17 December 2022 Flashcards
What is a condition in which macrogol should be used with caution and why?
Macrogol has a high sodium content so should be used with caution in heart failure
What should you always do when making recommendations to the team?
You should always quote your evidence when making recommendations to the team (such as relevant obs or labs)
What should you consider with bedbound patients?
Patients lose 1% muscle mass every day they spend in bed
Describe the role of oral iron in HFrEF
Oral iron has little evidence in HFrEF so should not be used
What must you keep in mind when monitoring the use of beta blockers in heart failure?
Beta blockers can increase BNP
How long should you wait after an iron infusion before starting oral iron?
Don’t start oral iron for 5 days post iron infusion
How do we approach iron supplementation in children?
We always want to use oral iron where possible in children
What reference should you cite for iron infusions in patients with heart failure?
There is a SALHN protocol for iron infusions in HFrEF
Which is preferred in HFrEF and why: iron carboxymaltose or iron polymaltose?
Iron carboxymaltose is preferred to polymaltose in HFrEF because it has less fluid and better evidence
How should electrolytes be monitored for patients on furosemide?
For furosemide we monitor electrolytes every 1-2 weeks until stable, then every 6 months, and 1-2 weeks after every dose change
What monitoring is required after an iron carboxymaltose infusion?
Monitor EUC 2 weeks post iron infusions as iron carboxymaltose can cause hypophosphataemia
Describe the role of diltiazem in heart failure.
Diltiazem can worsen Heart failure
What is the target haemoglobin in males with heart failure?
145
What is the target haemoglobin in females with heart failure?
135
What does STML stand for?
Short Term Memory Loss
What is the active ingredient in Rulide?
Roxithromycin
When should you request iron studies?
You only need iron studies if haemoglobin is low
What should you consider about the timing of iron studies?
Don’t take iron studies in infectious patients as ferritin will be falsely elevated
What is claudication?
Muscle pain due to a lack of oxygen that’s triggered by activity and relieved by rest
How are premature babies monitored in hospital?
Prem babies stay in NICU until they are at term
How is carvedilol dosed?
Carvedilol is used once daily for hypertension and twice daily for heart failure
Do you need consent before giving iron infusions?
Yes
Do you always need to hold SGLT2 inhibitors for surgery?
Only if the patient is fasting
What should you always remember when reviewing iron deficiency anaemia?
You should check the lowest level from this admission
When should you request lipid studies?
Only if it is implicated in one of the patient’s current issues
When should you request lipid studies?
Only if it is implicated in one of the patient’s current issues
When should you request HbA1c?
Only if it is implicated in one of the patient’s current issues
What is the drug class of milrinone?
Phosphodiesterase 3 inhibitor
What is the mechanism of action of milnirone?
Inotrope; increases force of myocardial contraction; systemic and pulmonary arterial vasodilator.
What are two indications for milrinone?
Severe heart failure refractory to other treatment, for short-term use (48 hours) in intensive or coronary care units
Low cardiac output states, eg after cardiac surgery, particularly when associated with pulmonary hypertension
