACE-I

7

Potent, balanced vasodilator, act on vascular smooth muscleMOA of?

Nitroprusside

8

Indication of Nitroprusside

vasodilator of the vascular (NO donor)
also for hypertensive crisis
protection from light

9

ADE nitroprusside

hypotension
coronary
renal syndrome (worse in s/p MI pt with heart failure)

10

consideration of nitroprusside

breaks down to thiocyanate/cyanide (orange-brown-blue)
so increase risk of toxicity for renal dysfxn pts or if HIGH dose is prolonged
antidote=sodium thiosulfate

11

What is the MOA and Indications of Nitroglycerin?

acts as a primary venous vasodilator
acts as a NO donor
used in HF with myocardial ischemia

12

What are the ADEs of Nitro? Can it be used IV?

H/A
hypotension
tachyphylaxsis
YES IV

13

What are the drugs for Inotropic therapy?

Dobutamine
Dopamine
Milrione

14

What is the MOA of dobutamine?

B agonist: binds to B1 receptor and increase calcium influx during systole

15

Indications of Dobutamine?

typical used in "cold" HF, almost cardiogenic shock
increase in contractility causes increase CO/CI
place in therapy: acute CHF "cold" pts

16

Tachycardiaarrththymogenicincrease mortality with long term useADE's of?

Dobutamine

17

MOA dopamine?Indications of dopamine?

converts to NE, activates alpha, beta and dopaminergic receptor
also for "cold" patients
D+D for cold
Inotropic + vasopressor activity

18

MOA Milrione?

Phosphodiesterase inhibitor (PDE3)
increase intracellular cAMP which increases intracellular calcium in the heart

19

Indications of Milrione

increase contractility because increase cAMP vasodilatory effects
"inodilator"

20

Arrhthmogenicmay decrease BP and result in reflex tachycardiathrobocytopeniaincrease in mortality

ADE of Milrione

21

What percent of patients present with heart failure to the ED?What is their average length of stay?

75%
3-4days

22

What is the Cardiac index?What is it's utility?

CI= CO/ m^2 determines the O2 delivery and perfusion

23

What is the normal range of the CI?In pts with acute CHF, is CI high or low?

2.5-4
Low

24

What determines the pts preload/ volume status?

pulmonary capillary wedge pressure/pulmonary artery occlusion pressure (PAOP)

25

What is the normal PAOP/PCWP range?Is it high or low in patients with acute heart failure?

8-12 mmHg
High

26

What is the most common warm/cold dry/wet type?

Warm and wet!

27

What is the action of Endothelin-1

potent vasoconstriction, induce cardiac remodeling, decrease renal blood flow (GSR), stimulate RAAS+SNS elevated levels in heart failure + other diseases
ET-1 hurts us

28

Where does ET-1 monitor for its effects?

at the carotids and kidneys

29

What is the Action of Arginine Vasopressin (antiduretic hormone)

hormone secreted by the posterior pituitary to maintain water homeostasis
inhibits renal excretion of free water
potent vasoconstriction
elevated AVP levels in heart failure
AVP- hurts us

30

Atrial Naturetic Peptide function

released from atrial myocardium in response to atrial dilation and stretch

31

B- Type naturetic Peptide

released from ventricular myocardium in response to elevated end diastolic volume (preload)

32

What is the action of BNP?

vasodilation
natriuresis
diuresis
antagonize RAAS
inhibit SNS
antagonize ET-1

33

What are the important values of BNP? No HFinconclusive"cardiac issue"

No HF is less than 100
inconclusive is 100-500
"cardiac issue" greater than 500

34

Does BNP help or hurt us

HELPS us!!!

35

What are the two main reasons ADHF occurs

Decrease CO/CI
Sodium/H2O restriction

36

What are the non drug related precipitating factors

ischemia
diet indiscretion
PE
valvular dysfunction
anemia
worse renal fxn
arrhythmias
disease progression
thyroid disorders
electrolyte abnormalities
infection
non compliance

37

Drugs that cause water and sodium retention

corticosteroids
thiazolindediones
NSAIDS
some abx

38

Drugs that decrease cardiac contractility

alcohol
beta blockers
some antiarrhythmics
some chemo agents

39

Adequate perfusionvolume overloadPCWP greater than 18CI greater than 2.2 characteristics of:

Warm and Wet
subset II
(this pt gets a holiday heart)

40

hypoperfusiongood volume statusPCWP less than 18CI less than 2.2

"cold and dry"
this is the pt who has chronic HF, and super vigilant about Na and H2O who gets dehydrated, arrhthymias and low BP

41

Ssx: pulm congetsion, and/or system congestion, the congestion is visible on CXR or legs Tx?

Wet and Warm
ACE I plus diuretic

42

Ssx: hypoperfusion, see cyanosis, cold extremities and low BPTx?

Cold and Dry
NO diuretics, Inotropic meds but NOT digoxin
YES dobutamine

43

Hypoperfusionvolume overloadPCWP greater than 18CI less than 2.2

Cold and Wet

44

Ssx: pulm or systemic congestion and hypoperfustionTx?

Cold and Wet
low dose diuretic, inotropic- dobutamine

45

cold and wet pt appearance

almost in cardiogenic shock?
MI?
to high dose of BB diuretic/inotropes/vasodilators