pharm CHF

Question 1

inotropes

Answer 1

increase cardiac contractility

Question 2

vasopressors

Answer 2

increase MAP

Question 3

when to use vasopressors

Answer 3

MAP < 60 mmHg or SBP drop 30+ mmHg from baseline when causing end-organ dysfunction related to hypoperfusion- at this point would use vasopressors

Question 4

risk of vasopressors

Answer 4

decreased perfusion to peripheral tissues, risk of necrosis if administered via peripheral vein

Question 5

use for Phenylephrine

Answer 5

increase systemic vascular resistant anesthesia induced hypotension

Question 6

use for norepinephrine

Answer 6

alpha 1 and beta 1 increase MAP and CO septic shock

Question 7

use for epinephrine

Answer 7

alpha 1 beta 1 and 2 anaphylactic shock

Question 8

use for vasopressin

Answer 8

vasopressin 1 used for septic shock - only in addition to norepi this is always a second or 3rd line add on

Question 9

name my H causes for cardiac arrest

Answer 9

hypovolemia
hypoxia
hydrogen ion (acidosis)
hyper/hypo kalemia
hypothermia
also kind hypoglycemia

Question 10

name my T causes for cardiac arrest

Answer 10

toxins
tamponade
tension pneumothorax
thrombosis (mi or pe)
also kinda trauma- but mostly from the hypovolemia side of bleeding

Question 11

v-fib no pulse

Answer 11

epinephrine (push very 3-5 min)
amiodarone
lidocaine
mag sulfate for torsades de pointes

Question 12

PAE/asystole

Answer 12

epinephrine

Question 13

bradycardia with pulse

Answer 13

atropine
epi
dopamine

Question 14

tachycardia with pulse regular monomophic

Answer 14

give adenosine then saline

Question 15

tachycardia with pulse

Answer 15

synchronized cardioversion 
amiodarone
diltiazem
sotalol
digoxin
verapamil

Question 16

indications for pharmacologic cardioversion

Answer 16

SVT, v-tach with pulse, afib, torsades

Question 17

contraindications for pharmacologic cardioversion

Answer 17

-unstable (nausea, poor mentation, SBP <90, chest pain, SOB)

a-fib longer than 48 hrs or unknown duration (need anticoagulation before converting)

Question 18

adenosine PC

Answer 18

only in monomorphic tach (no fib or flutter) if not successful pharm cardioversion may slow rate down enough to determine rhythm

Question 19

amiodarone PC

Answer 19

not for a fib if duration over 48 hrs

can convert svt v tach or afib

Question 20

digoxin PC

Answer 20

rate control good for a fib regardless of coag

also for svt

Question 21

dofetilide

Answer 21

1c class- na channels and effects phase 0
must recheck QTc 2-3 hours and remain in patient for 3 days
afib/flutter

Question 22

metoprolol tartrate

Answer 22

goof for svt and a fib

*not good for sinus tach- this is compensatory so slow down heart got a big prob

Question 23

CHF diuretics

Answer 23

almost all patients start a loop
if poor renal function will need hig doses but monitor K and Mg
*if not enough can add a thiazide or spirolactone but caution K sparing of Spirolactone

Question 24

Bblockers to use for CHF

Answer 24

Bisoprolol carvedilol metroprolol sucsinate

Question 25

Adequate end organ perfusion AND hypertension or mitral or aortic valve regurgitation

Answer 25

nitroprusside

Question 26

Adequate end organ perfusion AND inadequate response to diuretics (no longer than 15-30 mins in sick patients):

Answer 26

nitroglycerin to reduce preload

Question 27

Known systolic HF (low EF) with cardiogenic shock

Answer 27

stop bblocker and give inotrope (dobutamine) and mechanical heart support

Question 28

loops dose IV to home

Answer 28

2 mg home to 1 mg iv

Question 29

after digoxin od

Answer 29

give digoxin immune fab and monitor ecg and serum K