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Pharm-HTN/CHF > Acute decompensated Heart Failure > Flashcards

Acute decompensated Heart Failure Flashcards

1
Q

CI cardiac index =

A 
CO/m2
Cardiac output (CO) is the volume of blood ejected from left ventricle during systole (L/min)
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2
Q

what is the normal range of CI

A

Normal range 2.5-4 L/min/m2

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3
Q

You would predict that CI is ___________ in patient with ADHF

A

Low

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4
Q

You would predict that PCWP is __________in patient with ADHF?

A

High

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5
Q

What is Endothelin-1 (ET-1)

A

Potent vasoconstriction
Induces cardiac remodeling
Decreases renal blood flow (GFR)
Also acts to further stimulate the RAAS and SNS systems
Elevated ET-1 levels in heart failure and other diseases

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6
Q

Pharmacologic actions of Arginine Vasopressin (AVP )

A 
Hormone secreted by posterior pituitary to maintain water homeostasis
Also known as antidiuretic hormore
Actions
Inhibits renal excretion of free water
Potent vasoconstriction
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7
Q

Used as a diagnostic tool, very valuable from differentiating between ADHF and ?

A

pneumonia

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8
Q

Also, in a patient with a baseline of BNP, any sharp increase is an indicator of ?

A

worsening of their HF

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9
Q

BNP “helps us” do what with ET-1 and AVP

A

it balances ET-1 and AVP;

Science has even made synthetic BNP as a medication

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10
Q

what are the two main reason ADHF occur

A

Decreased CO/CI

Sodium/H2O retention

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11
Q

Drugs that cause water and Na retention

A

Corticosteroids
NSAIDs (ibuprofen, naproxen)
Thiazolidinediones (pioglitazone, rosiglitazone)
Some antibiotics

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12
Q

Drugs that decrease cardiac contractility

A 
Alcohol
 Beta blockers
 Non-dihydropyridine CCB
 Some antiarrhythmics
 Some chemotherapy agents (doxorubicin)
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13
Q 
Factors for in-hospital mortality include
�BUN
SBP 
SCr 
�
A

≥ 43 mg/dL
< 115 mmHg
≥ 2.75 mg/dL

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14
Q

Goals of therapy for all ADHF patients

A

Relieve congestion and optimize volume status
Treat symptoms of low CO
Minimize risks associated with drug therapy
Avoid future hospitalization by optimizing chronic therapies and providing patient education

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15
Q

Forrester Hemodynamic subset II?

A

Warm and wet

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16
Q

Forrester Hemodynamic subset III?

A

cold and dry

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17
Q

Forrester Hemodynamic subset IV?

A

cold and wet

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18
Q

“Warm & Wet”, subset II

A

Adequate perfusion

Volume overload

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19
Q

what are the Signs and symptoms of a person warm and wet

A

normal BP but increased weight

20
Q

what would you use to treat a warm and wet Pt

A

furosemide and nitroglycerine

21
Q

cold and dry subset III volume and perfusion status?

A

Hypoperfusion

Good volume status

22
Q

what are the signs and symptoms of cold and dry?

A

lower BP systolic low 90’s, dehydrated

23
Q

how do you treat cold and dry

A

gentle rehydration and intoptrope, dobutamine

24
Q

cold and wet subset IV volume and perfusion status?

A

Hypoperfusion

Volume overload

25
Q

cold and wet signs and symptoms

A

low SBP, increased volume i.e weight increase peripheral edema,

26
Q

cold and wet Tx,

A

diuretics to lose water and dobutamine get CI up

possibly vasodilator depending on SBP

27
Q

what is the Cornerstone of HF management

A

ACE-inhibitors

Most likely used in “warm and wet” while the other types of ADHF doesn’t have the BP tolerance

28
Q

what drugs are part of the loop diuretic class

A

Furosemide (Lasix)
Bumetanide (Bumex)
Torsemide (Demadex)

29
Q

loop diuretic MOA

A

Increases Na excretion at the loop of Henle

30
Q

loop diuretic ADR

A 
Electrolyte abnormalities
Hyponatremia
Hypokalemia
Hypomagnesemia
Renal dysfunction
Hypotension
31
Q

what is diuretic resistance

A

Failure to respond to several IV bolus doses of loop diuretics
Occurs in 1 of 3 pts taking diuretics at home

32
Q

Methods for overcoming diuretic resistance?

A 
Student responses?
Increase loop diuretice
Start loop diuretic infusion
Add thiazide diuretic for synergy
Ultrafiltration
33
Q

what are 3 vasodilators

A

Nitroglycerin
Nitroprusside (Nipride™)
Nesiritide (Natrecor™)

34
Q

Nitroprusside MOA

A

potent, balanced vasodilator
acts directly on vascular smooth muscle (nitric oxide donor)
also used for hypertensive crisis
CAN NOT BE USED IN RENAL DYSFUNCTION because it will cause cyanide poisioning

35
Q

Nitroprusside adverse drug effects

A

Hypotension
Coronary steal syndrome
worse outcomes in s/p MI patients who are NOT in heart failure
Metabolized to cyanide and thiocyanate, increased risk of toxicity in patients with renal dysfunction or if high dose for prolonged period
antidote (sodium thiosulfate)

36
Q

Nitroglycerin MOA

A

primarily a venous vasodilator

Acts as a nitric oxide donor

37
Q

Nitroglycerin side notes

A

IV infusion, short-term
useful in heart failure with myocardial ischemia
Risk of tachyphylaxis
Other side effects: HA, hypotension

38
Q

Nesiritide MOA

A

Recombinant B-type Natriuretic Peptide
reduces sympathetic stimulation
inhibits renin-angiotension-aldosterone system
Results in vascular smooth muscle relaxation, balanced vasodilator AND diuresis

39
Q

Nesiritide adverse effects

A

hypotension, especially if on ACE-I
worsens renal function
Increased mortality?

40
Q

Dopamine MOA

A

Has inotropic and vasopressor activities, converted in norepinephrine

41
Q

dobutamine MOA

A

– β-agonist:

Binds to beta 1 receptor and increases calcium influx during systole

42
Q

dobutamine pharmacologic effects and place in therapy

A

Increase contractility  increase CO/CI

43
Q

dobutamine adverse effects

A

Adverse effects:
Tachycardia
Arrythymogenic
Increase in mortality in long term use

44
Q

Milrinone MOA

A 
Phosphodiesterase inhibitor (PDE3)
Increases intracellular cAMP which increases intracellular calcium
45
Q

Milrinone Pharmacologic effect:

A

increased contractility

Vasodilatory effects

46
Q

milrinone adverse effects

A 
Arrythymogenic 
May decrease BP and result in reflex tachycardia
Hypotension
Thrombocytopenia
Increase in mortality
47
Q

Diagnostic value of BNP�

A

less than 100 pg/ml no HF
inconclusive 100-500pg/ml
greater than 500 pg/ml high sensitivity to cardiac issues

Pharm-HTN/CHF (4 decks)

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