Exam 2 - Acute HF Flashcards
BNP > _____ is closely associated with acute HF
> 400
four classes of ADHF
I - warm and dry (normal)
II - warm and wet (pulm congestion)
III - cool and dry (hypoperfusion)
IV - cool and wet (hypoperfusion and pulm congestion)
what initial IV dose should be used for diuretics in hospitalized pts with ADHF?
IV dose should equal or exceed the chronic daily dose and give as intermittent bolus (inc dose pt was receiving at home)
when is vasodilator therapy used for ADHF?
used (in combo with diuretics) to reduce pulmonary congestion in wet, stage II and IV, HF
venodilators inc venous capacitance and reduce _____ and reduce myocardial _____
preload; stress
true or false: pts with symptomatic HTN should not receive vasodilators for ADHF
true
which vasodilator favors venous vasodilation over arterial?
a. nitroprusside
b. NTG
c. nesiritide
b. NTG
nitroprusside is a balanced vasodilator and decreases _____
SVR
which vasodilator for ADHF is not used for HTN crisis?
a. nitroprusside
b. NTG
c. nesiritide
c. nesiritide (the other two are)
nesiritide is a balanced vasodilator and increases what 2 things? (slide 23 of 34)
inc urine output and Na excretion
which vasodilator for ADHF is not used for ACS?
a. nitroprusside
b. NTG
c. nesiritide
b. NTG
what are the half lives for nitroprusside, NTG, and nesiritide when used for ADHF?
nitroprusside < 10 min
NTG ~1-4 min
nesiritide ~20 min
which vasodilator for ADHF has an AE for cyanide toxicity?
a. nitroprusside
b. NTG
c. nesiritide
a. nitroprusside (usually > 3 days after use)
which vasodilator for ADHF is NOT used alternatively to inotropes for cold and wet pts?
a. nitroprusside
b. NTG
c. nesiritide
b. NTG
what are the 3 positive inotropes we talked about for ADHF?
dobutamine
milrinone
dopamine
(we also mentioned amrinone, but idk if we need to know this one)
which positive inotrope stimulates adenylyl cyclase to increase cAMP?
a. dobutamine
b. milrinone
c. dopamine
a. dobutamine
which positive inotrope is considered both an inotrope and a vasodilator (inodilator)?
a. dobutamine
b. milrinone
c. dopamine
b. milrinone
does milrinone favor venous or arterial vasodilation?
venous
in which subset are positive inotropes used for ADHF?
cold and wet (IV)
(or cold and dry if PCWP > 15)
which positive inotrope is preferred in pts with high SVR or for a pt on BB?
a. dobutamine
b. milrinone
b. milrinone
when should we consider dobutamine vs milrinone?
consider dobutamine if low BP; consider milrinone if on BB
use of dopamine in ADHF
typically secondary role to dobutamine/milrinone; sometimes referred to as a vasopressor (inc BP)
do diuretics decrease afterload, preload, or both?
dec preload
do vasodilators reduce preload, afterload, or both?
both
what is the only definitive long term therapy for ADHF?
cardiac transplant
