Lab 2 - Heart Failure, Pulmonary Edema Flashcards
Furosemide - MoA
Loop diuretic. Inhibit sodium, potassium, chloride symporter.
Furosemide - Dose and route
20 mg IV
Furosemide - Adverse effects
Hypokalemia and metabolic alkalosis Hypocalcemia Hyponatremia Hypomagnesemia Hyperglycemia Hyperlipidemia Hyperuricemia
Furosemide - Contraindications
Diabetes
Gout
Allergy to sulfonamides
Furosemide - Interactions
- The diuretic effect will be decreased with NSAIDs.
- If administered with ACE inhibitors, it may cause excessive hypotension, but have opposite effects on potassium.
- Increases levels of lithium
Captopril - MoA
ACE inhibitor. Blocks production of angiotensin II and reduces after load and mortality.
Captopril - Dose and route
6.25mg orally every 8 hours (3x daily)
Captopril - Adverse effects
Hypotension
Hyperkalemia
Azotemia
Dry cough
Captopril - Contraindications
Pregnancy Renal artery stenosis Impaired renal function Hypovolemia K>5,5
Captopril - Interactions
- Potentiate the hyperkalemia effects with potassium-sparing diuretics
- Opposite effect on potassium with diuretics
- NSAIDs and ACE inhibitors can cause renal failure because of effect on GFR
- Increase levels of lithium
Digoxin - MoA
Positive inotropic agent. Inhibit Na+/K+ ATP-ase.
Digoxin - Dose and route
0.125 mg orally
Digoxin - Adverse effects
Nause Vomiting Diarrhea Tachyarrhytmias and Bradyarryhtmias AV block Blurred vision Yellow-green or blue chromatopsia
Digoxin - Contraindications
Ventricular fibrillation
Rapid IV administration of potassium
AV block
Cardiomyopathies
Digoxin - Interactions
- Antacids and cholestyramine reduce the absorption of digoxin
- Dilitiazem and quinidine increases the levels of digoxin which can lead to toxicity
- Diuretics cause hypokalemia which can precipitate digoxin toxicity
Metoprolol - MoA
Selective B1 antagonist
Metoprolol - Dose and route
12.5 mg orally every 12h (2xdaily)
Metoprolol - Adverse effects
Dizziness
Drowsiness
Fatique
High doses:
Hypoglycemia (tachycardia sweating)
Bronchoconstriction
Metoprolol - Contraindications
AV block
Bradycardia
Cardiogenic shock
Hypotension
High doses:
Asthma
Diabetes
Metoprolol - Interactions
- Metabolized by cytochrome P450 enzymes so serum concentration can be increased with the use of antiarrhytmics, H2 blockers, COX2 inhibitors and decreased with use of rifampin
- Potentiate the hypoglycemic effects of insulin
- Negative ionotropic effect potentiated with dilitiazem and verapamil
HF - Diagnosis
Laboratory testing to exclude other diseases (anemia, DM, thyroid disease, liver and renal disease): CBC, electrolytes, BUN, urinalysis, fasting glucose, OGTT, TSH, total cholesterol
Biomarkers: BNP and N-terminal pro-BNP
ECG: rhythm, LV hypertrophy, prior MI
CXR: cardiac size, shape, pulmonary vasculature –> ABCDE
Doppler Echo: LV size and function (EF), valvular/regional wall motion abnormalities
MRI: ventricular structure, mass, volume
Other: coronary angiography, stress testing, myocardial biopsy, Swan-Ganz catheterization
HF - Treatment
Treat the underlying cause, Valve replacement CABG
Life style changes
HF confirmed –> Fluid retention –>: Furosemide (20 mg PO) —> Captopril (6,25 mg x3 PO). (If not fluid retention start directly with Captopril) –> Metoprolol (12,5 mg x4 PO) –> Persistent symptoms: Spironolactone (12,5 mg PO), Hydralazine (10mg) + Isosorbide (10 mg), Digoxin (0,125 mg PO, used if systolic HF + atrial fibrillation)
Class II-III: Implantable cardioverter defibrillator (ICD)
Class III-IV + qrs>120ms: Cardiac resynchronization therapy (CRT); pacemaker
HF - Differential diagnosis
Pulmonary disease: chronic bronchitis, emphysema, asthma
Other causes of peripheral edema: obesity, varicose veins, venous insufficiency, renal dysfunction
PE- Diagnosis
ABG: reduction of PaO2 and PaCO2; Hypercapnia and acidosis with progression of disease
CXR: ABCDE
Kerley A and B lines
Biomarkers: low/normal levels of BNP
Swan-Ganz catheter: measures pulmonary capillary wedge pressure; differentiate cardiogenic from noncardiogenic causes of PE
Troponins: to exclude MI
ECG: visualize ischemia, arrhythmia
Echo: check EF, wall motion abnormalities
PE - Treatment
CPAP (continous positive airway pressure) - 100% O2
Reduce preload:
- sit upright, remove tight clothes
- Nitroglycerin (0,5 mg subl)
- Furosemide (20 mg IV)
- Morphine (10 mg IV) + Metoclopromide (10 mg IV)
- Anxiety - Diazepam (10 mg IV)
- ACE- inh if pt in hypertensive, acute MI with HF
- Ventricular tachycardia - Amiodarone (300 mg IV)
PE - Differential diagnosis
Asthma, COPD, pneumonia (especially hard to distinguish in elderly –> may coexist)
