Chapter 38 Cardiogenic pulmonary edema

Question 1

What is the onset of action and duration for IV furosemide?

Answer 1

Onset of action 5 min, duration of action 120-180min

Question 2

Does furosemide attach to receptors on the luminal side of the collecting ducts?

Answer 2

No, on the luminal side of the loop of henle. It is actively secreted from the proximal tubule and travels down to the loop of henle with the urine.

Question 3

T/F Does a patient with CHF also has severe hypoalbuminemia, and hx of NSAID administration high need an increased dose of furosemide to reach effect?

Answer 3

True. The efficacy of the organic ion transporter that is used to secrete furosemide in the proximal convoluted tubule might be reduced.
NSAIDS - like other organic ions compete with furosemide about the transport
Furosemide is transported bound to albumin

Question 4

Hydrochlorothiazide can be used instead of furosemide in emergency settings?

Answer 4

No, not as useful in emergency settings.

Question 5

Pimobendan is a vasodilator of the arterials, veins or both?

Answer 5

Arterial

Question 6

What other vasodilators can be considered in CHF?

Answer 6

Nitroglycerine, nitroprusside, hydralazine,

Question 7

How does inotrops help alleviate pulmonary edema?

Answer 7

Increase cardiac forward flow, increase renal flow and diuretic delivery to kidneys.

Question 8

Mechanism of action of dobutamin and dopamine

Answer 8

Binds to beta 1 receptors on the heart. This causes norepinephrine release which increase cytocolic Ca release and improved contractility

Question 9

T/F Human patients with cardiogenic pulmonary edema is always given oxygen therapy even if SpO2 is within normal limits?

Answer 9

No normal routine is to give O2 only if SaO2 > 90%. (systemic vasoconstriction, bradycardia, and decreased cardiac output, especially in those with systolic dysfunction)