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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?

A

2.5-4

Low

25
Q

What determines the pts preload/ volume status?

A

pulmonary capillary wedge pressure/ Pulmonary artery occlusion pressure (PAOP)

26
Q

What is the normal PAOP/PCWP range?

Is it high or low in patients with acute heart failure?

A

8-12mmHg

High

27
Q

What is the most common warm/cold dry/wet type?

A

Warm and wet!

28
Q

What is the action of Endothelin-1

A

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
Q

Where does ET-1 monitor for its effects?

A

at the carotids and kidneys

30
Q

What is the Action of Arginine Vasopressin

antiduretic hormone

A

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
Q

Atrial Naturetic Peptide function

A

released from atrial myocardium in response to atrial dilation and stretch

32
Q

B- Type naturetic Peptide

A

released from ventricular myocardium in response to elevated end diastolic volume (preload)

33
Q

What is the action of BNP?

A 
vasodilation
natriuresis
diuresis
antagonize RAAS
inhibit SNS
antagonize ET-1
34
Q

What are the important values of BNP?
No HF
inconclusive
“cardiac issue”

A

No HF is less than 100
inconclusive is 100-500
“cardiac issue” greater than 500

35
Q

Does BNP help or hurt us

A

HELPS us!!!

36
Q

What are the two main reasons ADHF occurs

A

Decrease CO/CI

Sodium/H2O restriction

37
Q

What are the non drug related precipitating factors

A 
ischemia
diet indiscretion
pulmonary embolism
valvular dysfunction
anemia
worse renal fxn
arrhythmias
disease progression
thyroid disorders
electrolyte abnormalities
infection
non compliance
38
Q

Drugs that cause water and sodium retention

A

corticosteroids
thiazolindediones
NSAIDS
some abx

39
Q

Drugs that decrease cardiac contractility

A

alcohol
beta blockers
some antiarrhythmics
some chemo agents

40
Q

What are the treatment goals

A

relieve congestion and optimize volume states
treat symptoms of low O2
minimize rise associated with drug therapy
avoid future hospitalization

41
Q

Adequate perfusion
volume overload
PCWP greater than 18
CI greater than 2.2

characteristics of:

A

Warm and Wet
subset II

(this pt gets a holiday heart)

42
Q

hypoperfusion
good volume status
PCWP less than 18
CI less than 2.2

A

“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
Q

Ssx: pulm congetsion, and/or system congestion, the congestion is visible on CXR or legs
Tx?

A

Wet and Warm

ACE I plus diuretic

44
Q

Ssx: hypoperfusion, see cyanosis, cold extremities and low BP
Tx?

A

Cold and Dry

NO diuretics, Inotropic meds but NOT digoxin
YES dobutamine

45
Q

Hypoperfusion
volume overload
PCWP greater than 18
CI less than 2.2

A

Cold and Wet

46
Q

Ssx: pulm or systemic congestion and hypoperfustion

Tx?

A

Cold and Wet

low dose diuretic, inotropic- dobutamine

47
Q

cold and wet pt appearance

A

almost in cariogenic shock
?MI
?to high dose of BB diuretic/inotropes/vasodilators

Pharm II MHM - Exam 3 (5 decks)

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