DI Vasodilation (ADHF) Flashcards
In what classification would you use Vasodilatory agents?
Class III (Cold and Dry) Class IV (Cold and Wet)
What is the clinical presentation of decreased cardiac output?
Hypoperfusion (tachycardia, fatigue, cyanosis, cold extremities, organ dysfunction; increased SCr creatinine, increased LFTs, Confusion/AMS)
Congestion (weight gain, SOB, orthopnea, paroxysmal nocturnal dyspnea, pleural effusion on CXR, crackles/rales on auscultation, S3 and S4, peripheral edema, BNP, JVD)
What is hypoperfusion?
Not enough oxygenated blood is moving forward from the heart to perfuse the vital organs.
What is congestion?
Blood back backs up from the LV to the lungs, possibly the RV, and beyond.
Nitroglycerin MOA
Nitroglycerin forms free radical nitric oxide. In smooth muscle, nitric oxide activates
guanylate cyclase which increases guanosine 3’5’ monophosphate (cGMP) leading to dephosphorylation of myosin light chains and smooth muscle relaxation. Produces a vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins (more impact on venous circulation at low doses and arterial at high doses)
Nitroglycerin Contraindications/drug interactions
Concurrent use with PDE
5 inhibitors (avanafil, sildenafil, tadalafil, or vardenafil);
concurrent use with soluble guanylate cyclase stimulators (vericiguat, riociguat
Nitroglycerin monitoring
BP, HR
Nitroglycerin Adverse effects
Headache, hypotension
Nitroglycerin Pearls
Given as a continuous infusion
Nitroprusside MOA
Causes peripheral vasodilation by direct action on venous and arteriolar smooth muscle and release of NO, thus reducing peripheral resistance; will increase cardiac output by decreasing afterload
Nitroprusside Monitoring
Blood pressure, cyanide and thiocyanate toxicity (particularly if on for >
3 days at > 3 mcg/kg/ min)
Nitroprusside Adverse effects
Hypotension, cyanide/thiocyanate toxicity (by arterial blood gas or
levels)
Nitroprusside Pearls
Given as a continuous IV infusion
