Heart/Diuretics

Question 1

What is preload?

Answer 1

tension in myocardium before contraction

Question 2

What is afterload?

Answer 2

pressure in aorta & pulmonary trunk that opposes the opening of respective valves

Question 3

What does right-side heart failure cause?

Answer 3

peripheral edema

Question 4

What does left-side heart failure cause?

Answer 4

pulmonary edema

Question 5

Atrial natriuretic peptide (ANP) lab value

Answer 5

20-77 pg/mL

Question 6

Brain natriuretic peptide (BNP) lab value

Answer 6

<100 pg/mL

“positive” result is >100

Question 7

What do ANP vs BNP values show?

Answer 7

• one higher than other means that is where the issue is
• higher ANP means heart disease, higher BNP is lung disease

Question 8

BUN level

Answer 8

7-20 mg/dL

Question 9

Creatinine level

Answer 9

0.6-1.2 mg/dL

Question 10

Potassium level

Answer 10

3.5-5 mEq/L

Question 11

Digoxin

Answer 11

• positive inotrope, negative chronotrope, negative dromotrope, increases stroke volume

Question 12

digitalis toxicity

Answer 12

• digoxin toxicity
• blurred vision, w/ halos
• hold med, get serum digoxin (0.8-2) and K+ (3.5-5) levels, digoxin immune fab (digibind)

Question 13

Phosphodiasterase inhibitors

Answer 13

• milrinone lactate
• inhibits phosphodiasterase, positive inotrope

ie. viagra

Question 14

Types of diuretics

Answer 14

potassium wasting & potassium sparing

Question 15

What are the most powerful diuretics & where do they work?

Answer 15

loop diuretics, loop of henle

Question 16

Thiazide & Thiazide-like diuretics

Answer 16

• K, Na, H2O wasting
• promotes Ca2+ reabsorption
• often in a combo pill with BP med(s)
• watch for hypokalemia, monitor weight, ortho. hypo.

hydrochlorothiazide

no w/ kidney failure, caution w/ hx of kidney stones, may increase dig toxicity

Question 17

Loop Diuretics

Answer 17

• K, Na, H2O, Ca, Mg wasting
• monitor serum electrolytes, BUN, creatinine
• specific –> photosensitivity, ototoxicity

furosemide

no w/ kidney failure, may increase dig toxicity

Question 18

Osmotic Diuretics

Answer 18

• increases sodium reabsorption
• K, Na, H2O, Cl wasting
• contraindicated w/ HF, DM, kidney failure
• specific –> acidosis, decreases ICP/IOP

mannitol

Question 19

Carbonic Anhydrase Inhibitors

Answer 19

• K, Na, H2O, HCO3 wasting
• specific –> metabolic acidosis, calculi, hemolytic anemia, decrease IOP in chronic glaucoma

acetazolamide, methazolimide

Question 20

Spironolactone

Answer 20

• K sparing, Na & H2O wasting
• blocks action of aldosterone
• can take 48hrs (not as potent)
• specific –> hyperkalemia, hyperuricemia