Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio Final > Acute Decompensated HF Drugs 1 > Flashcards

Acute Decompensated HF Drugs 1 Flashcards

1
Q

Type 1

A

Warm and dry

- Patients are okay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Type 2

A

Warm and wet

- Typically caused by too much sodium or forgot their diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Type 3

A

Cold and Dry

- Typically hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Type 4

A

Cold and Wet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Wet =

A

Congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Wet symptoms

A 
Peripheral edema
Pulmonary edema: dyspnea, orthopnea, nocturnal dyspnea, rales, wheezing
Ascites
GI edema: Early satiety/reduced appetite
Abdominal fullness
Jugular distention
Hepatojugular reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define orthopnea

A

Water goes from your legs to your lungs, making it hard to breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cold Symptoms

A 
Reduced Cardiac Output
Cold/clammy extremities
Renal insufficiency
Altered mental status
Hypotension
Fatigue
Narrow pulse pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Too much diuretics =

A

Dry

& vice versa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If your pulmonary artery occlusion pressure (PAOP) is not within 15-18,

A

You will show signs of edema if it is greater than 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CI greater than 2.2 =

A

Hyperperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diuretics are First Line when?

A

Warm and Wet
Cold and Wet
** any signs of fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diuretics titration

A

Want to lose 1-1.5 kg/day (1000-1500 mL)

Urine output should increase in 1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Monitoring for diuretics

A 
BP
K
MG
Na
Ca
SCr
Urine output 
Daily weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diuretic dosing

A

Needs to be BID or else the body will start to retain the water later on in the day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diuretics AE

A

Hypotension, worsening of renal function, electrolyte abnormalities
Contraction alkalosis
Ototoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If the urine output does not increase,

A 
Double initial IV bolus dose
Add continuous infusion
Add a thiazide
Consider addition of vasodilator or inotrope if hypotensive
Last line: ultrafiltration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Thiazides that can be used are

A

Metolazone

Chlorothiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of Hypotensive for Diuretics

A

Reduce the rate of diuresis
May require IV fluid bolus or inotrope if it is severe
Reduce/hold BP meds

20
Q

Management of worsening renal failure

A

Slower diuresis

Vasodilators (if BP is okay) or inotrops (if BP is low)

21
Q

Define contraction alkalosis

A

Occurs as a result of removing water but not bicabonate from the body so the same amount of bicarb in a smaller volume = alkalosis

22
Q

Warm and Wet Treatment includes

A

Vasodilators (nitroglycerin, nitroprusside, nesiritide)

23
Q

Vasodilators are usefule for

A

Those patients who failed to respond to IV diuretics
Or who have severe pulmonary congestion with hypoxia ad need for rapid resolution
So mainly for warm and wet patients but can also be used for cold and wet if they have adequate organ perfusion (BP > 110/70)

24
Q

Nitroglycern Hemodynamic effects

A

Mostly venous but high doses can do arterial dilation

25
Q

Na Nitroprusside Hemodynamic effects

A

Venous and arterial dilators

26
Q

Nesiritide Hemodynamic effects

A

Venous and arterial dilator
Rapidly reduces PAOP to relieve congestion
Enhances natriuresis

27
Q

Titration for Nitroglycerin and Nitroprusside

A

Relief of pulmonary congestion, increase in diuresis and BP no less than 100/65

28
Q

Nesiritide

A

(Natrecor)

is not usually titrated and it has a really long half life

29
Q

Monitoring for Nitroglycerin

A

BP
Urine output
May need Swan-Ganz

30
Q

Monitoring for Na Nitroprusside

A

BP
Urine Output
Need Swan-Ganz
Thiocyanate levels

31
Q

Monitoring for Nesiritide

A

BP
Urine Output
No Swan-Ganz**

32
Q

Nitroglycerin AE

A

Hypotension
Reflex tachycardia
Tachyphylaxis
Headache

33
Q

Nitroprusside AE

A

Hypotension
Reflex tachycardia
Tachyphylaxis
Cyanide toxicity

34
Q

Nesiritide AE

A

Hypotension
tachycardia (continuous EKG)
Acute RF
Expensive

35
Q

Manage Hypotension for Vasodilators

A

Reduce the dose but do not stop (must taper)

May d/c nesiritide

36
Q

What do you treat Cold and Dry ADHP or Cold and Wet ADHP with?

A

Inotropes

37
Q

Cold and dry ADHP requires

A

Patient has optimal PAOP, preload, volume status

38
Q

Cold and wet ADHP inotrope therapy when

A

vasodilators are not an option due to hypotension or they failed

39
Q

Dobutamine Hemodynamic effects

A

+ inotrope
+ Chronotrope (tachycardia)
Slight vasodilation

40
Q

Milirinone Hemodynamic effects

A

+ Inotropic
Few chronotropic changes
+ Vasodilation (possible hypOTN)

41
Q

Milrinone is preferred if

A

on a beta blocker

BUT NOT HYPOTENSIVE

42
Q

Dobutamine is preferred in

A

frank hypotension

43
Q

Titration targets to the intropes is:

A

CI > 2.2

44
Q

Intropes Monitoring

A

Continuous EKG for arrhythmias, BP, urine output, new onset chest pain

45
Q

Dobutamine AE

A 
Arrhythmias
Tachycardia
Hypotension
Myocardial Ischemia
Tachyphylaxis
46
Q

Milirinone AE

A 
Arrhythmias
Tachycardia
Hypotension
Myocardial Ischemia
Thrombocytopenia
47
Q

Long term use of inotropes is associated with

A

Increased mortality

Cardio Final (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions