Class 6 Deck 2 Flashcards
Inamrinone is what type of drug? and what does it do?
- P.D.E. Inhibitors
- increase SV and CO and Decreases SVR and PVR after CABG
How does inamrinone compare to dobutamine?
-More effective with less complications when separating from CPB
How does inamrinone compare to Epi?
-With poor LV function, it is as effective Epi, but they to work better together
What are the adverse reaction of inamrinone?
- Thromocytopenia
- ↑ LFTs
- Arrhythmias
- Intrapulmmonary shunting
- Decreased PaO2
What is milrinone? and how does it compare to inamrinone?
- P.D.E. Inhibitors (inotropic and vasodilator)
- 15-20x more potent than inamrinone w/o the thrombocytopenia
What is the antidote for Beta-blocker OD?
Glucagon
Glucagon use is limited by what?
- N/V
- ↑ blood sugar
- ↑ coronary and pulmonary vascular resistance
Where is BNP synthesized and where is it stored? When is it released?
- Synthesized in atrium = released when over distended
- Stored in brain = excreted with venous congestion
What 7 things does BNP do?
- Sodium excretion
- Suppress RAA Axis
- Lower sympathetic tone
- Lower vagal threshold
- Diuresis
- Vasodilate
- Inhibit vasopressin
How does neseritide work and when is it used?
- Stimulates cGMP = vascular smooth muscle relax
- Used in decompensated CHF
What is digoxin and what does it do to the heart?
- Cardiac glycoside
- Positive inotrope (Ca binds to Troponin)
- Negative dromotrope
- Negative chromotrope
What is digoxins mechanism of action?
- Inhibits Na-K ATPase which increases intracellular Na and Ca
- Increase LV shortening and EF
What are the uses for digoxin?
- Mild to moderate heart failure (w/diuretic and ACEI)
- Control chronic AFib
What are the 3 indirect actions digoxin has on the CV system?
- Vagomimetic effect (Slow HR w/ ↓ conduction of AV node)
- Baroreceptor sensitization
- Toxic effect on CNS (↑ sympathetic outflow)
What blood level is digoxin considered toxic?
> 3
- If treating CHF <3
- If treating AFib treat to results
What are the signs and symptoms of digoxin toxicity?
- Early = Anorexia and N/V
- PVCs
- Atrial tach w/ block
- Mobitz type 2
- VFib = most frequent cause of death
How to treat digoxin toxicity?
- Supplement K, Mag
- Correct hypoxemia
- Phenyotoin to correct Ventricular dysrhythmias
- Atropine to treat brady
- Beta blocker to suppress increased automaticity
- Digibind
- Temp Pacing
What are the catecholamine complications?
- Local tissue ischemia
- ↑ Myocardial work and O2 consumption
- ↑ cardiac arrhythmias
- Alter electrolytes and CO distribution
- Activate Coags
- Enhance lipolysis and gluconeogensis
- Override microvascular control mechanisms
What are the potential complications with PDE inhibitors and Beta Agonists?
-Intrapulmonary shunt after CABG
What are the steps in the theraputic plan for Low CO?
- Optimize HR and Rhythm
- Optimize preload (increase intravascular volume)
- Administer arteriole dilator to decrease SV (optimize afterload)
- Low BP = Add inotrope
What is the initial drug selection for pulmonary or systemic HTN?
- Something to dilate
- Dobutamine
- inamrinone / milrinone
- Isoproterenol
What is the initial drug selection for Low SVR?
- Need to tighten up
- NorEpi
- Dopamine
- Epi
What is the initial drug selection for normal PVR and SVR?
- Dopamine
- Epi
What is the initial drug selection for tachycardia?
- Inamrinone / milrinone
- Calcium
- Nor Epi
- Epi
To treat Myocardial Ischemia, Decrease BP and SVR, Normal CO and no heart failure what would you treat with?
- Vasoconstrictor (phenylepherine)
- NTG
Why would one Reserve vasoconstrictors for patients with small hearts?
-They are preload sensitive and afterload insensitive
What does a heart need with PCWP <18
Volume expanded
