Heart failure pt 2 important stuff

Question 1

List the 4 subsets of HF and their treatments

(will be on exam)

Answer 1

Question 2

List the 4 subsets of heart failure

Answer 2

1) Subset 1: warm and dry
2) Subset 2: warm and wet
3) Subset 3: cold and dry
4) Subset 4: cold and wet

Question 3

List the 4 categories of pharmacologic Tx and 2 members of each category

Answer 3

1) Loop and adjunct diuretics: Furosemide, Hydrochlorothiazide
2) Vasopressin antagonist: Tolvaptan, Conivaptan
3) Vasodilators: Nitroglycerin, Sodium nitroprusside
4) Inotropes: Dobutamine, Milrinone

Question 4

IV loop diuretics __________ and ____________ are the mainstay of therapy for relieving congestion in the setting of ADHF

Answer 4

furosemide; bumetanide

Question 5

List 2 Vasopressin receptor antagonists

Answer 5

Tolvaptan (Samsca or Jynarque) + Conivaptan (Vaprisol)

Question 6

List 2 vasodilators and their MOAs

Answer 6

1) Nitroglycerin
-MOA: venodilator
2) Nitroprusside
-MOA: mixed venous and arterial vasodilator

Question 7

You should avoid use of which meds in the presence of elevated intracranial pressure because it may worsen cerebral edema in this setting?

Answer 7

Nitroglycerin + Nitroprusside

Question 8

Why aren’t inotropes a first line treatment?

Answer 8

↑ mortality compared to vasodilators

Question 9

Name 2 inotropes and differentiate between them

Answer 9

1) Dobutamine
-MOA: direct stimulation of β-adrenergic receptors; some α1-agonist effects
-Associated with more pronounced increases in heart rate compared to milrinone
2) Milrinone
-MOA: inhibits phosphodiesterase type 3
-Associated with greater relaxation in arterial smooth muscle

Question 10

List 2 Catecholamines

Answer 10

Norepinephrine + dopamine

Question 11

What do dopamine and norepi have a BBW for?

Answer 11

They’re vesicants; may cause tissue damage with extravasation (black box warning)

Question 12

What is the antidote to norepinephrine and dopamine tissue damage?

Answer 12

Alpha-1-blocker phentolamine