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Pharm II MHM - FINAL > Acute HF > Flashcards

Acute HF 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, hypokalemia, hypomagnesemia
Renal dysfunction
Hypotension

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3
Q

Name loops

A

Furosemide
Butemanide
Torsemide

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4
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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5
Q

What are the vasodilators?

A

Nitroprusside

Nitroglycerin

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6
Q

What is the cornerstone drug in acute heart failure?

A

ACE-I

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7
Q

Potent, balanced vasodilator, act on vascular smooth muscleMOA of?

A

Nitroprusside

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8
Q

Indication of Nitroprusside

A

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

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9
Q

ADE nitroprusside

A

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

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10
Q

consideration of nitroprusside

A

breaks down to thiocyanate/cyanide (orange-brown-blue)
so increase risk of toxicity for renal dysfxn pts or if HIGH dose is prolonged
antidote=sodium thiosulfate

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11
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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12
Q

What are the ADEs of Nitro? Can it be used IV?

A

H/A
hypotension
tachyphylaxsis
YES IV

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13
Q

What are the drugs for Inotropic therapy?

A

Dobutamine
Dopamine
Milrione

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14
Q

What is the MOA of dobutamine?

A

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

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15
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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16
Q

Tachycardiaarrththymogenicincrease mortality with long term useADE’s of?

A

Dobutamine

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17
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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18
Q

MOA Milrione?

A 
Phosphodiesterase inhibitor (PDE3)
increase intracellular cAMP which increases intracellular calcium in the heart
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19
Q

Indications of Milrione

A

increase contractility because increase cAMP vasodilatory effects
“inodilator”

20
Q

Arrhthmogenicmay decrease BP and result in reflex tachycardiathrobocytopeniaincrease in mortality

A

ADE of Milrione

21
Q

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

A

75%

3-4days

22
Q

What is the Cardiac index?What is it’s utility?

A

CI= CO/ m^2 determines the O2 delivery and perfusion

23
Q

What is the normal range of the CI?In pts with acute CHF, is CI high or low?

A

2.5-4

Low

24
Q

What determines the pts preload/ volume status?

A

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

25
Q

What is the normal PAOP/PCWP range?Is it high or low in patients with acute heart failure?

A

8-12 mmHg

High

26
Q

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

A

Warm and wet!

27
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

28
Q

Where does ET-1 monitor for its effects?

A

at the carotids and kidneys

29
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
30
Q

Atrial Naturetic Peptide function

A

released from atrial myocardium in response to atrial dilation and stretch

31
Q

B- Type naturetic Peptide

A

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

32
Q

What is the action of BNP?

A 
vasodilation
natriuresis
diuresis
antagonize RAAS
inhibit SNS
antagonize ET-1
33
Q

What are the important values of BNP? No HFinconclusive”cardiac issue”

A

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

34
Q

Does BNP help or hurt us

A

HELPS us!!!

35
Q

What are the two main reasons ADHF occurs

A

Decrease CO/CI

Sodium/H2O restriction

36
Q

What are the non drug related precipitating factors

A 
ischemia
diet indiscretion
PE
valvular dysfunction
anemia
worse renal fxn
arrhythmias
disease progression
thyroid disorders
electrolyte abnormalities
infection
non compliance
37
Q

Drugs that cause water and sodium retention

A

corticosteroids
thiazolindediones
NSAIDS
some abx

38
Q

Drugs that decrease cardiac contractility

A

alcohol
beta blockers
some antiarrhythmics
some chemo agents

39
Q

Adequate perfusionvolume overloadPCWP greater than 18CI greater than 2.2 characteristics of:

A

Warm and Wet
subset II
(this pt gets a holiday heart)

40
Q

hypoperfusiongood volume statusPCWP less than 18CI 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

41
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

42
Q

Ssx: hypoperfusion, see cyanosis, cold extremities and low BPTx?

A

Cold and Dry
NO diuretics, Inotropic meds but NOT digoxin
YES dobutamine

43
Q

Hypoperfusionvolume overloadPCWP greater than 18CI less than 2.2

A

Cold and Wet

44
Q

Ssx: pulm or systemic congestion and hypoperfustionTx?

A

Cold and Wet

low dose diuretic, inotropic- dobutamine

45
Q

cold and wet pt appearance

A

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

Pharm II MHM - FINAL (17 decks)

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