Exam 2 lecture 4 Flashcards

1
Q

acute worsening of chronic HF accounts for what percent of cases

A

25%

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2
Q

CI (cardiac index) is a measure of what

A

stroke volume

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3
Q

PCWP (pulmonary capillary wedge pressure) is a measure of

A

preload

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4
Q

What are the 4 hemodynamic subsets when pt presents with ADHF

A

I- warm and dry
II-Warm and wet
III- cool and dry
IV- cool and wet

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5
Q

what do wet or dry describe

A

volume status
dry- euvolemic
wet- fluid overloaded

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6
Q

what do cool and warm describe

A

ability to perfuse tissue
warm- adequate cardiac output
cool- hypoperfusion

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7
Q

what do we do if pt presents with ADHF and is on SGLT2, ARNI, BB and MRA

A

we continue those meds unless they are in cardiogenic shock (low BP)

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8
Q

What to do with BB in patient that presents with ADHF

A

do not stop BB unless it is a recent initiation
consider holding BB if dobutamine needed or hemodynamically unstable

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9
Q

What are the drugs used in ADHF

A

Diuretics, Inotropes, Vasodilators, Vasopressors

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10
Q

ADHF classifications and hemodynamics

A

I- Warm and dry- PCWP 15-18, CI> or =2.2

II=- Warm and wet- PCWP> or = 18, CI> or =2.2

III- Cold and dry- PCWP 15-18, CI<2.2

IV- Cold and wet- PCWP > or = 18, CI<2.2

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11
Q

Treatment of different classes of ADHF

A

I (warm and dry)- optimize current therapy

II - IV diuretics (+/- venous vasodilator)

III- If PCWP <15, IV until 15-18
If PCWP is 15 or greater and SBP<90, IV inotrope
If PCWP is 15 or greater, SBP> or = 90, IV inotrope or arterial vasodilator

IV- Cold and wet- IV diuretics+ (if SBP<90, IV inotrope,
if SBP>90, IV arterial vasodilation)

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12
Q

what is DOE? orthopnea?

A

DOE- dyspnea on exertion
Orthopnea- discomfort when breathing while lying down

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13
Q

In a patient admitted for ADHF Subset II what to do? What not to do?

A

Do not increase BB, you should increase IV diuretic

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14
Q

What is usually used to treat Classes II and IV

A

diuretics

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15
Q

What to do if pt is ADHF II or IV and is resistent to diuretics

A

Na and H20 restriction
increase dose rather than frequency
Combo therapy
ultrafiltration

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16
Q

How to dose diuretics during Stage II and IV for ADHF

A

Increase dose pt was on at home.

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17
Q

Furosemide bioavailability Po and IV equivalence

A

160-200 mg IV furosemide is equivalent to 320-400 PO furosemide

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18
Q

is giving intermittent doses of diuretics better or continous diuretics doses for ADHF

A

Intermittent

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19
Q

Monitoring while on diuretics for stage II and IV ADHF

A

urine output
ins and outs, body weights, vitals
serum electrolytes, BUN creatinine daily

20
Q

when a pt gets started on IV furosemide and Secr and K go up drastically, what does that mean

A

his kidneys are shutting down

21
Q

What is used in combination with diuretics to reduce pulmonary congestion in stage II and IV ADHF

A

Vasodilators

22
Q

what is the vasodilator of choice

23
Q

how do vasodilators affect preload

24
Q

who should not receive vasodilators

A

pts with hypotension

25
Name the 3 vasodilators. Are they balanced, venous or arterial
Nitroprusside (nitropress) Nesiritide (Natrecor) NTG NTG is venous and the others are balanced
26
Use of nitroprusside and NTG
Nitroprusside - HTN crisis NTG- ACS, HTN crisis
27
adverse effects of nitropress
Cyanide and theocyanate toxicity if > 3 days use
28
What drugs are positive inotropes
B agonists and PDE3 inibitors
29
What are B agonist drugs
Dobutamine and dopamine
30
What are PDE3 inhibitors
Milrinone Amrinone
31
dobutamine brand
Dobutrex
32
Milrinone brand
Primacor
33
Difference between Dobutamine and milrinone? what should we be cautious of?
dobutamine stimulates increase in CAMP that requires B receptor Milrinone does not That is why we should be cautious of dobutamine use if pt is on BB
34
When are positive inotropes used?
Primarily used in pts who are hypoperfused or cold HF pts
35
When would we use dobutamine over milrinone
high systemic vascular resistance (SVR) or if BB is being used
36
monitoring of ADHF pts
weight (in AM) Fluid intake/output Vital signs BID S/S (BID) electrolytes QD renal functions (QD)
37
If pt is not experiencing any sx what stage of HF is he in?
Stage B
38
Stage B HF tx
ACE and BB
39
when do we reduce dose of ACE in relation to SeCr/eGFR
30 percent reduction
40
why should we change from furosemide to torsemide
bioavailability is low for furosemide, better for torsemide
41
metorpolol succinate target dosing
200 mg daily
42
SGLT2 inhibitor CI
Crcl<30
43
when not to use MRA
Crcl<30
44
Sacubitril/valsartan dose if CRCL<30
24/26
45
Know brand names of drugs