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Therapeutics > Exam 2 lecture 4 > Flashcards

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

A

NTG

23
Q

how do vasodilators affect preload

A

reduce it

24
Q

who should not receive vasodilators

A

pts with hypotension

25
Q

Name the 3 vasodilators. Are they balanced, venous or arterial

A

Nitroprusside (nitropress)
Nesiritide (Natrecor)
NTG

NTG is venous and the others are balanced

26
Q

Use of nitroprusside and NTG

A

Nitroprusside - HTN crisis
NTG- ACS, HTN crisis

27
Q

adverse effects of nitropress

A

Cyanide and theocyanate toxicity if > 3 days use

28
Q

What drugs are positive inotropes

A

B agonists and PDE3 inibitors

29
Q

What are B agonist drugs

A

Dobutamine and dopamine

30
Q

What are PDE3 inhibitors

A

Milrinone
Amrinone

31
Q

dobutamine brand

A

Dobutrex

32
Q

Milrinone brand

A

Primacor

33
Q

Difference between Dobutamine and milrinone? what should we be cautious of?

A

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
Q

When are positive inotropes used?

A

Primarily used in pts who are hypoperfused or cold HF pts

35
Q

When would we use dobutamine over milrinone

A

high systemic vascular resistance (SVR) or if BB is being used

36
Q

monitoring of ADHF pts

A

weight (in AM)
Fluid intake/output
Vital signs BID
S/S (BID)
electrolytes QD
renal functions (QD)

37
Q

If pt is not experiencing any sx what stage of HF is he in?

A

Stage B

38
Q

Stage B HF tx

A

ACE and BB

39
Q

when do we reduce dose of ACE in relation to SeCr/eGFR

A

30 percent reduction

40
Q

why should we change from furosemide to torsemide

A

bioavailability is low for furosemide, better for torsemide

41
Q

metorpolol succinate target dosing

A

200 mg daily

42
Q

SGLT2 inhibitor CI

A

Crcl<30

43
Q

when not to use MRA

A

Crcl<30

44
Q

Sacubitril/valsartan dose if CRCL<30

A

24/26

45
Q

Know brand names of drugs

A

Therapeutics (38 decks)

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