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Pharm II MHM - Exam 3 > Acute Heart Failure > Flashcards

Acute Heart Failure Flashcards

1
Q

MOA of Loop Diuretics

A

Increase Na excretion at the loop of henle

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2
Q

ADEs of loop diuretics

A 
Electrolyte abnormalities-
Hyponatremia
Hypokalemka
Hypomagnesemia
Renal dysfunction
Hypotension
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3
Q

Oral onset 30 min, duration 6 hours
IV onset 5 mins, duration 2 hours

For

A

Loop diuretics

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4
Q

Name loops

A

Furosemide
Butemanide
Torsemide

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5
Q

What is the Function and indication of ultrafiltration aka aquaphoresis

A

Removes a predictable amount of H2O

Diuretic resistance
Severe renal impairment

Only a minimal drop in BP

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6
Q

What are the vasodilators?

A

Nitroprusside

Nitroglycerin

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7
Q

What is the cornerstone drug in acute heart failure?

A

ACE-

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8
Q

Potent, balanced vasodilator, act on vascular smooth muscle

MOA of?

A

Nitroprusside

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9
Q

Indication of Nitroprusside

A

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

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10
Q

ADE nitroprusside

A

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

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11
Q

consideration of nitroprusside

A

breaksdown to thiocyanate/cyanide
(orange - brown - blue solution)
so increase risk of toxicity for renal dysfxn pts or if HIGH dose is prolonged

antidote=sodium thiosulfate

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12
Q

What is the MOA and Indications of Nitroglycerin?

A

acts as a primary venous vasodilator
acts as a NO donor

used in HF with myocardial ischemia

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13
Q

What are the ADEs of Nitro?

Can it be used IV?

A

H/A
hypotension
tachyphylaxsis
YES

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14
Q

What are the drugs for Inotropic therapy?

A

Dobutamine
Dopamine
Milrione

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15
Q

What is the MOA of dobutamine?

A

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

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16
Q

Indications of Dobutamine?

A

typical used in “cold” HF, almost cardiogenic shock
increase in contractility causes increase CO/CI

place in therapy: acute CHF “cold” pts

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17
Q

Tachycardia
arrththymogenic
increase mortality with long term use

ADE’s of?

A

Dobutamine

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18
Q

MOA dopamine?

Indications of dopamine?

A

converts to NE, activates alpha, beta and dopaminergic receptor

also for “cold” patients

D+D for cold
Inotropic + vasopressor activity

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19
Q

MOA Milrione?

A

Phosphodiesterase inhibitor (PDE3)

increase intracellular cAMP which increases intracellular calcium in the heart

20
Q

Indications of Milrione

A

increase contractility because increase cAMP vasodilatory effects

“inodilator”

21
Q

Arrhthmogenic
may decrease BP and result in reflex tachycardia
throbocytopenia
increase in mortality

A

ADE of Milrione

22
Q

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

A

75%

3-4days

23
Q

What is the Cardiac index?

What is it’s utility?

A

CI= CO/ m^2

determines the O2 delivery and perfusion

24
Q

What is the normal range of the CI?

In pts with acute CHF, is CI high or low?

25
What determines the pts preload/ volume status?
pulmonary capillary wedge pressure/ Pulmonary artery occlusion pressure (PAOP)
26
What is the normal PAOP/PCWP range? Is it high or low in patients with acute heart failure?
8-12mmHg High
27
What is the most common warm/cold dry/wet type?
Warm and wet!
28
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
29
Where does ET-1 monitor for its effects?
at the carotids and kidneys
30
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
31
Atrial Naturetic Peptide function
released from atrial myocardium in response to atrial dilation and stretch
32
B- Type naturetic Peptide
released from ventricular myocardium in response to elevated end diastolic volume (preload)
33
What is the action of BNP?
``` vasodilation natriuresis diuresis antagonize RAAS inhibit SNS antagonize ET-1 ```
34
What are the important values of BNP? No HF inconclusive "cardiac issue"
No HF is less than 100 inconclusive is 100-500 "cardiac issue" greater than 500
35
Does BNP help or hurt us
HELPS us!!!
36
What are the two main reasons ADHF occurs
Decrease CO/CI Sodium/H2O restriction
37
What are the non drug related precipitating factors
``` ischemia diet indiscretion pulmonary embolism valvular dysfunction anemia worse renal fxn arrhythmias disease progression thyroid disorders electrolyte abnormalities infection non compliance ```
38
Drugs that cause water and sodium retention
corticosteroids thiazolindediones NSAIDS some abx
39
Drugs that decrease cardiac contractility
alcohol beta blockers some antiarrhythmics some chemo agents
40
What are the treatment goals
relieve congestion and optimize volume states treat symptoms of low O2 minimize rise associated with drug therapy avoid future hospitalization
41
Adequate perfusion volume overload PCWP greater than 18 CI greater than 2.2 characteristics of:
Warm and Wet subset II (this pt gets a holiday heart)
42
hypoperfusion good volume status PCWP less than 18 CI 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
43
Ssx: pulm congetsion, and/or system congestion, the congestion is visible on CXR or legs Tx?
Wet and Warm ACE I plus diuretic
44
Ssx: hypoperfusion, see cyanosis, cold extremities and low BP Tx?
Cold and Dry NO diuretics, Inotropic meds but NOT digoxin YES dobutamine
45
Hypoperfusion volume overload PCWP greater than 18 CI less than 2.2
Cold and Wet
46
Ssx: pulm or systemic congestion and hypoperfustion | Tx?
Cold and Wet low dose diuretic, inotropic- dobutamine
47
cold and wet pt appearance
almost in cariogenic shock ?MI ?to high dose of BB diuretic/inotropes/vasodilators

Pharm II MHM - Exam 3 (5 decks)

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